Christensen Jesse C, Mizner Ryan L, Foreman Kenneth Bo, Marcus Robin L, Pelt Christopher E, LaStayo Paul C
Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, Utah 84108.
School of Physical Therapy & Rehabilitation Science, University of Montana, 135 Skaggs Building, Missoula, Montana.
J Orthop Res. 2018 Sep;36(9):2355-2363. doi: 10.1002/jor.23894. Epub 2018 Apr 24.
Patients with total knee arthroplasty (TKA) have large deficits in physical performance in comparison to their healthy age-matched peers. Limb asymmetry stemming from less relative load borne by the surgical limb during daily mobility is associated with diminished performance and worsens with greater mobility demands. How common targets of postoperative care, such as muscle weakness, lower limb extension power, residual knee pain, and poor balance confidence can influence asymmetrical limb loading remains unclear. Forty-six patients with unilateral TKA underwent testing of impairments and motion analysis during 10° decline walking at 3 and 6 months postoperatively. At 3 months, only quadriceps femoris strength asymmetry was found to be significantly related to both total support moment (M ) (β = 0.431; p < 0.001) and knee extensor moment (M ) (β = 0.493; p < 0.001) asymmetry. Again at 6 months, only quadriceps strength asymmetry was related to M (β = 0.432; p < 0.001) and M (β = 0.534; p < 0.001) asymmetry. Quadriceps strength significantly improved over time in both limbs, however, deficits between limbs remained. Persistent quadriceps weakness is a key factor associated with walking compensation patterns that are limiting the capacity for greater physical performance of patients with TKA. The pronounced asymmetry in limb and knee loading at 3 months remains unchanged until at least 6 months after surgery, and its association with quadriceps strength asymmetry does not substantially change over time. While other factors may also prompt gait compensations, emphasis on improved quadriceps strength should be a focus of efforts to resolve gait compensations and enhance physical performance outcomes. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2355-2363, 2018.
与年龄匹配的健康同龄人相比，全膝关节置换术（TKA）患者的身体机能存在较大缺陷。日常活动中手术侧肢体承受的相对负荷较小导致的肢体不对称与机能下降有关，且随着活动需求增加而恶化。术后护理的常见目标，如肌肉无力、下肢伸展力量、残留膝关节疼痛和平衡信心不足如何影响不对称肢体负荷仍不清楚。46例单侧TKA患者在术后3个月和6个月进行了10°下坡行走时的功能障碍测试和运动分析。在3个月时，仅发现股四头肌力量不对称与总支撑力矩（M）（β = 0.431；p < 0.001）和膝关节伸肌力矩（M）（β = 0.493；p < 0.001）不对称显著相关。同样在6个月时，仅股四头肌力量不对称与M（β = 0.432；p < 0.001）和M（β = 0.534；p < 0.001）不对称相关。随着时间推移，双下肢股四头肌力量均有显著改善，但双下肢之间的差距仍然存在。持续的股四头肌无力是与步行代偿模式相关的关键因素，限制了TKA患者提高身体机能的能力。术后3个月时明显的肢体和膝关节负荷不对称至少在术后6个月仍未改变，其与股四头肌力量不对称的关联也未随时间发生实质性变化。虽然其他因素也可能促使步态代偿，但强调改善股四头肌力量应是解决步态代偿和提高身体机能结果的努力重点。© 2018骨科学研究协会。由威利期刊公司出版。《矫形外科学研究》36:2355 - 2363，2018。
