Gommans Lindy N M, Smid Annemieke T, Scheltinga Marc R M, Cancrinus Ernst, Brooijmans Frans A M, Meijer Kenneth, Teijink Joep A W
Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands; CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands.
J Vasc Surg. 2017 Aug;66(2):515-522. doi: 10.1016/j.jvs.2017.02.033. Epub 2017 May 11.
Patients with intermittent claudication (IC) tend to walk slower and consume approximately 40% more oxygen during walking compared with healthy individuals. An unfavorable locomotion pattern has been suggested to explain this metabolic inefficiency. However, detailed knowledge of gait parameters in IC is lacking.
In a cross-sectional study, the gait pattern of newly diagnosed IC patients was compared with that of healthy controls. Spatiotemporal gait parameters such as step length and duration of stance phase were obtained by a photoelectric technique (OptoGait; Microgate, Bolzano, Italy). This system was previously found to have favorable concurrent validity and test-retest reliability characteristics. Parameters were determined during pain-free and painful treadmill walking at a comfortable self-determined walking pace. Each parameter was averaged on the basis of 80 steps.
A total of 28 patients and 28 controls were examined. IC patients walked 1.2 km/h (-27%) slower than controls (P < .001), coinciding with a significantly shorter step length (-20%) and lower cadence (-11%). IC patients demonstrated a longer stance and double support phase, even before the onset of ischemic pain. Differences were also observed in segments of the stance phase, as a 14% shorter propulsion (P < .001) and 17% longer flat foot phase (P < .001) during painful walking were found. In considering the absolute duration of these stance phase segments, differences were found only for the flat foot time (Δ0.10 second; P < .001).
Patients with IC demonstrate an altered gait pattern compared with healthy controls. The most prominent differences were a prolonged relative and absolute duration of the flat foot position during the stance phase. This adaptation may be intuitive as an augmented arterial blood flow into skeletal muscles is allowed during a prolonged relaxation phase. Therefore, not only the lack of propulsion but also a gain of relaxation may explain these gait alterations.
与健康个体相比，间歇性跛行（IC）患者往往行走速度较慢，且行走过程中消耗的氧气大约多40%。有人提出一种不利的运动模式来解释这种代谢低效情况。然而，目前缺乏关于IC患者步态参数的详细知识。
在一项横断面研究中，将新诊断的IC患者的步态模式与健康对照组进行比较。通过光电技术（OptoGait；意大利博尔扎诺的Microgate公司）获取时空步态参数，如步长和站立相持续时间。此前发现该系统具有良好的同时效度和重测信度特征。在无痛和疼痛状态下以舒适的自我确定步行速度在跑步机上行走时确定参数。每个参数基于80步进行平均。
共检查了28例患者和28例对照。IC患者的行走速度比对照组慢1.2 km/h（-27%）（P <.001），同时步长显著缩短（-20%），步频降低（-11%）。即使在缺血性疼痛发作之前，IC患者的站立相和双支撑相也较长。在站立相的各段中也观察到差异，发现疼痛行走时推进期缩短14%（P <.001），平足期延长17%（P <.001）。在考虑这些站立相段的绝对持续时间时，仅平足时间存在差异（Δ0.10秒；P <.001）。
与健康对照组相比，IC患者表现出步态模式改变。最显著的差异是站立相期间平足位置的相对和绝对持续时间延长。这种适应性可能是直观的，因为在延长的放松期允许更多动脉血流进入骨骼肌。因此，不仅推进不足，而且放松增加都可能解释这些步态改变。
