Lucareli Paulo Roberto Garcia, Greve Julia Maria D'Andrea
Department of Orthopedics, University of São Paulo, Medical School, São Paulo, SP, Brazil.
Clinics (Sao Paulo). 2006 Aug;61(4):295-300. doi: 10.1590/s1807-59322006000400004.
The aims of this study were to evaluate the variables found in the alteration of the load-response mechanism on 3-dimensional kinematic analysis of the knee joint during hemiparetic gait following stroke.
We evaluated 66 adult patients (33 men and 33 women), aged 45.4 +/- 8.5 years (mean +/- SD), with a diagnosis of ischemic cerebrovascular accident either right or left hemiparesis and brachial prevalence. All the participants underwent 3-dimensional gait evaluation with a Vicon 370, and the values of the angular kinematics of the knee joint were selected for analysis.
There were no statistically significant differences (by the Kruskal-Wallis test) between the subjects regarding the following variables: angular knee position at initial contact and time of peak knee flexion in the stance. The clinically relevant characteristics found were: an increase in knee joint flexion during the initial contact and a movement amplitude below that anticipated in this phase of the walking cycle. These should be taken into account when choosing the best treatment, because they are the ones which exhibit the most important alteration in the load-response mechanism in all patients.
There is still no consensus among the different specialists regarding the variations in kinematics during the hemiparetic gait. One of the most frequently discussed joints is the knee--the way the main changes take place during the gait cycle and whether the gait velocity changes the patterns of joint mobility.
本研究旨在评估中风后偏瘫步态期间膝关节三维运动分析中负荷反应机制改变所发现的变量。
我们评估了66名成年患者（33名男性和33名女性），年龄为45.4±8.5岁（均值±标准差），诊断为缺血性脑血管意外伴右侧或左侧偏瘫及臂丛神经受累。所有参与者均使用Vicon 370进行三维步态评估，并选择膝关节角运动学值进行分析。
在以下变量方面，受试者之间无统计学显著差异（通过Kruskal-Wallis检验）：初始接触时的膝关节角度位置和站立期膝关节屈曲峰值时间。发现的临床相关特征为：初始接触期间膝关节屈曲增加，且运动幅度低于步行周期此阶段预期值。选择最佳治疗方法时应考虑这些因素，因为它们在所有患者的负荷反应机制中表现出最重要的改变。
不同专家对于偏瘫步态期间运动学变化仍未达成共识。讨论最多的关节之一是膝关节——步态周期中主要变化的发生方式以及步态速度是否会改变关节活动模式。
