尸体步态模拟中踝关节融合术后相邻关节的运动学
Adjacent Joint Kinematics After Ankle Arthrodesis During Cadaveric Gait Simulation.
作者信息
Sturnick Daniel R, Demetracopoulos Constantine A, Ellis Scott J, Queen Robin M, Kolstov Jayme C B, Deland Jonathan T, Baxter Josh R
机构信息
1 Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA.
2 Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA.
出版信息
Foot Ankle Int. 2017 Nov;38(11):1249-1259. doi: 10.1177/1071100717726806. Epub 2017 Aug 24.
BACKGROUND
Arthrodesis is an effective and reliable treatment for end-stage ankle arthritis; however, many patients develop ipsilateral adjacent joint arthritis following surgery. The mechanism that drives adjacent joint arthritis remains uncertain. Cadaveric simulation permits direct investigation of the effects of both arthrodesis and movement strategy on adjacent joints during simulated walking. The objective of this study was to identify the isolated effect of ankle arthrodesis on adjacent joint kinematics during simulated walking.
METHODS
Effects of ankle arthrodesis on adjacent joint kinematics were assessed in 8 cadaveric foot and ankle specimens using a robotic gait simulator. Gait parameters acquired from healthy adults and patients with ankle arthrodesis were used as inputs for simulations. Three-dimensional subtalar and talonavicular joint kinematics were directly measured before and after ankle arthrodesis, and healthy- and arthrodesis-gait parameters were applied to identify the isolated effect of the ankle arthrodesis on adjacent joint kinematics.
RESULTS
Ankle arthrodesis increased subtalar and talonavicular joint motion during early and midstance independent of which gait parameters were used as inputs to the gait simulator. However, adjacent joint motions did not differ between the control and arthrodesis condition during late stance, when the healthy gait parameters were used as inputs. Conversely, adjacent joint motion decreased during late stance following arthrodesis when simulating gait using parameters typical in arthrodesis patients.
CONCLUSIONS
Regardless of the gait parameter inputs, subtalar and talonavicular joint motions increased from normal kinematics, which likely increase the biomechanical burden placed on these adjacent joints and may lead to joint degeneration.
CLINICAL RELEVANCE
Increased motion of the adjacent joints caused by ankle arthrodesis may explain the articular degeneration observed clinically.
背景
关节融合术是治疗终末期踝关节关节炎的一种有效且可靠的方法；然而，许多患者术后会出现同侧相邻关节关节炎。导致相邻关节关节炎的机制尚不清楚。尸体模拟可以直接研究关节融合术和运动策略在模拟行走过程中对相邻关节的影响。本研究的目的是确定踝关节融合术对模拟行走过程中相邻关节运动学的单独影响。
方法
使用机器人步态模拟器在8个尸体足踝关节标本中评估踝关节融合术对相邻关节运动学的影响。从健康成年人和踝关节融合术患者获得的步态参数用作模拟的输入。在踝关节融合术前和术后直接测量距下关节和距舟关节的三维运动学，并应用健康和融合术步态参数来确定踝关节融合术对相邻关节运动学的单独影响。
结果
无论将哪种步态参数用作步态模拟器的输入，踝关节融合术都会在站立前期和中期增加距下关节和距舟关节的运动。然而，当使用健康步态参数作为输入时，在站立后期，对照组和融合术组之间的相邻关节运动没有差异。相反，当使用融合术患者典型的参数模拟步态时，融合术后站立后期相邻关节运动减少。
结论
无论步态参数输入如何，距下关节和距舟关节的运动均比正常运动学增加，这可能会增加这些相邻关节上的生物力学负担，并可能导致关节退变。
临床意义
踝关节融合术引起的相邻关节运动增加可能解释临床上观察到的关节退变。
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