Baylor University Medical Center, 3500 Gaston Ave, Dallas, Texas, 75246, USA.
Baylor Motion and Sports Performance Center, 411 N Washington Ave, Suite 2100, Dallas, TX, 75246, USA.
Bone Joint J. 2016 Oct;98-B(10):1369-1375. doi: 10.1302/0301-620X.98B10.37614.
The surgical management of ankle arthritis with tibiotalar arthrodesis is known to alter gait, as compared with normal ankles. The purpose of this study was to assess post-operative gait function with gait before arthrodesis.
We prospectively studied 20 patients who underwent three-dimensional gait analysis before and after tibiotalar arthrodesis. Cadence, step length, walking velocity and total support time were assessed. Kinetic parameters, including the moment and power of the ankle in the sagittal plane and hip power were also recorded.
Significant improvement was recorded across numerous parameters compared with pre-operative measurements. Temporal-spatial data demonstrated a significant increase in step length (p = 0.003) and velocity (p = < 0.001). Total support time decreased for the unaffected limb (p = 0.01). Kinematic results demonstrated that in the affected limb, total sagittal range of movement did not change significantly (p = 0.1259). However, the arc of movement had a near congruent shift with mean maximal dorsiflexion increasing from 5° (-17° to 16°) to 12° (5° to 18°) (p < 0.001) and mean maximal plantarflexion decreasing from 6.8° (6° to 21°) to 0.9° (-9° to 8°) (p = 0.003). Mean hip joint range of movement increased by 6° (-7° to 24°; p = 0.003). Kinetic results demonstrated no statistically significant change in ankle power (p = 0.1292). However, there was an increase in ankle moment (p = 0.04) and hip power (p = 0.01) in the surgically treated extremity. Sagittal plane range of movement was not reduced after tibiotalar fusion.
Although following tibiotalar arthrodesis the gait demonstrated never matched the gait shown in unaffected ankles, compared with the pre-operative analysis there was improvement in numerous temporal-spatial, kinematic, and kinetic measures. Cite this article: Bone Joint J 2016;98-B:1369-75.
与正常踝关节相比，经胫距关节融合术治疗踝关节关节炎会改变步态。本研究的目的是评估踝关节融合术后的术后步态功能。
我们前瞻性地研究了 20 例接受三维步态分析的患者，这些患者在接受胫距关节融合术前和术后均接受了检查。评估了步频、步长、步行速度和总支撑时间。还记录了动力学参数，包括矢状面踝关节的力矩和功率以及髋关节的功率。
与术前测量值相比，多项参数均有显著改善。时空数据显示步长（p = 0.003）和速度（p < 0.001）显著增加。未受影响的肢体的总支撑时间减少（p = 0.01）。运动学结果表明，在患病肢体中，总矢状面运动范围没有明显变化（p = 0.1259）。然而，运动弧有一个近乎一致的移位，最大背屈的平均角度从 5°（-17°至 16°）增加到 12°（5°至 18°）（p < 0.001），最大跖屈的平均角度从 6.8°（6°至 21°）减少到 0.9°（-9°至 8°）（p = 0.003）。髋关节的平均运动范围增加了 6°（-7°至 24°；p = 0.003）。动力学结果表明踝关节的功率没有统计学上的显著变化（p = 0.1292）。然而，在接受手术治疗的肢体中，踝关节的力矩（p = 0.04）和髋关节的功率（p = 0.01）增加。胫距融合后矢状面运动范围没有减少。
虽然胫距关节融合术后的步态与正常踝关节的步态从不匹配，但与术前分析相比，在许多时空、运动学和动力学测量方面都有所改善。
Bone Joint J 2016;98-B:1369-75.
