Trehan Samir K, Wolff Aviva L, Gibbons Mandi, Hillstrom Howard J, Daluiski Aaron
Department of Hand & Upper Extremity Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
Leon Root, MD Motion Analysis Laboratory, Hospital for Special Surgery, 510 East 73rd Street, New York, NY 10021, USA.
Gait Posture. 2015 Mar;41(3):791-4. doi: 10.1016/j.gaitpost.2015.02.010. Epub 2015 Feb 28.
Elbow contractures can be functionally debilitating. Extensive research has been published on treatments to restore elbow motion, but few have discussed clinical implications beyond the affected extremity. Reciprocal arm swing in normal gait has been shown to increase stability and reduce energy expenditure. The importance of arm swing has been clinically demonstrated in patients with cerebral palsy, stroke and Parkinson's disease. We hypothesized that elbow contractures would result in an abnormal spatio-temporal gait parameters.
Forty volunteer subjects walked on the Gaitmat II which provided real-time analysis of temporal and distance gait parameters. Five conditions were tested: no brace (control 1), elbow brace unlocked (control 2) and brace locked in 30°, 90° or 120° flexion (simulating fixed elbow contractures). Condition order was randomized for each subject. Each condition consisted of five walking trials.
All three fixed elbow conditions (120°, 90° and 30°) demonstrated significantly decreased gait velocity (1.37, 1.39 and 1.39m/s) and stride length (1.45, 1.46 and 1.46m) compared to the control condition (1.42m/s and 1.48m, respectively). Single limb stance and double support times were decreased and increased, respectively, compared to control. There was no significant difference in cadence or limb asymmetry in the three fixed elbow conditions.
Despite well-established functional limitations in elbow contracture patients and importance of arm swing in normal gait, the impact of elbow contractures on gait is unknown. This study demonstrates that simulated elbow contracture results in significant differences in spatio-temporal gait parameters suggesting that elbow contractures have a broader functional impact beyond the affected extremity.
II.
肘部挛缩会导致功能障碍。关于恢复肘部活动的治疗方法已有大量研究发表，但很少有研究讨论其对患肢以外部位的临床影响。正常步态中双臂交替摆动已被证明可提高稳定性并减少能量消耗。在脑瘫、中风和帕金森病患者中，手臂摆动的重要性已得到临床证实。我们假设肘部挛缩会导致异常的时空步态参数。
40名志愿者在Gaitmat II上行走，该设备可对时间和距离步态参数进行实时分析。测试了五种情况：不戴支具（对照1）、肘部支具解锁（对照2）以及支具锁定在30°、90°或120°屈曲位（模拟固定肘部挛缩）。每个受试者的情况顺序是随机的。每种情况包括五次步行试验。
与对照情况（分别为1.42m/s和1.48m）相比，所有三种固定肘部情况（120°、90°和30°）的步态速度（分别为1.37、1.39和1.39m/s）和步长（分别为1.45、1.46和1.46m）均显著降低。与对照相比，单腿支撑时间减少，双腿支撑时间增加。三种固定肘部情况在步频或肢体不对称方面无显著差异。
尽管肘部挛缩患者存在明确的功能限制，且手臂摆动在正常步态中很重要，但肘部挛缩对步态的影响尚不清楚。本研究表明，模拟肘部挛缩会导致时空步态参数出现显著差异，提示肘部挛缩对患肢以外部位具有更广泛的功能影响。
II级。
