Hastings Mary K, Sinacore David R, Woodburn James, Paxton E Scott, Klein Sandra E, McCormick Jeremy J, Bohnert Kathryn L, Beckert Krista S, Stein Michelle L, Strube Michael J, Johnson Jeffrey E
Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63108, USA.
Clin Biomech (Bristol). 2013 Jun;28(5):555-61. doi: 10.1016/j.clinbiomech.2013.04.008. Epub 2013 May 15.
The Bridle procedure restores active ankle dorsiflexion through a tri-tendon anastomosis of the tibialis posterior, transferred to the dorsum of the foot, with the peroneus longus and tibialis anterior tendon. Inter-segmental foot motion after the Bridle procedure has not been measured. The purpose of this study is to report kinetic and kinematic variables during walking and heel rise in patients after the Bridle procedure.
18 Bridle and 10 control participants were studied. Walking and heel rise kinetic and kinematic variables were collected and compared using an ANOVA.
During walking the Bridle group, compared with controls, had reduced ankle power at push-off [2.3 (SD 0.7) W/kg, 3.4 (SD 0.6) W/kg, respectively, P<.01], less hallux extension during swing [-13 (SD 7)°, 15 (SD 6)°, respectively, P<.01] and slightly less ankle dorsiflexion during swing [6 (SD 4)°, 9 (SD 2)°, respectively, P=.03]. During heel rise the Bridle group had 4 (SD 6)° of forefoot on hindfoot dorsiflexion compared to 8 (SD 3)° of plantarflexion in the controls (P<.01).
This study provides evidence that the Bridle procedure restores the majority of dorsiflexion motion during swing. However, plantarflexor function during push-off and hallux extension during swing were reduced during walking in the Bridle group. Abnormal mid-tarsal joint motion, forefoot on hindfoot dorsiflexion instead of plantarflexion, was identified in the Bridle group during the more challenging heel rise task. Intervention after the Bridle procedure must maximize ankle plantarflexor function and midfoot motion should be examined during challenging tasks.
“缰绳”手术通过将胫后肌腱与腓骨长肌及胫前肌腱进行三腱吻合，将胫后肌腱转移至足背，从而恢复踝关节主动背屈功能。“缰绳”手术后节段间足部运动尚未得到测量。本研究的目的是报告“缰绳”手术后患者行走和足跟抬起时的动力学和运动学变量。
对18例接受“缰绳”手术的患者和10例对照参与者进行研究。收集行走和足跟抬起时的动力学和运动学变量，并使用方差分析进行比较。
在行走过程中，与对照组相比，“缰绳”手术组在蹬离时踝关节功率降低[分别为2.3（标准差0.7）W/kg和3.4（标准差0.6）W/kg，P<0.01]，摆动期拇趾伸展减少[分别为-13（标准差7）°和15（标准差6）°，P<0.01]，摆动期踝关节背屈也略减少[分别为6（标准差4）°和9（标准差2）°，P=0.03]。在足跟抬起时，“缰绳”手术组前足相对于后足有4（标准差6）°的背屈，而对照组为8（标准差3）°的跖屈（P<0.01）。
本研究提供的证据表明，“缰绳”手术可恢复摆动期的大部分背屈运动。然而，“缰绳”手术组在行走时蹬离期跖屈肌功能和摆动期拇趾伸展减少。在更具挑战性的足跟抬起任务中，“缰绳”手术组出现了异常的中跗关节运动，即前足相对于后足背屈而非跖屈。“缰绳”手术后的干预必须使踝关节跖屈肌功能最大化，并且在具有挑战性的任务中应检查中足运动。
