Bennett Hunter J, Shen Guangping, Cates Harold E, Zhang Songning
Department of Human Movement Sciences, Old Dominion University, Norfolk, VA, USA.
Department of Kinesiology, Recreation, and Sport Studies, The University of Tennessee, Knoxville, TN, USA.
Knee. 2017 Dec;24(6):1326-1334. doi: 10.1016/j.knee.2017.08.058. Epub 2017 Sep 30.
Increased peak external knee adduction moments exist for individuals with knee osteoarthritis and varus knee alignments, compared to healthy and neutrally aligned counterparts. Walking with increased toe-in or increased step width have been individually utilized to successfully reduce 1st and 2nd peak knee adduction moments, respectfully, but have not previously been combined or tested among all alignment groups. The purpose of this study was to compare toe-in only and toe-in with wider step width gait modifications in individuals with neutral, valgus, and varus alignments.
Thirty-eight healthy participants with confirmed varus, neutral, or valgus frontal-plane knee alignment through anteroposterior radiographs, performed level walking in normal, toe-in, and toe-in with wider step width gaits. A 3×3 (group×intervention) mixed model repeated measures ANOVA compared alignment groups and gait interventions (p<0.05).
The 1st peak knee adduction moment was reduced in both toe-in and toe-in with wider step width compared to normal gait. The 2nd peak adduction moment was increased in toe-in compared to normal and toe-in with wider step width. The adduction impulse was also reduced in toe-in and toe-in with wider step width compared to normal gait. Peak knee flexion and external rotation moments were increased in toe-in and toe-in with wider step width compared to normal gait.
Although the toe-in with wider step width gait seems to be a viable option to reduce peak adduction moments for varus alignments, sagittal, and transverse knee loadings should be monitored when implementing this gait modification strategy.
与健康且膝关节中立位的个体相比，膝关节骨关节炎患者和膝内翻患者的膝关节外展峰值力矩增加。单独采用增加内八字或增加步宽的方式行走，已分别成功降低了第一和第二膝关节内收峰值力矩，但此前尚未在所有对线组中进行组合或测试。本研究的目的是比较中立位、外翻位和内翻位个体单纯内八字步态与增加步宽的内八字步态改变。
38名通过前后位X线片确诊为内翻、中立或外翻位额状面膝关节对线的健康参与者，分别以正常、内八字以及增加步宽的内八字步态进行平地行走。采用3×3（组×干预）混合模型重复测量方差分析来比较对线组和步态干预（p<0.05）。
与正常步态相比，内八字步态和增加步宽的内八字步态均降低了第一膝关节内收峰值力矩。与正常步态和增加步宽的内八字步态相比，内八字步态增加了第二内收峰值力矩。与正常步态相比，内八字步态和增加步宽的内八字步态的内收冲量也降低了。与正常步态相比，内八字步态和增加步宽的内八字步态增加了膝关节屈曲峰值和外旋力矩。
尽管增加步宽的内八字步态似乎是降低内翻对线患者内收峰值力矩的可行选择，但在实施这种步态改变策略时，应监测矢状面和横断面的膝关节负荷。
