Yao Daiwei, Lahner Matthias, Jakubowitz Eike, Thomann Anna, Ettinger Sarah, Noll Yvonne, Stukenborg-Colsman Christina, Daniilidis Kiriakos
Department of Orthopaedic Surgery, Hannover Medical School, Hannover 30625, Germany.
Department of Orthopaedic Surgery and Traumatology, University Hospital Bochum, Bochum 44791, Germany.
Technol Health Care. 2017;25(3):599-606. doi: 10.3233/THC-171297.
An active ankle dorsiflexion is essential for a proper gait pattern. If there is a failure of the foot lifting, considerable impairments occur. The therapeutic effect of an implantable peroneus nerve stimulator (iPNS) for the ankle dorsiflexion is already approved by recent studies. However, possible affection for knee and hip motion after implantation of an iPNS is not well described.
The objective of this retrospective study was to examine with a patient cohort whether the use of iPNS induces a lower-extremity flexion withdrawal response in the form of an increased knee and hip flexion during swing phase.
Eighteen subjects (12 m/6 w) treated with an iPNS (ActiGait®, Otto Bock, Duderstadt, Germany) were examined in knee and hip motion by gait analysis with motion capture system (Vicon Motion System Ltd®, Oxford, UK) and Plug-in-Gait model after a mean follow up from 12.5 months. The data were evaluated and compared in activated and deactivated iPNS.
Only little changes could be documented, as a slight average improvement in peak knee flexion during stand phase from 1.0° to 2.5° and peak hip flexion in stance from 3.1° to 2.1° In contrast, peak knee flexion during swing appeared similar (25.3° to 25.7°) same as peak hip flexion during swing. In comparison with the healthy extremity, a more symmetric course of the knee flexion during stand phase could be shown.
No statistical significant improvements or changes in hip and knee joint could be shown in this study. Only a more symmetric knee flexion during stand phase and a less hip flexion during stand phase might be hints for a positive affection of iPNS for knee and hip joint. It seems that the positive effect of iPNS is only based on the improvement in ankle dorsiflexion according to the recent literature.
主动踝关节背屈对于正常步态模式至关重要。如果足部抬起功能出现障碍，将会导致相当严重的功能受损。近期研究已证实植入式腓总神经刺激器（iPNS）对踝关节背屈具有治疗效果。然而，iPNS植入后对膝关节和髋关节运动可能产生的影响尚无详尽描述。
本回顾性研究旨在通过一组患者队列，探讨iPNS的使用是否会在摆动期引发以膝关节和髋关节屈曲增加形式出现的下肢屈曲退缩反应。
对18名接受iPNS（ActiGait®，奥托博克公司，德国杜德施塔特）治疗的受试者（12名男性/6名女性）进行研究，在平均随访12.5个月后，使用动作捕捉系统（英国牛津Vicon Motion System Ltd®）和插件式步态模型对其膝关节和髋关节运动进行步态分析。对iPNS开启和关闭状态下的数据进行评估和比较。
仅记录到微小变化，站立期膝关节屈曲峰值平均略有改善，从1.0°增至2.5°，站立期髋关节屈曲峰值从3.1°降至2.1°。相比之下，摆动期膝关节屈曲峰值相似（25.3°至25.7°），摆动期髋关节屈曲峰值也相似。与健侧相比，站立期膝关节屈曲过程更为对称。
本研究未显示髋关节和膝关节有统计学意义上的显著改善或变化。站立期膝关节屈曲更对称以及站立期髋关节屈曲减少，可能暗示iPNS对膝关节和髋关节有积极影响。根据近期文献，iPNS的积极作用似乎仅基于踝关节背屈的改善。
