Sliepen Maik, Mauricio Elsa, Rosenbaum Dieter
Institut für Experimentelle Muskuloskelettale Medizin (IEMM), Universitätsklinikum Münster (UKM), Westfälische Wilhelms-Universität Münster (WWU), Münster, Germany.
Institut für Experimentelle Muskuloskelettale Medizin (IEMM), Universitätsklinikum Münster (UKM), Westfälische Wilhelms-Universität Münster (WWU), Münster, Germany; Otto Bock Healthcare GmbH, Göttingen, Germany.
Gait Posture. 2018 May;62:297-302. doi: 10.1016/j.gaitpost.2018.03.034. Epub 2018 Mar 26.
Knee osteoarthritis (KOA) is a painful disease commonly caused by high loads on the articular cartilage. Orthotic interventions aim to reduce mechanical loading, thereby alleviating pain. Traditional orthotics appear effective, but high drop-out rates have been reported over prolonged periods.
The aim of this study was to examine the effect of a novel ankle-foot orthosis (AFO) on gait parameters, physical function and activity of KOA patients.
29 clinically diagnosed KOA patients with varus malalignment wore an AFO for 6 weeks. Prior to and after the intervention period, 3D gait analysis, physical function tests and the KOOS questionnaire were administered. Physical activity was objectively assessed with accelerometers.
The AFO immediately reduced the first peak of the knee adduction moment (KAM) and the KAM impulse by 41% and 19%. The knee flexion moment (KFM) was increased by 48%. After six weeks, the first KAM peak and KAM impulse were decreased by 27% and 19% while using the AFO. The KFM was increased by 71%. Furthermore, patients completed the functional tests faster (1.4-2.6%). The KOOS scores decreased significantly. No significant differences were found in physical activity parameters.
The six-week AFO application significantly reduced the KAM. The patients' physical function appeared improved; yet these improvements were only minor and therefore arguably clinically irrelevant. The KFM appeared to be negatively affected after six weeks, as were the scores on the KOOS subscales. In summary, even though the AFO reduced the KAM and improved physical function, the clinical benefit for KOA patients with varus malalignment after the 6-week AFO application is debatable.
膝关节骨关节炎（KOA）是一种常见的疼痛性疾病，通常由关节软骨承受高负荷引起。矫形器干预旨在减少机械负荷，从而减轻疼痛。传统矫形器似乎有效，但长期使用的脱落率较高。
本研究的目的是检验一种新型踝足矫形器（AFO）对KOA患者步态参数、身体功能和活动的影响。
29例临床诊断为内翻畸形的KOA患者佩戴AFO 6周。在干预期前后，进行三维步态分析、身体功能测试和膝关节损伤与骨关节炎疗效评分（KOOS）问卷。使用加速度计客观评估身体活动。
AFO立即使膝关节内收力矩（KAM）的第一个峰值和KAM冲量分别降低了41%和19%。膝关节屈曲力矩（KFM）增加了48%。六周后，使用AFO时，KAM的第一个峰值和KAM冲量分别降低了27%和19%。KFM增加了71%。此外，患者完成功能测试的速度更快（1.4 - 2.6%）。KOOS评分显著降低。身体活动参数未发现显著差异。
六周的AFO应用显著降低了KAM。患者的身体功能似乎有所改善；然而，这些改善很小，因此在临床上可能无关紧要。六周后，KFM似乎受到负面影响，KOOS子量表的得分也是如此。总之，尽管AFO降低了KAM并改善了身体功能，但对于内翻畸形的KOA患者，六周的AFO应用后的临床益处仍存在争议。
