Department of Rehabilitation Medicine, Research Institute MOVE, VU University Medical Center, Amsterdam, The Netherlands.
Hum Mov Sci. 2013 Jun;32(3):412-24. doi: 10.1016/j.humov.2012.02.009. Epub 2013 May 4.
It has been suggested to use gait modifications in the retraining of patients with knee osteoarthritis (OA), in order to reduce the external knee adduction moment (KAdM). This study focused on the effect of walking speed, foot position and trunk sway, and on the 3D knee moments. Gait analyses of fourteen healthy volunteers were performed in a gait laboratory. Subjects walked at three different speeds in their normal gait pattern, as well as with toe-in and toe-out gait and with medio-lateral trunk sway at a self-selected speed. Fast walking speed increased the KAdM (17-30%) and flexion moment (32%). A slower walking speed did not decrease the KAdM. Toe-in mainly decreased the KAdM (45%) and the transverse moment (38%) during early stance. Toe-out decreased the KAdM during late stance (56%), but increased the KAdM during early stance and midstance (21-24%), due to decreased endorotation of the hip with knee flexion. Trunk sway decreased the KAdM during early stance and midstance (31-33%). Gait modifications mainly affected the KAdM, but changes in sagittal and transverse knee moments and kinematics were also observed. This indicates that, when estimating knee load, taking only the frontal plane kinetics into consideration may lead to erroneous simplifications. No conclusive beneficial effects were found in any of the gait modifications throughout the entire stance phase.
有人建议在膝关节骨关节炎（OA）患者的重新训练中使用步态修改，以减少膝关节外在内收力矩（KAdM）。本研究重点研究了行走速度、脚位和躯干摆动以及 3D 膝关节力矩的影响。在步态实验室对 14 名健康志愿者进行了步态分析。受试者以三种不同的速度在正常步态模式下行走，以及在自选速度下采用内八字和外八字步态以及左右躯干摆动。快走速度增加了 KAdM（17-30%）和屈曲力矩（32%）。较慢的行走速度并没有降低 KAdM。内八字主要在早期站立阶段降低 KAdM（45%）和横向力矩（38%）。外八字在晚期站立阶段降低 KAdM（56%），但由于膝关节屈曲时髋关节的内旋减少，在早期站立和中期站立阶段增加了 KAdM（21-24%）。躯干摆动在早期站立和中期站立阶段降低 KAdM（31-33%）。步态修改主要影响 KAdM，但也观察到矢状面和横向膝关节力矩和运动学的变化。这表明，在估计膝关节负荷时，仅考虑额状面动力学可能会导致错误的简化。在整个站立阶段，任何步态修改都没有发现明显的有益效果。
