Magrath Walker J, Qiu Cecil S, Hanwright Philip J, Tuffaha Sami H, Khavanin Nima
Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Md.
Plast Reconstr Surg Glob Open. 2022 Aug 15;10(8):e4438. doi: 10.1097/GOX.0000000000004438. eCollection 2022 Aug.
Functional lower extremity reconstruction primarily aims to restore independent ambulation. We sought to define the synergies recruited during a walking gait to inform donor selection for various motor deficits. With these findings, we discuss the functional neuromuscular components of independent gait with the goal of informing lower extremity reconstruction.
A systematic review was performed using MEDLINE for articles published between January 2000 and December 2020. Search terms included (1) "motor module(s)," "synergy," "motor pattern," or "motor primitive" and (2) "gait," "walking," "ambulation," or "locomotion." Abstracts/full texts were reviewed by two independent reviewers.
A total of 38 studies were selected. The average reported number of synergies and variance accounted for was 4.5 ± 0.9 and 88.6% ± 7.7%, respectively. Four motor modules were conserved across nearly all studies.
Walking can be reduced to the sequential activation of four motor modules. Activities during the stance phase are critical for both standing stability and forward progression and should be prioritized for reconstruction with the goal of preserving efficient gait. Muscles recruited during swing, except those used for ankle dorsiflexion, are less prone to injury and benefit from greater redundancy, less often necessitating reconstruction. With the emphasis on stability during stance, several synergistic or sometimes even antagonistic tendons can be used to replace their counterparts and restore efficient, independent ambulation. With a finite supply of donor tissues, and in the absence of well-defined clinical outcomes data, this research allows us to effectively prioritize reconstructive goals and maximize patient outcomes.
功能性下肢重建主要旨在恢复独立行走能力。我们试图确定在步行步态中募集的协同作用，以为各种运动功能障碍的供体选择提供依据。基于这些发现，我们讨论独立步态的功能性神经肌肉组成部分，目的是为下肢重建提供信息。
使用MEDLINE对2000年1月至2020年12月发表的文章进行系统综述。检索词包括（1）“运动模块”、“协同作用”、“运动模式”或“运动原基”，以及（2）“步态”、“行走”、“步行”或“移动”。摘要/全文由两名独立评审员进行评审。
共筛选出38项研究。报告的协同作用平均数量和方差分别为4.5±0.9和88.6%±7.7%。几乎所有研究中都保留了四个运动模块。
行走可简化为四个运动模块的顺序激活。站立期的活动对于站立稳定性和向前推进都至关重要，应以保留高效步态为目标优先进行重建。摆动期募集的肌肉，除了用于踝关节背屈的肌肉外，受伤的可能性较小，且受益于更大的冗余度，因此较少需要重建。由于强调站立期的稳定性，几条协同甚至有时拮抗的肌腱可用于替代其对应肌腱，恢复高效、独立的行走能力。鉴于供体组织供应有限，且缺乏明确的临床结局数据，这项研究使我们能够有效地确定重建目标的优先级，并使患者结局最大化。
