Mandeville David, Osternig Louis R, Chou Li-Shan
Motion Analysis Laboratory, Department of Human Physiology, 1240 University of Oregon, Eugene, OR 97403, USA.
Gait Posture. 2008 Jan;27(1):103-9. doi: 10.1016/j.gaitpost.2007.02.009. Epub 2007 Apr 6.
The purpose of this study was to investigate the effect of knee pain and total knee replacement (TKR) surgery on the gait stability of knee osteoarthritis (OA) patients compared to controls. Gait spatio-temporal measures, center of mass kinematics and pain levels of 21 TKR subjects and 21 controls (CON) were assessed during level walking and obstacle crossing at two testing periods, pre-surgery (P1) and 6 months post-surgery (P2). The TKR patients reported greater pain and disability than CONs at P1 and P2, walked and negotiated the obstacle more slowly and had a shorter stride length than CONs. After surgery, the TKR center of mass-center of pressure (COM-COP) separation distance and the peak anterior inclination angle were significantly smaller than CONs. Pain was found to be significantly related to sagittal plane measures, but not to similar measures in the frontal plane. The data suggest that total knee replacement surgery and pain affect gait stability predominantly in sagittal plane variables. The TKR subjects used a conservative strategy to manage the COM and COP in the sagittal plane, possibly to reduce the kinetic demands on the involved limb.
本研究的目的是调查与对照组相比，膝关节疼痛和全膝关节置换术（TKR）对膝骨关节炎（OA）患者步态稳定性的影响。在两个测试阶段，即术前（P1）和术后6个月（P2），对21名接受全膝关节置换术的受试者和21名对照组（CON）的步态时空参数、质心运动学和疼痛程度进行了评估，评估内容包括平地上行走和跨越障碍物的情况。全膝关节置换术患者在P1和P2阶段报告的疼痛和残疾程度均高于对照组，行走和跨越障碍物的速度比对照组慢，步幅也比对照组短。术后，全膝关节置换术患者的质心-压力中心（COM-COP）分离距离和最大前倾角度明显小于对照组。研究发现，疼痛与矢状面测量指标显著相关，但与额状面的类似测量指标无关。数据表明，全膝关节置换术和疼痛主要影响矢状面变量的步态稳定性。全膝关节置换术受试者采用保守策略来控制矢状面的质心和压力中心，可能是为了减少患侧肢体的动力学需求。
