Sotelo Michael, Eichelberger Patric, Furrer Martina, Baur Heiner, Schmid Stefan
Bern University of Applied Sciences, Department of Health Professions, Bern, Switzerland.
Bern University of Applied Sciences, Department of Health Professions, Bern, Switzerland.
Gait Posture. 2018 Sep;65:182-189. doi: 10.1016/j.gaitpost.2018.07.177. Epub 2018 Jul 25.
Unilateral knee flexion contractures (KFC) are frequently seen in orthopedic rehabilitation and often interfere with the normal gait pattern, resulting in passive and/or active secondary deviations. In order to prevent KFC-related complications such as patellofemoral pain or the knee spine syndrome, a comprehensive understanding of such deviations is necessary.
How does an artificially induced unilateral KFC affect whole body biomechanics in young healthy adults during gait?
Twenty-four healthy young adults (females/males: 13/11; mean age: 27.3 ± 3.8 years) were included in this cross-sectional study. Using an 8-camera optical motion capture system and two embedded force plates, three-dimensional lower extremity, pelvis and trunk kinematics as well as lower extremity joint moments were derived during normal walking and walking with unilateral KFCs by means of a lightweight knee brace locked at 30° and 60° of flexion. Data were analyzed using one-dimensional statistical parametric mapping, allowing explorative group comparisons of continuous data rather than pre-defined discrete parameters.
On the braced side, increased hip flexion (p < 0.001, 1-100 % of gait cycle [%GC]), knee flexion (p < 0.001, 1-72 and 82-100 %GC) and ankle dorsiflexion angles (p < 0.001, 1-100 %GC) as well as external knee flexion moments (p < 0.001, 1-98 % of stance phase [%StPh]) and decreased ankle dorsiflexion (p < 0.001, 74-94 %StPh), hip flexion and hip adduction moments (p < 0.001, 1-32 %StPh and p < 0.001, 71-92 %StPh, respectively) were observed. The unbraced side showed similar but less pronounced deviations. Pelvis and upper body kinematics were not altered, suggesting that the lower limbs fully compensate for KFCs of less than 30°.
Asymmetric limb loading and considerable increases in external knee flexion moments might increase the risk for adverse effects of lower extremity joints in the long-term. It seems therefore important to treat KFCs as early as possible and to implement preventive strategies to avoid possible complications.
单侧膝关节屈曲挛缩（KFC）在骨科康复中较为常见，常干扰正常步态模式，导致被动和/或主动的继发性偏差。为预防与KFC相关的并发症，如髌股疼痛或膝关节脊柱综合征，有必要全面了解此类偏差。
人工诱导的单侧KFC如何影响年轻健康成年人在步态中的全身生物力学？
本横断面研究纳入了24名健康的年轻成年人（女性/男性：13/11；平均年龄：27.3±3.8岁）。使用8台摄像机的光学运动捕捉系统和两个嵌入式测力板，通过锁定在30°和60°屈曲的轻质膝关节支具，在正常行走和单侧KFC行走过程中获取三维下肢、骨盆和躯干运动学以及下肢关节力矩数据。使用一维统计参数映射分析数据，允许对连续数据进行探索性组间比较，而非预先定义的离散参数。
在支具侧，观察到髋关节屈曲增加（p<0.001，步态周期的1-100%[％GC]）、膝关节屈曲增加（p<0.001，1-72和82-100％GC）和踝关节背屈角度增加（p<0.001，1-100％GC），以及膝关节外部屈曲力矩增加（p<0.001，站立期的1-98％[％StPh]），而踝关节背屈减少（p<0.001，74-94％StPh）、髋关节屈曲和髋关节内收力矩减少（分别为p<0.001，1-32％StPh和p<0.001，71-92％StPh）。未支具侧显示出类似但不太明显的偏差。骨盆和上身运动学未改变，表明下肢可充分代偿小于30°的KFC。
不对称的肢体负荷和膝关节外部屈曲力矩的显著增加可能会长期增加下肢关节出现不良反应的风险。因此，尽早治疗KFC并实施预防策略以避免可能的并发症似乎很重要。
