Interdisciplinary Center of Musculoskeletal Training and Research, Department of Orthopaedics and Rehabilitation, Division of Research, University of Florida College of Medicine, Gainesville, Florida 32607, USA.
Surg Obes Relat Dis. 2012 May-Jun;8(3):346-54. doi: 10.1016/j.soard.2011.11.020. Epub 2012 Jan 16.
Joint pain is a common musculoskeletal complaint of morbidly obese patients that can result in gait abnormalities, perceived mobility limitations, and declining quality of life (QOL). It is not yet known whether weight loss 3 months after bariatric surgery can induce favorable changes in joint pain, gait, perceived mobility, and QOL. Our objectives were to examine whether participants who had undergone bariatric surgery (n = 25; laparoscopic Roux-en-Y gastric bypass or laparoscopic adjustable gastric banding) demonstrate improvements in joint pain, gait (speed, stride/step length, width of base of support, toe angles, single/double support, swing and stance time, functional ambulatory profile), mobility, and QOL by 3 months compared with nonsurgical controls (n = 20). The setting was an orthopedics laboratory at a university hospital in the United States.
The present study was a prospective, comparative study. Numeric pain scales (indicating the presence and severity of pain), mobility-related surveys, and the Medical Outcomes Study short-form 36-item questionnaire (SF-36) were completed, and gait and walking speed were assessed at baseline and at month 3.
The bariatric group lost an average of 21.6 ± 7.7 kg. Significant differences existed between the 2 groups at month 3 in step length, heel to heel base of support, and the percentage of time spent in single and double support during the gait cycle (all P <.05). The severity of low back pain and knee pain decreased by 54% and 34%, respectively, with no changes in the control group (P = .05). The walking speed increased by 15% in the bariatric group (108-123 cm/s; P <.05) but not in the control group. Compared with the control group, fewer bariatric patients perceived limitations with walking and stair climbing by month 3. The bariatric group had a 4.8-cm increase in step length, 2.6% increase in single support time during the gait cycle, and 2.5-cm reduction in the base of support (all P <.05). The SF-36 physical component scores increased 11.8 points in the bariatric group compared with the control group, which showed no improvement by month 3 (P <.0001).
Improvements in some, but not all, gait parameters, walking speed, and QOL and of perceived functional limitations occur by 3 months after a bariatric procedure.
关节疼痛是病态肥胖患者常见的肌肉骨骼投诉，可导致步态异常、感知活动受限和生活质量下降（QOL）。目前尚不清楚减重手术后 3 个月是否会引起关节疼痛、步态、感知活动能力和 QOL 的有利变化。我们的目的是检查接受过减重手术的参与者（n=25；腹腔镜 Roux-en-Y 胃旁路手术或腹腔镜可调胃带术）是否与非手术对照组（n=20）相比，在 3 个月时在关节疼痛、步态（速度、步长/步长、支撑基底宽度、脚趾角度、单/双支撑、摆动和站立时间、功能活动轮廓）、活动能力和 QOL 方面有所改善。该研究地点是美国一家大学医院的骨科实验室。
本研究为前瞻性比较研究。在基线和第 3 个月时完成数字疼痛量表（表示疼痛的存在和严重程度）、与移动性相关的调查以及医疗结果研究简表 36 项问卷（SF-36），并评估步态和步行速度。
减重组平均减重 21.6±7.7kg。第 3 个月时，两组在步长、脚跟到脚跟支撑基底以及步态周期中单脚和双脚支撑的时间百分比方面存在显著差异（均 P<.05）。下腰痛和膝关节痛的严重程度分别下降了 54%和 34%，而对照组没有变化（P=.05）。减重组的步行速度增加了 15%（108-123cm/s；P<.05），而对照组没有增加。与对照组相比，到第 3 个月时，更少的减重患者认为步行和爬楼梯有困难。与对照组相比，减重组的步长增加了 4.8cm，步态周期中单脚支撑时间增加了 2.6%，支撑基底宽度减少了 2.5cm（均 P<.05）。与对照组相比，减重组的 SF-36 生理成分评分增加了 11.8 分，而对照组在第 3 个月时没有改善（P<.0001）。
减重手术后 3 个月时，一些但不是所有的步态参数、步行速度和生活质量以及感知功能受限都有所改善。
