Wang Yingpeng, Qie Shuyan, Li Yingqi, Yan Songhua, Zeng Jizhou, Zhang Kuan
Department of Rehabilitation, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China.
School of Biomedical Engineering, Capital Medical University, Beijing, China.
Front Bioeng Biotechnol. 2022 Feb 24;10:839909. doi: 10.3389/fbioe.2022.839909. eCollection 2022.
Precise identification of deficient intersegmental coordination patterns and functional limitations is conducive to the evaluation of surgical outcomes after total knee arthroplasty (TKA) and the design of optimal personalized rehabilitation protocols. However, it is still not clear how and when intersegmental coordination patterns change during walking, and what functional limitations are in patients with TKA. This study was designed to investigate lower limb intersegmental coordination patterns in patients with knee osteoarthritis before and after TKA and identify how intersegmental coordination of patients is altered during walking before and after TKA. It was hypothesized that 6-month after TKA, intersegmental coordination patterns of patients are improved compared with that before TKA, but still do not recover to the level of healthy subjects. Gait analysis was performed on 36 patients before and 6-month after TKA and on 34 healthy subjects. Continuous relative phase (CRP) derived from the angle-velocity phase portrait was used to measure the coordination between interacting segments throughout the gait cycle. Thigh-shank CRP and shank-foot CRP were calculated for each subject. Statistical parametric mapping (SPM), a one-dimensional analysis of the entire gait cycle curve, was performed directly to determine which periods of the gait cycle were different in patients and healthy subjects. Six-month after TKA, thigh-shank CRP was significantly higher during 5-12% of the gait cycle ( = 0.041) and lower during 44-95% of the gait cycle ( < 0.001) compared with healthy subjects, and was significantly higher during 62-91% of the gait cycle ( = 0.002) compared with pre-operation. Shank-foot CRP was significantly lower during 0-28% of the gait cycle ( < 0.001) and higher during 58-94% of the gait cycle ( < 0.001) compared with healthy subjects, and was significantly lower during 3-18% of the gait cycle ( = 0.005) compared with pre-operation. This study found that patients exhibited altered intersegmental coordination during the loading response and swing phase both before and after TKA. Six-month after TKA, the thigh-shank coordination was partially improved compared with pre-operation, but still did not recover to the level of healthy subjects, while there was no improvement in the shank-foot coordination pattern after TKA compared with pre-operation. CRP combined with SPM methods can provide insights into the evaluation of surgical outcomes and the design of rehabilitation strategy.
精确识别节段间协调模式缺陷和功能限制，有助于评估全膝关节置换术（TKA）后的手术效果以及设计最佳的个性化康复方案。然而，目前仍不清楚节段间协调模式在行走过程中如何以及何时发生变化，以及TKA患者存在哪些功能限制。本研究旨在调查TKA前后膝关节骨关节炎患者的下肢节段间协调模式，并确定TKA前后患者在行走过程中的节段间协调是如何改变的。研究假设是，TKA后6个月，患者的节段间协调模式与TKA前相比有所改善，但仍未恢复到健康受试者的水平。对36例患者在TKA前和TKA后6个月以及34名健康受试者进行了步态分析。从角速度相图导出的连续相对相位（CRP）用于测量整个步态周期中相互作用节段之间的协调性。计算了每个受试者的大腿-小腿CRP和小腿-足部CRP。直接进行统计参数映射（SPM），即对整个步态周期曲线进行一维分析，以确定患者和健康受试者在步态周期的哪些时间段存在差异。与健康受试者相比，TKA后6个月，在步态周期的5%-12%期间大腿-小腿CRP显著更高（P = 0.041），在步态周期的44%-95%期间显著更低（P < 0.001），与术前相比，在步态周期的62%-91%期间显著更高（P = 0.002）。与健康受试者相比，小腿-足部CRP在步态周期的0%-28%期间显著更低（P < 0.001），在步态周期的58%-94%期间显著更高（P < 0.001），与术前相比，在步态周期的3%-18%期间显著更低（P = 0.005）。本研究发现，患者在TKA前后的负重反应和摆动期均表现出节段间协调改变。TKA后6个月，与术前相比大腿-小腿协调性部分改善，但仍未恢复到健康受试者的水平，而与术前相比，TKA后小腿-足部协调模式没有改善。CRP结合SPM方法可为手术效果评估和康复策略设计提供见解。
