Duda Georg N, Bartmeyer Barbara, Sporrer Simon, Taylor Wiliam R, Raschke Michael, Haas Norbert P
Research Laboratory, Department of Trauma and Reconstructive Surgery, Charité, Campus Virchow-Klinikum, Humboldt-University of Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
Langenbecks Arch Surg. 2003 Oct;388(5):298-304. doi: 10.1007/s00423-003-0386-2. Epub 2003 Sep 13.
Partial weight bearing is thought to unload and protect the healing bone. Until now, there has been no objective method of assessing the amount of weight placed on the healing zone by the patient. The goal of this study was to determine the effects of partial weight bearing on the loading of the healing bone in tibial osteotomies.
Six patients with complex tibial osteotomies, stabilized with Ilizarov ring fixator constructs, took part in this study. Three-dimensional interfragmentary movements were measured with reflective markers that were attached to the Schanz screws of the fixator. Patients were asked to rest, to co-contract the musculi gastrocnemii, to stand up, to walk slowly and to load partially the affected limb with 20 kg of weight.
Compared with co-contraction, ground reaction forces of partial weight bearing, standing up and walking were significantly increased (P<0.05). The interfragmentary movements during partial weight bearing were, however, comparable in partial weight bearing, standing up and walking (P>>0.05).
Partial weight bearing did not unload the defect zone. No direct relationship between interfragmentary movement magnitudes and ground reaction forces was identified. Therefore, the concept of partial weight bearing cannot reliably reduce loading of a healing zone. It may, however, help to prevent patients from undergoing critical situations, such as stumbling, by increasing their general awareness.
部分负重被认为可减轻并保护正在愈合的骨骼。到目前为止，尚无客观方法来评估患者施加于愈合部位的负重大小。本研究的目的是确定部分负重对胫骨截骨术中愈合骨骼负荷的影响。
六名采用伊利扎罗夫环形固定器构建物稳定固定的复杂胫骨截骨术患者参与了本研究。使用附着于固定器斯氏针上的反光标记物测量三维骨折块间运动。要求患者休息、同时收缩腓肠肌、站立、缓慢行走以及用20千克重量对患侧肢体进行部分负重。
与同时收缩相比，部分负重、站立和行走时的地面反作用力显著增加（P<0.05）。然而，部分负重、站立和行走过程中的骨折块间运动相当（P>>0.05）。
部分负重并未减轻缺损区域的负荷。未发现骨折块间运动幅度与地面反作用力之间存在直接关系。因此，部分负重的概念无法可靠地减轻愈合部位的负荷。然而，它可能有助于通过提高患者的整体意识来防止患者遭遇如绊倒等危急情况。
