Lee Seung Yeol, Kwon Soon-Sun, Chung Chin Youb, Lee Kyoung Min, Sung Ki Hyuk, Kim Sangwoo, Park Moon Seok
Department of Orthopaedic Surgery, Ewha Womans University Mokdong Hospital, Seoul, South Korea.
Department of Mathematics, College of Natural Science, Ajou University, Suwon, Gyeonggi, South Korea.
BMC Musculoskelet Disord. 2018 Mar 15;19(1):82. doi: 10.1186/s12891-018-2003-0.
Simultaneous motion of the knee and ankle joints is required for many activities including gait. We aimed to evaluate the influence of surgery involving tendons around the knee on ankle motion during gait in the sagittal plane in cerebral palsy patients.
We included data from 55 limbs in 34 patients with spastic cerebral palsy. Patients were followed up after undergoing only distal hamstring lengthening with or without additional rectus femoris transfer. The patients' mean age at the time of knee surgery was 11.2 ± 4.7 years, and the mean follow-up duration was 2.2 ± 1.5 years (range, 0.9-6.0 years). Pre- and postoperative kinematic variables that were extracted from three-dimensional gait analyses were then compared to assess changes in ankle motion after knee surgery. Outcome measures included ankle dorsiflexion at initial contact, peak ankle dorsiflexion during stance, peak ankle dorsiflexion during swing, and dynamic range of motion of the ankle. Various sagittal plane knee kinematics were also measured and used to predict ankle kinematics. A linear mixed model was constructed to estimate changes in ankle motion after adjusting for multiple factors.
Improvement in total range of motion of the knee resulted in improved motion of the ankle joint. We estimated that after knee surgery, ankle dorsiflexion at initial contact, peak ankle dorsiflexion during stance, peak ankle dorsiflexion during swing, and dynamic range of motion of the ankle decreased, respectively, by 0.4° (p = 0.016), 0.6° (p < 0.001), 0.2° (p = 0.038), and 0.5° (p = 0.006) per degree increase in total range of motion of the knee after either knee surgery. Furthermore, dynamic range of motion of the ankle increased by 0.4° per degree increase in postoperative peak knee flexion during swing.
Improvement in total knee range of motion was found to be correlated with improvement in ankle kinematics after surgery involving tendons around the knee. As motion of the knee and ankle joints is cross-linked, surgeons should be aware of potential changes in the ankle joint after knee surgery.
包括步态在内的许多活动都需要膝关节和踝关节同时运动。我们旨在评估涉及膝关节周围肌腱的手术对脑瘫患者矢状面步态中踝关节运动的影响。
我们纳入了34例痉挛性脑瘫患者55个肢体的数据。患者在仅接受或未接受额外股直肌转移的远端腘绳肌延长术后进行随访。患者膝关节手术时的平均年龄为11.2±4.7岁，平均随访时间为2.2±1.5年（范围0.9 - 6.0年）。然后比较从三维步态分析中提取的术前和术后运动学变量，以评估膝关节手术后踝关节运动的变化。结果指标包括初始接触时的踝关节背屈、站立期踝关节背屈峰值、摆动期踝关节背屈峰值以及踝关节的动态运动范围。还测量了各种矢状面膝关节运动学，并用于预测踝关节运动学。构建线性混合模型以估计在调整多个因素后踝关节运动的变化。
膝关节总运动范围的改善导致踝关节运动改善。我们估计，在膝关节手术后，膝关节总运动范围每增加一度，初始接触时的踝关节背屈、站立期踝关节背屈峰值、摆动期踝关节背屈峰值以及踝关节的动态运动范围分别降低0.4°（p = 0.016）、0.6°（p < 0.001）、0.2°（p = 0.038）和0.5°（p = 0.006）。此外，摆动期术后膝关节屈曲峰值每增加一度，踝关节的动态运动范围增加0.4°。
发现膝关节总运动范围的改善与涉及膝关节周围肌腱的手术后踝关节运动学的改善相关。由于膝关节和踝关节的运动是相互关联的，外科医生应意识到膝关节手术后踝关节可能发生的变化。
