Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, Neb, USA.
J Vasc Surg. 2010 Jan;51(1):80-8. doi: 10.1016/j.jvs.2009.07.117. Epub 2009 Oct 17.
Symptomatic peripheral arterial disease (PAD) results in significant gait impairment. In an attempt to fully delineate and quantify these gait alterations, we analyzed joint kinematics, torques (rotational forces), and powers (rotational forces times angular velocity) in patients with PAD with unilateral claudication for both the affected and nonaffected legs.
Twelve patients with unilateral PAD (age, 61.69 +/- 10.53 years, ankle-brachial index [ABI]: affected limb 0.59 +/- 0.25; nonaffected limb 0.93 +/- 0.12) and 10 healthy controls (age, 67.23 +/- 12.67 years, ABI >1.0 all subjects) walked over a force platform to acquire gait kinetics, while joint kinematics were recorded simultaneously. Data were collected for the affected and nonaffected limbs during pain free (PAD-PF) and pain induced (PAD-P) trials. Kinetics and kinematics were combined to quantify torque and powers during the stance period from the hip, knee, and ankle joints.
The affected limb demonstrated significantly (P <.05) reduced ankle plantar flexion torque compared to controls during late stance in both PAD-PF and PAD-P trials. There were significant reductions in ankle plantar flexion power generation during late stance for both the affected (P <.05) and nonaffected limbs (P <.05) compared to control during PAD-PF and PAD-P trials. No significant differences were noted in torque comparing the nonaffected limbs in PAD-PF and PAD-P conditions to control for knee and hip joints throughout the stance phase. Significant reductions were found in knee power absorption in early stance and knee power generation during mid stance for both limbs of the patients with PAD as compared to control (P <.05).
Patients with PAD with unilateral claudication demonstrate significant gait impairments in both limbs that are present even before they experience any claudication symptoms. Overall, our data demonstrate significantly reduced ankle plantar flexion torque and power during late stance with reduced knee power during early and mid stance for the affected limb. Further studies are needed to determine if these findings are dependent on the location and the severity of lower extremity ischemia and whether the changes in the nonaffected limb are the result of underlying PAD or compensatory changes from the affected limb dysfunction.
有症状的外周动脉疾病（PAD）可导致明显的步态障碍。为了全面描绘和量化这些步态改变，我们分析了有单侧跛行的 PAD 患者双侧下肢的关节运动学、力矩（旋转力）和功率（旋转力乘以角速度）。
12 名单侧 PAD 患者（年龄 61.69 ± 10.53 岁，踝肱指数 [ABI]：患侧肢体 0.59 ± 0.25；健侧肢体 0.93 ± 0.12）和 10 名健康对照者（年龄 67.23 ± 12.67 岁，所有受试者 ABI>1.0）在测力台上行走以采集步态动力学，同时同步记录关节运动学。在无痛（PAD-PF）和疼痛诱导（PAD-P）试验中采集患侧和健侧肢体的数据。结合动力学和运动学数据，从髋关节、膝关节和踝关节定量计算站立期的力矩和功率。
在 PAD-PF 和 PAD-P 试验中，在晚期站立时，患侧肢体的踝关节背屈力矩明显（P<.05）小于对照组。在 PAD-PF 和 PAD-P 试验中，与对照组相比，患侧（P<.05）和健侧（P<.05）在晚期站立时的踝关节背屈功率生成均显著降低。在整个站立阶段，患侧和健侧肢体的膝关节力矩与对照组相比，在 PAD-PF 和 PAD-P 条件下均无显著差异。在 PAD 患者的双侧肢体中，在早期站立时膝关节的功率吸收和在中期站立时膝关节的功率生成显著降低（P<.05）。
单侧跛行的 PAD 患者在双侧肢体中均表现出明显的步态障碍，即使在出现任何跛行症状之前也是如此。总的来说，我们的数据显示，在晚期站立时，患侧踝关节背屈力矩和功率明显降低，在早期和中期站立时膝关节功率降低。需要进一步的研究来确定这些发现是否取决于下肢缺血的位置和严重程度，以及非患侧肢体的变化是否是由潜在的 PAD 或患侧肢体功能障碍的代偿性变化引起的。
