Human Motion and Performance Laboratory, Baylor University Medical Center, Dallas, TX 75246, USA.
J Bone Joint Surg Am. 2011 Oct 19;93(20):1890-6. doi: 10.2106/JBJS.J.00347.
There is a resurgence of popularity with regard to total ankle arthroplasty, although there are limited data documenting the effect of total ankle arthroplasty on ankle joint motion, gait, or ankle function. The purpose of this study was to perform a prospective evaluation of the effect of the Scandinavian Total Ankle Replacement on gait.
We prospectively studied fifty consecutive patients with advanced ankle arthritis who underwent unilateral total ankle arthroplasty with the Scandinavian Total Ankle Replacement ankle prosthesis. Three-dimensional gait analysis was performed with use of a twelve-camera digital-motion capture system. Kinetic parameters were collected with use of two force plates. Temporal-spatial measurements included stride length and cadence. The kinematic parameters that were measured included the sagittal plane range of motion of the ankle, knee, and hip. The kinetic parameters that were studied included ankle plantar flexion-dorsiflexion moment and sagittal plane ankle power. The mean period of follow-up was forty-nine months (range, twenty-four to 108 months).
Temporal-spatial analysis showed that walking velocity increased as a function of increases in both cadence and stride length, and to significant levels for each. Kinematic analysis showed that ankle range of motion increased from a mean of 14.2° to 17.9° (p < 0.001), with the increase coming from increased plantar flexion. Increased motion was also measured at the hip and knee. Significant increases were found in ankle power (from 0.69 to 1.00 W/kg [p < 0.001]) and ankle plantar flexion moment (from 0.88 to 1.09 Nm/kg [p < 0.001]).
This study demonstrated that, at the time of intermediate-term follow-up and in comparison with the effects of ankle arthrodesis on gait as reported in previous studies, total ankle arthroplasty was associated with a more normal ankle function and a more normal gait, both kinetically and in terms of temporal-spatial parameters. More importantly, the study demonstrated marked improvement in multiple, objective parameters of gait following total ankle arthroplasty as compared with the patient's own preoperative function. The long-term maintenance of the gait improvements will require further study.
全踝关节置换术的应用再次流行起来，尽管目前仅有有限的数据可以记录全踝关节置换术对踝关节活动度、步态或踝关节功能的影响。本研究旨在前瞻性评估 Scandinavian Total Ankle Replacement 对步态的影响。
我们前瞻性研究了 50 例单侧全踝关节置换术患者，使用 Scandinavian Total Ankle Replacement 踝关节假体。采用 12 台摄像机数字运动捕捉系统进行三维步态分析。采用两个测力板收集动力学参数。时间-空间测量包括步幅长度和步频。测量的运动学参数包括踝关节矢状面活动度、膝关节和髋关节。研究的动力学参数包括踝关节跖屈-背屈力矩和矢状面踝关节功率。平均随访时间为 49 个月（24-108 个月）。
时间-空间分析显示，步行速度随步频和步幅长度的增加而增加，且每种参数的增加均具有显著意义。运动学分析显示，踝关节活动度从平均 14.2°增加到 17.9°（p<0.001），增加主要来自跖屈的增加。髋关节和膝关节的运动也增加了。踝关节功率（从 0.69 增加到 1.00 W/kg，p<0.001）和踝关节跖屈力矩（从 0.88 增加到 1.09 Nm/kg，p<0.001）也显著增加。
本研究表明，在中期随访时，与之前研究中踝关节融合术对步态的影响相比，全踝关节置换术与更正常的踝关节功能和更正常的步态相关，无论是在动力学方面还是在时间-空间参数方面。更重要的是，与患者术前功能相比，全踝关节置换术后多个客观步态参数有明显改善。步态改善的长期维持需要进一步研究。
