Department of Rehabilitation Medicine, Ten-Chan General Hospital, No. 155 Yanping Rd, Zhongli Dist., Taoyuan City, 320, Taiwan.
Department of Biomedical Engineering, Chung Yuan Christian University, No. 200, Zhongbei Rd, Zhongli Dist., Taoyuan City, 320, Taiwan (ROC).
Biomed Eng Online. 2019 Mar 19;18(1):26. doi: 10.1186/s12938-019-0644-3.
Studies have shown that gait asymmetry and activity limitation can persist several months or years after ankle fracture. However, evidence of gait and trunk movement patterns following ankle fracture during the early rehabilitation period is scarce. Thus, we compared gait patterns and trunk movement during the early phase of rehabilitation between patients with ankle fracture and matched controls.
Ten patients with ankle fractures, and ten age- and sex-matched healthy controls were prospectively enrolled. An automated infrared-assisted, trunk accelerometer-based gait analysis system was used to measure walking speed, step length, and cadence. The median time of the evaluation following ankle fracture was 4.0 months. Trunk movement intensity was evaluated as acceleration root mean square. Trunk movement symmetry and regularity were analysed using the autocorrelation method. Differences in gait characteristics between the patient and control groups were analysed using the Mann-Whitney U test. Follow-up assessment of falls was performed 24 months after the fracture. The correlations between Lower Extremity Functional Scale (LEFS) scores/falls and gait parameters were evaluated using Spearman's rank correlation coefficient.
Walking speed (p = 0.019), step length (p = 0.023), cadence (p = 0.003), and trunk movement intensity in anterior-posterior and vertical axis (p = 0.001, p = 0.003, respectively) were all significantly lower in the ankle fracture group than in the control group. Trunk movement symmetry in vertical direction (p = 0.019) decreased significantly in patients with ankle fractures, whereas between-strides regularity did not differ between groups. LEFS scores were moderately correlated with walking speed (r = 0.60, p = 0.044) and step length (r = 0.68, p = 0.021). During the 24 months after the fracture, 3 falls were reported by 3 patients. Trunk acceleration root mean square ratio in mediolateral axis (r = 0.72, p = 0.018) was highly correlated with future falls.
During early rehabilitation, patients with ankle fracture may develop trunk movement asymmetry in the vertical direction accompanied with slower walking speed and cadence, and smaller step lengths, which can contribute to muscular imbalances and potential injury. Thus, proper rehabilitation strategies should be employed for these patients.
研究表明，踝关节骨折后数月甚至数年仍存在步态不对称和活动受限。然而，踝关节骨折后早期康复期间步态和躯干运动模式的证据很少。因此，我们比较了踝关节骨折患者和匹配对照组在早期康复期间的步态模式和躯干运动。
前瞻性纳入 10 例踝关节骨折患者和 10 例年龄和性别匹配的健康对照者。采用自动化红外辅助、基于躯干加速度计的步态分析系统测量行走速度、步长和步频。踝关节骨折后评估的中位时间为 4.0 个月。躯干运动强度评估为加速度均方根。采用自相关法分析躯干运动对称性和规律性。采用 Mann-Whitney U 检验分析患者组与对照组之间步态特征的差异。骨折后 24 个月进行下肢功能量表（LEFS）评分/跌倒随访评估。采用 Spearman 秩相关系数评估 LEFS 评分/跌倒与步态参数的相关性。
与对照组相比，踝关节骨折组的行走速度（p=0.019）、步长（p=0.023）、步频（p=0.003）和前-后轴及垂直轴的躯干运动强度（p=0.001，p=0.003）均显著降低。踝关节骨折患者的垂直方向躯干运动对称性显著降低，而步间规律性在两组间无差异。LEFS 评分与行走速度（r=0.60，p=0.044）和步长（r=0.68，p=0.021）中度相关。骨折后 24 个月内，3 例患者报告了 3 次跌倒。躯干加速度均方根比值在横-纵轴（r=0.72，p=0.018）与未来跌倒高度相关。
在早期康复期间，踝关节骨折患者可能会出现垂直方向的躯干运动不对称，伴行走速度和步频减慢，步长减小，这可能导致肌肉失衡和潜在损伤。因此，应针对这些患者采用适当的康复策略。
