Whelton C, Thomas A, Elson D W, Metcalfe A, Forrest S, Wilson C, Holt C, Whatling G
Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, UK; Cardiff School of Engineering, Trevithick Building, Cardiff, UK.
Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, UK; Cardiff and Vale Orthopaedic Centre, University Hospital of Wales, Cardiff, UK.
Clin Biomech (Bristol). 2017 Mar;43:109-114. doi: 10.1016/j.clinbiomech.2017.02.009. Epub 2017 Feb 14.
Gait adaptations, including toe out gait, have been proposed as treatments for knee osteoarthritis. The clinical application of toe out gait, however, is unclear. This study aims to identify the changes in Knee adduction moment in varus knee deformity assessing toe out gait as an alternative to high tibial osteotomy, and if any change in dynamic loading persists post operatively, when anatomical alignment is restored.
Three-dimensional motion analysis was performed on 17 patients with medial compartment knee osteoarthritis and varus deformity prior to undergoing high tibial osteotomy, 13 patients were assessed post-operatively, and results compared to 13 healthy controls.
Pre-operatively, there was no significant difference between natural and toe out gait for measures of knee adduction moment. Post high tibial osteotomy, first (2.70 to 1.51% BW·h) and second peak (2.28 to 1.21% BW·h) knee adduction moment were significantly reduced, as was knee adduction angular impulse (1.00 to 0.52% BW·h·s), to a healthy level. Adopting toe out gait post-operatively reduced the second peak further to a level below that of healthy controls.
Increasing the foot progression angle from 20° (natural) to 30° in isolation did not significantly alter the knee adduction moment or angular impulse. This suggests that adopting a toe out gait, in isolation, in an already high natural foot progression angle, is not of benefit. Adopting toe out gait post-operatively, however, resulted in a further reduction in the second peak to below that of the healthy control cohort, however, this may increase lateral compartment load.
包括外八字步态在内的步态适应性改变已被提议作为膝骨关节炎的治疗方法。然而，外八字步态的临床应用尚不清楚。本研究旨在确定在评估外八字步态作为高位胫骨截骨术替代方法时，内翻膝畸形患者的膝关节内收力矩变化，以及在恢复解剖对线后，术后动态负荷是否存在任何变化。
对17例内侧间室膝骨关节炎和内翻畸形患者在接受高位胫骨截骨术前进行三维运动分析，对13例患者术后进行评估，并将结果与13名健康对照者进行比较。
术前，自然步态和外八字步态在膝关节内收力矩测量方面无显著差异。高位胫骨截骨术后，第一个（从2.70%体重·身高降至1.51%体重·身高）和第二个峰值（从2.28%体重·身高降至1.21%体重·身高）膝关节内收力矩显著降低，膝关节内收角冲量（从1.00%体重·身高·秒降至0.52%体重·身高·秒）也降至健康水平。术后采用外八字步态进一步将第二个峰值降低至低于健康对照者的水平。
单独将足部前进角度从20°（自然）增加到30°并没有显著改变膝关节内收力矩或角冲量。这表明，在已经较高的自然足部前进角度下单独采用外八字步态并无益处。然而，术后采用外八字步态导致第二个峰值进一步降低至低于健康对照队列的水平，不过，这可能会增加外侧间室负荷。
