Heikkilä A, Sevander-Kreus N, Häkkinen A, Vuorenmaa M, Salo Petr, Konsta P, Ylinen J
Department of Health Sciences, University of Jyväskylä, Keskussairaalantie 4, 40620 Jyväskylä, Finland; Department of Orthopaedic Surgery, Central Finland Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland.
Department of Health Sciences, University of Jyväskylä, Keskussairaalantie 4, 40620 Jyväskylä, Finland; Department of Physical and Rehabilitation Medicine, Central Finland Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland; Department of Orthopaedic Surgery, Central Finland Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland.
Gait Posture. 2017 Mar;53:92-97. doi: 10.1016/j.gaitpost.2017.01.004. Epub 2017 Jan 16.
To evaluate the effects of surgery and a postoperative progressive home exercise program on gait parameters among individuals operated with total knee arthroplasty.
Single blinded randomized controlled trial.
108 patients (84 females, 24 males, mean age 69 years).
Patients were equally randomized into an exercise group (EG) and control group (CG). The 12-months progressive home exercise program starting two months postoperatively was compared to usual care.
Gait analysis was performed using the Gaitrite electronic walkway system. In addition, knee extension and flexion strength were measured by a dynamometer preoperatively, and pain on visual analog scale (VAS) at two months and 14 months postoperatively.
At the 12-month follow-up, maximal gait velocity (p=0.006), cadence (p=0.003) and stance time (p=0.039) showed a greater increase among EG than CG. All the other gait parameters improved among both groups, but with not statistically discernible difference between groups. Weak correlations were found between changes in maximal gait velocity and the knee extension (r=-0.31, p=0.002), flexion strength (r=0.28, p=0.004) and pain during loading (r=-0.27, p=0.005) values.
The intervention produced statistically significant changes in maximal gait velocity, cadence and stance times in the exercise group compared to controls. Although the average change was small it is of importance that biggest changes occurred in those with low performance.
评估手术及术后渐进性家庭锻炼计划对全膝关节置换术患者步态参数的影响。
单盲随机对照试验。
108例患者（84例女性，24例男性，平均年龄69岁）。
患者被随机分为锻炼组（EG）和对照组（CG）。将术后两个月开始的为期12个月的渐进性家庭锻炼计划与常规护理进行比较。
使用Gaitrite电子步道系统进行步态分析。此外，术前用测力计测量膝关节伸展和屈曲力量，术后两个月和14个月用视觉模拟量表（VAS）评估疼痛程度。
在12个月的随访中，锻炼组的最大步态速度（p = 0.006）、步频（p = 0.003）和站立时间（p = 0.039）的增加幅度大于对照组。两组的所有其他步态参数均有所改善，但组间差异无统计学意义。最大步态速度的变化与膝关节伸展（r = -0.31，p = 0.002）、屈曲力量（r = 0.28，p = 0.004）以及负重时疼痛（r = -0.27，p = 0.005）值之间存在弱相关性。
与对照组相比，该干预措施使锻炼组的最大步态速度、步频和站立时间产生了具有统计学意义的变化。尽管平均变化较小，但重要的是，表现较差的患者变化最大。
