胫骨近端肿瘤切除和内置假体重建后的步态结果。

Gait outcomes following proximal tibial tumor resection and endoprosthetic reconstruction.

机构信息

Department of Orthopaedic Surgery/Orthopaedic Institute for Children, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.

出版信息

Gait Posture. 2021 Jul;88:167-173. doi: 10.1016/j.gaitpost.2021.05.026. Epub 2021 May 27.

DOI:10.1016/j.gaitpost.2021.05.026

PMID:34098401

Abstract

BACKGROUND

Despite the proximal tibia being a common site of primary malignant bone tumors, there is limited information about gait function following proximal tibial tumor resection and endoprosthetic reconstruction (PTR).

RESEARCH QUESTION

What is the impact of PTR on gait and quality of life?

METHODS

This was a cross-sectional study of patients ≥18 years old who were ≥2 years post-PTR compared to a control group of similar age and sex distribution. Eighteen participants (9 PTR, 9 Control) were recruited. Gait spatial-temporal data, joint kinematics and kinetics were collected at preferred and fast walking speeds. Community walking cadence, health-related quality of life (SF-36) and knee joint torque were assessed. Comparisons were performed using one-way ANOVAs with Bonferroni corrections for multiple comparisons. Nonparametric tests were used for data not normally distributed.

RESULTS

Mean age was 31 years for each group (PTR range = 18-42 yrs, Control range = 18-44 yrs). Compared to both control and nonsurgical limbs, the surgical limb exhibited significantly decreased % single limb support time, reduced heel rise during terminal stance and an absence of normally occurring knee flexion angles, extensor moments and power generation during initial double limb support. Additionally, a reduced peak plantar flexor moment was found for the surgical as compared to the control limb. The number of gait abnormalities increased during fast walking. Significantly reduced surgical knee extensor torque on isokinetic testing and weakness of the knee and ankle on clinical examination support gait findings. During community walking, the number of low frequency strides was an average of 5.3 % greater for the PTR group (p <  0.05). Norm-based PTR group SF-36 component scores were within normal values (53.4 physical, 56.5 mental).

SIGNIFICANCE

Gait abnormalities were consistent with ankle muscle resection and transposition and knee extensor mechanism disruption. Despite these deficits, walking speed and quality of life were relatively normal.

摘要

背景

尽管胫骨近端是原发性恶性骨肿瘤的常见部位，但关于胫骨近端肿瘤切除和内置假体重建（PTR）后的步态功能，信息有限。

研究问题

PTR 对步态和生活质量有什么影响？

方法

这是一项横断面研究，纳入了年龄≥18 岁、PTR 后≥2 年的患者，并与年龄和性别分布相似的对照组进行比较。共招募了 18 名参与者（9 名 PTR，9 名对照组）。在自然步态和快速步行速度下，采集步态时空数据、关节运动学和动力学数据。评估社区行走步频、健康相关生活质量（SF-36）和膝关节扭矩。采用单因素方差分析（ANOVA）进行比较，并对多重比较进行 Bonferroni 校正。对非正态分布数据采用非参数检验。

结果

两组的平均年龄均为 31 岁（PTR 组范围为 18-42 岁，对照组范围为 18-44 岁）。与对照组和非手术侧相比，手术侧的单腿支撑时间百分比明显减少，终末站立时足跟抬高减少，并且在初始双腿支撑时没有出现正常的膝关节弯曲角度、伸肌力矩和功率生成。此外，与对照组相比，手术侧的峰值跖屈肌力矩减小。快速行走时，步态异常的数量增加。等速测试中手术侧膝关节伸肌力矩减小，以及临床检查中膝关节和踝关节无力，支持步态发现。在社区行走时，PTR 组的低频步幅数平均增加 5.3%（p<0.05）。基于标准的 PTR 组 SF-36 组成部分评分在正常值范围内（53.4 分身体，56.5 分心理）。