Ullrich Boris, Stening Jens, Pelzer Thiemo, Raab Jana
Department of Biomechanics, Olympic Training and Research Centre of Rheinland-Pfalz/Saarland, Bad Kreuznach, Germany.
Department of Orthopedic Surgery and Sports Medicine, Diakonie Hospital, Bad Kreuznach, Germany.
Clin Biomech (Bristol). 2015 Jun;30(5):462-8. doi: 10.1016/j.clinbiomech.2015.03.009. Epub 2015 Mar 10.
Despite the clinical success of total knee arthroplasty, impaired gait patterns and quadriceps and hamstring maximal voluntary force production might persist years post-surgery. Long-term data of gait patterns and quadriceps and hamstring maximal force production are rarely published with total knee arthroplasty patients. This work examined gait characteristics and the moment-knee angle relations of the knee extensors and flexors about 10 years post-total knee arthroplasty.
About a decade post-surgery, 10 female total knee arthroplasty patients (64 years, mobile-bearing inlay) and 10 age-matched female controls were examined. Sagittal plane kinematics in the hip and knee joint during treadmill walking at 2 kilometres per hour were recorded using motion analysis. Spatiotemporal gait parameters were analyzed at self-selected walking speeds with a pressure-platform. The unilateral isometric moment-knee angle relations of the knee extensors and flexors and the electromyographic knee angle relation of the quadriceps were studied using dynamometry. Due to group differences for body mass index values, univariate analysis of variance (main effect: group, secondary effect: body mass index) was used for statistical analysis.
Total knee arthroplasty patients demonstrated significant (P<0.05) gait deficits during constant and self-selected walking speeds and lower average absolute values in the moment-knee angle relations of the knee extensors and flexors. Significant (P<0.05) lower body-mass-normalized knee extension moments were detected at all knee joint positions for the patients.
Long-term impairments of gait characteristics and maximal voluntary force production, especially for the knee extensors, might persist after total knee arthroplasty.
尽管全膝关节置换术在临床上取得了成功，但步态模式受损以及股四头肌和腘绳肌的最大随意力产生可能在术后数年持续存在。全膝关节置换术患者很少发表关于步态模式以及股四头肌和腘绳肌最大力量产生的长期数据。这项研究检查了全膝关节置换术后约10年的步态特征以及膝关节伸肌和屈肌的力矩-膝关节角度关系。
术后约十年，对10名接受全膝关节置换术的女性患者（64岁，活动平台镶嵌物）和10名年龄匹配的女性对照者进行了检查。使用运动分析记录了在跑步机上以每小时2公里的速度行走时髋关节和膝关节在矢状面的运动学。使用压力平台在自选步行速度下分析时空步态参数。使用测力计研究了膝关节伸肌和屈肌的单侧等长力矩-膝关节角度关系以及股四头肌的肌电图膝关节角度关系。由于体重指数值存在组间差异，采用单因素方差分析（主效应：组，次效应：体重指数）进行统计分析。
全膝关节置换术患者在恒定和自选步行速度下表现出明显的（P<0.05）步态缺陷，并且膝关节伸肌和屈肌的力矩-膝关节角度关系的平均绝对值较低。在所有膝关节位置，患者的体重标准化膝关节伸展力矩均显著（P<0.05）降低。
全膝关节置换术后可能会持续存在步态特征和最大随意力产生的长期损害，尤其是膝关节伸肌。
