Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, ON, Canada.
J Biomech. 2013 Apr 26;46(7):1408-12. doi: 10.1016/j.jbiomech.2013.01.024. Epub 2013 Mar 13.
To elucidate the effects of frontal plane lower limb alignment on gait biomechanics, we compared knee joint moments and frontal plane angular impulse before and after varus or valgus producing osteotomy in patients with lateral or medial compartment osteoarthritis, and in healthy participants with neutral alignment. Thirty-nine subjects participated (13 valgus gonarthrosis, 13 varus gonarthrosis, 13 controls). Patients underwent 3D gait analysis and radiographic assessment of alignment (mechanical axis angle; MAA) before and 6 months after surgery, and were compared to controls. Mean changes (95%CI) in frontal plane angular impulse indicated a 0.82%BW·Ht·s (0.49,1.14) increase in adduction impulse in patients after varus osteotomy, and a 0.61%BW·Ht·s (0.37,0.86) decrease in adduction impulse in patients after valgus osteotomy, equating to a 53% and 45% change from preoperative values, respectively. Preoperative frontal plane angular impulse was significantly different between both patient groups and controls before surgery, but not after. The cross-sectional data suggest that frontal plane angular impulse is very highly correlated to MAA before surgery (R=0.87), but not after (R=0.39), and that an adduction impulse predominates until 7° of valgus, at which point an abduction impulse predominates. The prospective surgical realignment data indicate that for every 1° change in MAA toward varus, there is a 0.1%BW·Ht·s (or 1.6 N m s) change in frontal plane knee angular impulse toward adduction, and vice versa. These overall findings illustrate the potent effects that lower limb alignment can have on frontal plane gait biomechanics.
为了阐明额状面下肢对线对步态生物力学的影响，我们比较了外侧或内侧间室骨关节炎患者在接受内翻或外翻截骨术后和健康对照组中立对线时膝关节力矩和额状面角冲量的变化。39 名受试者参与（13 例外翻性膝关节炎，13 例内翻性膝关节炎，13 例健康对照组）。患者在术前和术后 6 个月接受了 3D 步态分析和对线的放射学评估（机械轴角；MAA），并与对照组进行比较。额状面角冲量的平均变化（95%CI）表明，内翻截骨术后患者的内收冲量增加了 0.82%BW·Ht·s（0.49,1.14），而外翻截骨术后患者的内收冲量减少了 0.61%BW·Ht·s（0.37,0.86），分别相当于术前值的 53%和 45%的变化。术前额状面角冲量在术前手术患者组和对照组之间存在显著差异，但术后无差异。横断面数据表明，术前额状面角冲量与 MAA 高度相关（R=0.87），但术后不相关（R=0.39），并且在 7°外翻之前，内收冲量占主导地位，此时外展冲量占主导地位。前瞻性手术矫正数据表明，MAA 每向内侧旋转 1°，额状面膝关节角冲量就会向内侧旋转 0.1%BW·Ht·s（或 1.6 N m s），反之亦然。这些总体发现说明了下肢对线对线对步态生物力学的强大影响。
