Koseki Kazunori, Mutsuzaki Hirotaka, Yoshikawa Kenichi, Endo Yusuke, Maezawa Takayuki, Takano Hanako, Yozu Arito, Kohno Yutaka
Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, 4733 Ami, Inashiki-gun, Ibaraki 300-0331, Japan.
Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Inashiki-gun, Ibaraki 300-0394, Japan.
Medicina (Kaunas). 2019 Mar 14;55(3):69. doi: 10.3390/medicina55030069.
The Honda Walking Assistive device® (HWA) is a light and easywearable robot device for gait training, which assists patients' hip flexion and extension movementsto guide hip joint movements during gait. However, the safety and feasibility of robot-assisted gaittraining after total hip arthroplasty (THA) remains unclear. Thus, we aimed to evaluate the safetyand feasibility of this gait training intervention using HWA in a patient who underwent THA.
The patient was a 76-year-old woman with right hip osteoarthritis. Gaittraining using HWA was implemented for 20 sessions in total, five times per week from 1 week to5 weeks after THA. Self-selected walking speed (SWS), step length (SL), cadence, timed up and go(TUG), range of motion (ROM) of hip extension, and hip abduction and extension torque weremeasured preoperatively, and at 1 (pre-HWA), 2, 3, 4, 5 (post-HWA), and 10 weeks (follow-up) afterTHA. The gait patterns at SWS without HWA were measured by using three-dimensional (3D) gaitanalysis and an integrated electromyogram (iEMG).
The patient completed 20 gait trainingsessions with no adverse event. Hip abduction torque at the operative side, hip extension torque,SWS, SL, and cadence were higher at post-HWA than at pre-HWA. In particular, SWS, TUG, andhip torque were remarkably increased 3 weeks after THA and improved to almost the same levelsat follow-up. Maximum hip extension angle and hip ROM during gait were higher at post-HWAthan at pre-HWA. Maximum and minimum anterior pelvic tilt angles were lower at post-HWA thanat pre-HWA. The iEMG of the gluteus maximus and gluteus medius in the stance phase were lowerat post-HWA than preoperatively and at pre-HWA.
In this case, the gait training usingHWA was safe and feasible, and could be effective for the early improvement of gait ability, hipfunction, and gait pattern after THA.
本田步行辅助装置（HWA）是一种轻便且易于穿戴的机器人设备，用于步态训练，可辅助患者进行髋关节屈伸运动，以在步态中引导髋关节运动。然而，全髋关节置换术（THA）后机器人辅助步态训练的安全性和可行性仍不明确。因此，我们旨在评估在接受THA的患者中使用HWA进行这种步态训练干预的安全性和可行性。
该患者为一名76岁的右侧髋骨关节炎女性。在THA后1周（术前）至5周，每周进行5次，共进行20次使用HWA的步态训练。测量术前、THA后1周（HWA前）、2周、3周、4周、5周（HWA后）和10周（随访）时的自选步行速度（SWS）、步长（SL）、步频、计时起立行走测试（TUG）、髋关节伸展活动范围（ROM）以及髋关节外展和伸展扭矩。使用三维（3D）步态分析和集成肌电图（iEMG）测量无HWA时SWS下的步态模式。
患者完成了20次步态训练，无不良事件发生。术后HWA时患侧髋关节外展扭矩、髋关节伸展扭矩、SWS、SL和步频均高于术前HWA时。特别是，THA后3周SWS、TUG和髋关节扭矩显著增加，并在随访时改善至几乎相同水平。步态中最大髋关节伸展角度和髋关节ROM术后HWA时高于术前HWA时。术后HWA时最大和最小骨盆前倾角度低于术前HWA时。站立期臀大肌和臀中肌的iEMG术后HWA时低于术前及术前HWA时。
在此病例中，使用HWA进行步态训练是安全可行的，并且可能对THA后步态能力、髋关节功能和步态模式的早期改善有效。
