Deleu Paul-André, Besse Jean-Luc, Naaim Alexandre, Leemrijse Thibaut, Birch Ivan, Devos Bevernage Bernhard, Chèze Laurence
Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, F69622, 43 Boulevard du 11 novembre 1918, 69622 Villeurbanne, France; Foot & Ankle Institute, 5 Avenue Ariane, 1200 Woluwe-Saint-Lambert, Belgium.
Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, F69622, 43 Boulevard du 11 novembre 1918, 69622 Villeurbanne, France; Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Chirurgie Orthopédique et Traumatologique, 69495 Pierre-Bénite Cedex, France.
Clin Biomech (Bristol). 2020 Mar;73:213-225. doi: 10.1016/j.clinbiomech.2020.01.015. Epub 2020 Jan 20.
The aim of this systematic review with meta-analysis was to determine the change in gait biomechanics after total ankle replacement and ankle arthrodesis for end-stage osteoarthritis.
Electronic databases were searched up until May 2019. Peer-reviewed journal studies including adult participants suffering from end-stage ankle osteoarthritis and reporting pre- and post-operative kinematics, kinetics and spatio-temporal effects of total ankle replacement and ankle arthrodesis during walking were included with a minimum of 12 months follow-up. Seventeen suitable studies were identified and assessed according to methodological and biomechanical qualities. Meta-analysis was performed by calculating the effect size using standard mean differences between pre- and post-operative gait status.
Seventeen studies with a total of 883 patients were included. Meta-analysis revealed moderate evidence of an improvement in lower limb kinematics, kinetics and spatio-temporal parameters after total ankle replacement. Moderate evidence indicated an increase in ankle moment, hip range of motion and walking speed after ankle arthrodesis.
The currently available evidence base of research papers evaluating changes in gait biomechanics after total ankle replacement and ankle arthrodesis is limited by a lack of prospective research, low sample sizes and heterogeneity in the patho-etiology of ankle osteoarthritis. Following total ankle replacement, improvements were demonstrated for spatio-temporal, kinematic and kinetic gait patterns compared to the pre-operative measures. Improvements in gait mechanics after ankle arthrodesis were limited to walking speed and ankle moment. Increased hip range of motion after ankle arthrodesis could represent a sign of compensation for the lack of ankle motion.
本系统评价及荟萃分析的目的是确定终末期骨关节炎患者行全踝关节置换术和踝关节融合术后步态生物力学的变化。
检索电子数据库至2019年5月。纳入经同行评审的期刊研究，研究对象为患有终末期踝关节骨关节炎的成年参与者，报告全踝关节置换术和踝关节融合术在行走过程中的术前和术后运动学、动力学及时空效应，且随访时间至少为12个月。根据方法学和生物力学质量确定并评估了17项合适的研究。通过计算术前和术后步态状态的标准平均差来计算效应量，进行荟萃分析。
共纳入17项研究，涉及883例患者。荟萃分析显示，有中等证据表明全踝关节置换术后下肢运动学、动力学和时空参数有所改善。中等证据表明踝关节融合术后踝关节力矩、髋关节活动范围和步行速度增加。
目前评估全踝关节置换术和踝关节融合术后步态生物力学变化的研究论文证据基础受到以下因素的限制：缺乏前瞻性研究、样本量小以及踝关节骨关节炎病理病因的异质性。与术前测量相比，全踝关节置换术后在时空、运动学和动力学步态模式方面均有改善。踝关节融合术后步态力学的改善仅限于步行速度和踝关节力矩。踝关节融合术后髋关节活动范围增加可能是对踝关节活动缺乏的一种代偿迹象。
