Zhang Hao-Hua, Yan Song-Hua, Fang Chen, Guo Xin-Yuan, Zhang Kuan
Department of Orthopaedics, Beijing Jishuitan Hospital, Beijing, China.
Department of Biomechanics and Rehabilitation Engineering, School of Biomedical Engineering, Capital Medical University, Beijing, China.
Orthop Surg. 2016 Aug;8(3):360-6. doi: 10.1111/os.12270.
To evaluate the effects of surgery and rehabilitation on patients undergoing total knee arthroplasty (TKA).
Twelve patients and 12 healthy controls were enrolled and their clinical scores evaluated by a doctor. Gait data, including walking velocity, stride length, single support time, foot fall and swing power, were collected using a portable gait analyzer from 12 patients before and 6 weeks and 6 months after surgery and from 12 healthy controls. The gait data and clinical scores at selected time points were compared and correlations between gait characteristics and clinical scores assessed.
Clinical knee and knee function scores increased significantly from before surgery to 6 weeks to 6 months after surgery (P < 0.001). The only significant differences identified were for single support time on the diseased side between before surgery and 6 months after surgery (P = 0.031) and for foot fall with the diseased side between 6 weeks and 6 months after surgery (P = 0.016). Foot fall and speed of the healthy or diseased sides were significantly different in patients at all time points from those of the healthy subjects (P < 0.05). Single support time on the diseased side was significantly different 6 months after surgery (P = 0.035) in patients than in healthy controls. Single support time on the healthy side before surgery was significantly different from that of healthy controls (P = 0.048) and 6 weeks after surgery (P = 0.042). Stride lengths differed significantly between patients and healthy subjects before surgery (healthy side: P = 0.007; diseased side: P = 0.008) and 6 weeks after surgery (healthy side: P = 0.001; diseased side: P = 0.001), but were not different at 6 months after surgery (healthy side: P = 0.088; diseased side: P = 0.077). The only significant correlations identified were between single support time with the diseased side of patients and their knee (r = 0.43, P = 0.032) and knee function scores (r = 0.493, P = 0.012).
A portable gait analyzer appears to be suitable for evaluating the effects of TKA. Single support time on the diseased side may be a sensitive quantitative index for determining the effect of TKA and rehabilitation.
评估手术及康复治疗对接受全膝关节置换术（TKA）患者的影响。
纳入12例患者及12名健康对照者，由医生对其临床评分进行评估。使用便携式步态分析仪收集12例患者术前、术后6周及6个月以及12名健康对照者的步态数据，包括步行速度、步长、单支撑时间、足跟着地和摆动功率。比较选定时间点的步态数据和临床评分，并评估步态特征与临床评分之间的相关性。
从术前到术后6周再到术后6个月，临床膝关节及膝关节功能评分显著升高（P < 0.001）。唯一发现的显著差异为术前与术后6个月患侧的单支撑时间（P = 0.031）以及术后6周与6个月患侧的足跟着地情况（P = 0.016）。患者在所有时间点患侧或健侧的足跟着地和速度与健康受试者相比均有显著差异（P < 0.05）。术后6个月患者患侧的单支撑时间与健康对照者相比有显著差异（P = 0.035）。术前健侧的单支撑时间与健康对照者相比有显著差异（P = 0.048），术后6周也有显著差异（P = 0.042）。术前患者与健康受试者之间健侧（P = 0.007；患侧：P = 0.008）及术后6周健侧（P = 0.001；患侧：P = 0.001）的步长有显著差异，但术后6个月无差异（健侧：P = 0.088；患侧：P = 0.077）。唯一发现的显著相关性为患者患侧的单支撑时间与其膝关节（r = 0.43，P = 0.032）及膝关节功能评分（r = 0.493，P = 0.012）之间的相关性。
便携式步态分析仪似乎适用于评估TKA的效果。患侧的单支撑时间可能是确定TKA及康复治疗效果的敏感定量指标。
