Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede 7500 AH, the Netherlands; Roessingh Centre for Rehabilitation, Roessinghsbleekweg 33, Enschede 7500 AH, the Netherlands; University of Twente, Enschede, the Netherlands.
Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede 7500 AH, the Netherlands; University of Twente, Enschede, the Netherlands.
Gait Posture. 2024 Oct;114:101-107. doi: 10.1016/j.gaitpost.2024.08.001. Epub 2024 Aug 28.
Stiff knee gait is characterized by a reduced peak knee flexion during swing. Overactivity of the rectus femoris is often cited as a main cause for stiff knee gait. Little is known about the effect of an isolated rectus femoris transfer treatment on kinematic and functional outcomes in a group of stroke survivors.
To perform an experimental study to evaluate the effect of an isolated rectus femoris transfer on knee and hip kinematics and functional outcomes in adult stroke patients walking with a stiff knee gait.
In this experimental study, 10 stroke survivors were included. During the surgical procedure, the distal rectus femoris tendon of the affected side was transferred to the medial knee flexors to improve knee flexion during swing. Knee and hip kinematics and a variety of functional outcomes were measured within 3 weeks before surgery and between 6 and 7 months after the surgery.
We found a statistically significant improvements in peak knee flexion during swing and knee range of motion of 10.6° (sd 4.7, p=0.000) and 10.5° (sd 6.2, p=0.001) post-surgery, respectively. Hip kinematics showed no significant differences. In addition, we found statistically significant improvements on the 6-minute walk test (42.5, sd 36.7, p=0.008), 10-meter walk test (1.26, sd 1.4, p=0.030), Timed up-and-go test (1.34, sd 1.18, p=0.009), L-test (2.97 sd 2.85, p=0.014) and on a subjective BORG scoring of foot clearance (1.8, sd 0.6, p=0.006). No significant differences were found on other measured functional outcomes.
Rectus femoris transfer is a valuable treatment option for stroke patients walking with a stiff knee gait to improve knee kinematics and a selection of functional outcomes. There are no detrimental side effects on hip kinematics.
僵硬膝关节步态的特点是摆动期膝关节屈曲峰值降低。股直肌过度活跃常被认为是僵硬膝关节步态的主要原因。关于孤立性股直肌转移治疗对一组脑卒中幸存者的运动学和功能结果的影响知之甚少。
进行一项实验研究，以评估孤立性股直肌转移对僵硬膝关节步态的成年脑卒中患者的膝关节和髋关节运动学以及功能结果的影响。
在这项实验研究中，纳入了 10 名脑卒中幸存者。在手术过程中，将患侧的远端股直肌肌腱转移到膝关节内侧屈肌，以改善摆动期的膝关节屈曲。在手术前 3 周内和手术后 6 至 7 个月内测量膝关节和髋关节运动学以及各种功能结果。
我们发现，手术后摆动期膝关节屈曲峰值和膝关节活动度分别显著改善了 10.6°（标准差 4.7，p=0.000）和 10.5°（标准差 6.2，p=0.001）。髋关节运动学没有显著差异。此外，我们发现 6 分钟步行测试（42.5，标准差 36.7，p=0.008）、10 米步行测试（1.26，标准差 1.4，p=0.030）、起立-行走测试（1.34，标准差 1.18，p=0.009）、L 测试（2.97，标准差 2.85，p=0.014）和足部间隙主观 BORG 评分（1.8，标准差 0.6，p=0.006）均有统计学显著改善。在其他测量的功能结果方面没有发现显著差异。
股直肌转移是治疗僵硬膝关节步态的脑卒中患者的一种有价值的治疗选择，可以改善膝关节运动学和一系列功能结果。对髋关节运动学没有不利影响。
