Lee Pei-An, Wang Ting-Ming, Chen Yu-Ting, Wu Kuan-Hsien, Liu Hwa-Chang, Lu Tung-Wu
Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.
Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taipei, Taiwan.
Front Bioeng Biotechnol. 2023 Mar 22;11:1133992. doi: 10.3389/fbioe.2023.1133992. eCollection 2023.
Total knee arthroplasty (TKA) approaches affect recovery outcomes, with different levels of residual loss of muscle strength and functional deficits. The current study compared the gait balance control in older individuals 3 months after TKA the lateral parapatellar approach (LPPA) and mid-vastus approach (MVA) in terms of the inclination angle (IA) of the center of pressure (COP) to the body's center of mass (COM) vector, and the rate of change of IA (RCIA). In a gait laboratory, 12 patients with severe medial knee osteoarthritis who had undergone bilateral TKA LPPA and 12 MVA were evaluated and compared against 12 healthy controls for their balance control during gait 3 months after surgery. The participants' kinematic data and ground reaction forces were measured synchronously using an 8-camera motion capture system and three forceplates, respectively, from which the COM, COP, IA and RCIA were calculated using a 13-body-segment model. The LPPA group showed significantly greater sagittal IA during DLS ( < 0.01) but less sagittal and frontal RCIA throughout the gait cycle ( < 0.04) compared to controls. The MVA showed better recovery in the balance control with most IA and RCIA variables similar to those of the healthy controls throughout the gait cycle. The patients with LPPA walked with a compromised balance control throughout the gait cycle while the MVA group showed close-to-normal balance control with a slight decrease in sagittal RCIA during SLS. The current between-approach findings were likely related to the differences in the muscles involved during surgery, suggesting that MVA may be a better choice than LPPA when taking short-term gait balance control into consideration.
全膝关节置换术（TKA）的手术入路会影响恢复结果，导致不同程度的肌肉力量残留损失和功能缺陷。本研究比较了采用髌旁外侧入路（LPPA）和股中肌入路（MVA）进行TKA手术3个月后的老年患者的步态平衡控制情况，具体指标为压力中心（COP）相对于身体重心（COM）矢量的倾斜角度（IA）以及IA的变化率（RCIA）。在步态实验室中，对12例接受双侧TKA手术且分别采用LPPA和MVA的重度膝关节内侧骨关节炎患者进行评估，并与12名健康对照者比较术后3个月步态时的平衡控制情况。分别使用8台摄像机的运动捕捉系统和3块测力板同步测量参与者的运动学数据和地面反作用力，然后使用13节段模型计算COM、COP、IA和RCIA。与对照组相比，LPPA组在双支撑期（DLS）的矢状面IA显著更大（<0.01），但在整个步态周期中的矢状面和额状面RCIA均较小（<0.04）。MVA组在平衡控制方面恢复更好，在整个步态周期中，大多数IA和RCIA变量与健康对照者相似。LPPA组患者在整个步态周期中行走时平衡控制受损，而MVA组在单支撑期（SLS）矢状面RCIA略有下降，但显示出接近正常的平衡控制。目前不同入路之间的研究结果可能与手术过程中涉及的肌肉差异有关，这表明在考虑短期步态平衡控制时，MVA可能比LPPA是更好的选择。
