Myers Sara A, Applequist Bryon C, Huisinga Jessie M, Pipinos Iraklis I, Johanning Jason M
J Rehabil Res Dev. 2016;53(2):229-38. doi: 10.1682/JRRD.2015.02.0027.
Peripheral arterial disease (PAD) produces abnormal gait and disproportionately affects older individuals. The current study investigated PAD gait biomechanics in younger (<65 yr) and older (>/=65 yr) subjects. The study included 61 patients with PAD (31 younger, age: 57.4 +/- 5.3 yr, and 30 older, age: 71.9 +/- 5.2 yr) and 52 nondisabled age-matched control subjects. Patients with PAD were tested during pain-free walking and compared with control subjects. Joint kinematics and kinetics (torques) were compared using a 2 x 2 analysis of variance (groups: patients with PAD vs control subjects, age: younger vs older). Patients with PAD had significantly increased ankle and decreased hip range of motion during the stance phase as well as decreased ankle dorsiflexor torque compared with control subjects. Gait changes in older individuals are largely constrained to time-distance parameters. Joint kinematics and kinetics are significantly altered in patients with PAD during pain-free walking. Symptomatic PAD produces a consistent ambulatory deficit across ages definable by advanced biomechanical analysis. The most important finding of the current study is that gait, in the absence of PAD and other ambulatory comorbidities, does not decline significantly with age based on advanced biomechanical analysis. Therefore, previous studies must be examined in the context of patients with potential PAD being present in the population, and future ambulatory studies must include PAD as a confounding factor when assessing the gait function of elderly individuals.
外周动脉疾病(PAD)会导致步态异常,且对老年人的影响尤为严重。本研究调查了年轻(<65岁)和年长(≥65岁)受试者的PAD步态生物力学。该研究纳入了61例PAD患者(31例年轻患者,年龄:57.4±5.3岁;30例年长患者,年龄:71.9±5.2岁)以及52名年龄匹配的非残疾对照受试者。对PAD患者在无痛行走时进行测试,并与对照受试者进行比较。使用2×2方差分析比较关节运动学和动力学(扭矩)(分组:PAD患者与对照受试者,年龄:年轻与年长)。与对照受试者相比,PAD患者在站立期踝关节活动范围显著增加,髋关节活动范围减小,踝关节背屈扭矩也降低。老年人的步态变化主要局限于时间-距离参数。在无痛行走期间,PAD患者的关节运动学和动力学有显著改变。有症状的PAD会导致不同年龄段出现一致的行走功能缺陷,这可通过先进的生物力学分析确定。本研究最重要的发现是,基于先进的生物力学分析,在没有PAD和其他行走合并症的情况下,步态不会随年龄显著下降。因此,必须在人群中存在潜在PAD患者的背景下审视以往的研究,并且未来的行走研究在评估老年人的步态功能时必须将PAD作为一个混杂因素纳入考量。