Valderrabano Victor, Nigg Benno M, von Tscharner Vinzenz, Frank Cyril B, Hintermann Beat
Human Performance Laboratory, University of Calgary, Alberta, Canada.
Foot Ankle Int. 2007 Feb;28(2):281-91. doi: 10.3113/FAI.2007.0281.
The aim of this prospective study was to determine muscle rehabilitation in total ankle replacement (TAR) for unilateral severe ankle osteoarthritis.
Fifteen patients were assessed before and after TAR in 3-month intervals up to 1 year. Clinically, the pain score, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle score, ankle range of motion for dorsiflexion and plantarflexion (ROM DF/PF) and the calf circumference difference between the affected and contralateral healthy leg were measured. Radiographic assessment consisted of osteoarthritis grading abd evaluation of TAR loosening or migration. Biochemically, isometric maximal voluntary torque for ankle dorsiflexion and plantarflexion was measured simultaneously with surface electromyography (EMG; mean frequency and intensity) of the anterior tibial, medial gastrocnemius, soleus, and peroneus longus muscles. Data were compared to a group of 15 age-matched and gender-matched normal subjects.
From preoperative to 12 months after TAR, improvement was noted in pain scores (from 6.8 to 0.8 points), AOFAS ankle scores (33.7 to 93.3 points), and ROM DF/PF significantly (16.0 to 31.0 degrees). The difference in mean calf circumference between legs decreased not significantly from 2.1 cm to 1.7 cm. The mean DF torque (16.4 to 23.1 Nm) and PF torque (15.8 to 21.6 Nm) of the affected ankle increased significantly. Compared to the contralateral healthy side, the mean EMG intensity recovered.
TAR surgery improved muscle function (torque, EMG intensity) in osteoarthritic ankles. However, after 1 year, patients did not reach the level of the contralateral healthy leg, and the EMG frequency remained unchanged.
这项前瞻性研究的目的是确定全踝关节置换术（TAR）治疗单侧重度踝关节骨关节炎后的肌肉康复情况。
15例患者在TAR术前及术后每隔3个月进行评估，直至1年。临床方面，测量疼痛评分、美国矫形足踝协会（AOFAS）踝关节评分、背屈和跖屈的踝关节活动范围（ROM DF/PF）以及患侧与对侧健康腿之间的小腿围度差异。影像学评估包括骨关节炎分级以及TAR松动或移位的评估。生化方面，在测量踝关节背屈和跖屈等长最大自主扭矩的同时，记录胫前肌、腓肠肌内侧头、比目鱼肌和腓骨长肌的表面肌电图（EMG；平均频率和强度）。将数据与15名年龄和性别匹配的正常受试者组成的对照组进行比较。
从术前到TAR术后12个月，疼痛评分（从6.8分降至0.8分）、AOFAS踝关节评分（从33.7分升至93.3分）以及ROM DF/PF均有显著改善（从16.0度增至31.0度）。双腿平均小腿围度差异从2.1厘米降至1.7厘米，差异不显著。患侧踝关节的平均背屈扭矩（从16.4牛米增至23.1牛米）和跖屈扭矩（从15.8牛米增至21.6牛米）显著增加。与对侧健康侧相比，平均EMG强度恢复。
TAR手术改善了骨关节炎踝关节的肌肉功能（扭矩、EMG强度）。然而，1年后，患者未达到对侧健康腿的水平，且EMG频率保持不变。
