Chang Qi Zhong, Sohmiya Makoto, Wada Naoki, Tazawa Masayuki, Sato Naoki, Yanagisawa Shinya, Shirakura Kenji
Department of Rehabilitation Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan.
J Orthop Sci. 2011 Jul;16(4):382-8. doi: 10.1007/s00776-011-0066-y. Epub 2011 May 7.
Trunk movement is important but still little understood after total knee arthroplasty. The alternation of trunk movement was analyzed for use in a postoperative rehabilitation program in the short-term after arthroplasty.
The subjects were 25 patients with knee osteoarthritis (4 males, 21 females). The femorotibial angle was evaluated on standing anteriorposterior radiographs and recorded at pre- and post-arthroplasty. Using three-dimensional motion capture, the gait parameters (cadence, walking speed, stride length, step length, step width), range of motion of lower extremity joints (hip, knee, and ankle), and trunk movement parameters (angle, speed, and displacement) were measured and compared between the pre- and 4th post-arthroplasty week.
The femorotibial angles of the arthroplasty side were improved from an average of 189° to 175° after arthroplasty. At the 4th post-arthroplasty week, the range of motion of the hip and knee flexion, hip adduction on the arthroplasty side, and ankle dorsiflexion on the non-arthroplasty side were significantly increased compared to pre-arthroplasty. Among gait parameters, only the stride length increased significantly. Regarding the trunk movement in the coronal plane, the maximal trunk speed to the non-arthroplasty side and maximal trunk displacement to the arthroplasty side were both reduced in a medio-lateral direction; the upward maximal trunk speed on the arthroplasty side increased and the maximal trunk displacement on the non-arthroplasty side decreased significantly in an up-down direction.
The recovery of hip adduction during the standing phase caused by improvement of knee alignment contributed the reduction of trunk movement to the operated side. In the early post-arthroplasty period, the reduction of trunk movement in the coronal plane is beneficial to maintain trunk balance and prevent falls. Functional recovery of the lower extremities is a long-term process, and sustained functional training is necessary.
躯干运动很重要，但全膝关节置换术后对其了解仍较少。分析了躯干运动的变化，以便用于关节置换术后短期的康复计划。
研究对象为25例膝骨关节炎患者（4例男性，21例女性）。在站立位前后位X线片上评估股胫角，并在关节置换术前和术后记录。使用三维运动捕捉技术，测量并比较关节置换术前和术后第4周的步态参数（步频、步行速度、步幅、步长、步宽）、下肢关节活动范围（髋、膝和踝）以及躯干运动参数（角度、速度和位移）。
关节置换侧的股胫角术后平均从189°改善至175°。术后第4周，与术前相比，关节置换侧的髋和膝关节屈曲活动范围、髋关节内收以及非关节置换侧的踝关节背屈均显著增加。在步态参数中，只有步幅显著增加。关于冠状面的躯干运动，向非关节置换侧的最大躯干速度和向关节置换侧的最大躯干位移在内外侧方向均减小；关节置换侧向上的最大躯干速度增加，非关节置换侧在上下方向的最大躯干位移显著减小。
膝关节对线改善导致站立期髋关节内收的恢复有助于减少向手术侧的躯干运动。在关节置换术后早期，冠状面躯干运动的减少有利于维持躯干平衡并预防跌倒。下肢功能恢复是一个长期过程，持续的功能训练是必要的。
