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慢性踝关节不稳对慢性踝关节不稳患者步态加载策略的影响:一项对比研究。

Impact of chronic ankle instability on gait loading strategy in individuals with chronic ankle instability: a comparative study.

机构信息

Department of Orthopedics and its Surgeries, Faculty of Physical Therapy, Delta University for Science and Technology, Gamasa, Egypt.

Basic Science Department, Faculty of Physical Therapy, Benha University, Benha, Egypt.

出版信息

J Neuroeng Rehabil. 2024 Oct 18;21(1):185. doi: 10.1186/s12984-024-01478-8.

Abstract

BACKGROUND

Lateral ankle sprains rank among the most prevalent musculoskeletal injuries, while chronic ankle instability (CAI) is its most common cascade. In addition to the conflicting results of the previous studies and their methodological flaws, the specific gait loading strategy is still not well studied.

PURPOSE

The study aimed to investigate the fluctuations in gait loading strategy in people with chronic ankle instability compared to health control.

METHODS

A total of 56 male subjects participated in this study and were allocated into two groups: (A) CAI group: 28 subjects with unilateral CAI (age 24.79 ± 2.64 and BMI 26.25 ± 3.50); and (B) control group: 28 subjects without a history of ankle sprains (age 24.57 ± 1.17 and BMI 26.46 ± 2.597). Stance time, weight acceptance time, and load distribution were measured to investigate gait loading strategy.

RESULTS

The study findings revealed that the CAI group had a significant higher load over the lateral rearfoot. However, MANOVA indicates that there was no overall significant difference in gait loading strategy between the CAI and control groups. Furthermore, in terms of stance time, time of weight acceptance phase, load over medial foot, and load over lateral foot, CAI and healthy controls seemed to walk similarly.

CONCLUSIONS

The findings revealed that individuals with CAI had the significant alteration in the lateral rearfoot loading, suggesting a potential compensatory mechanism to address instability during the weight acceptance phase. This could manifest a laterally deviated center of pressure and increased frontal plane inversion during the early stance phase. However, it is acknowledged that these alterations could be both the result and the origin of CAI. The study highlights the vulnerability of CAI during the early stance phase, emphasizing the need for gait reeducation as individuals return to walking as healthcare clinicians should focus on treatment modalities aimed at reducing rearfoot inversion in individuals with CAI.

摘要

背景

外踝扭伤是最常见的肌肉骨骼损伤之一,而慢性踝关节不稳定(CAI)是其最常见的后果。除了先前研究结果的相互矛盾及其方法上的缺陷外,特定的步态加载策略仍未得到很好的研究。

目的

本研究旨在调查慢性踝关节不稳定患者与健康对照组相比步态加载策略的波动。

方法

共有 56 名男性受试者参与了这项研究,并被分为两组:(A)CAI 组:28 名单侧 CAI 患者(年龄 24.79±2.64 岁,BMI 26.25±3.50);(B)对照组:28 名无踝扭伤史的受试者(年龄 24.57±1.17 岁,BMI 26.46±2.597)。通过测量站立时间、承重时间和负荷分布来研究步态加载策略。

结果

研究结果表明,CAI 组的外侧后足负荷明显更高。然而,MANOVA 表明 CAI 组和对照组之间的步态加载策略没有总体显著差异。此外,在站立时间、承重阶段时间、内侧足负荷和外侧足负荷方面,CAI 和健康对照组似乎行走方式相似。

结论

研究结果表明,CAI 患者的外侧后足负荷明显改变,提示在承重阶段可能存在潜在的代偿机制来应对不稳定。这可能表现为压力中心的侧向偏离和早期站立阶段前平面内翻增加。然而,这些改变既可能是 CAI 的结果,也可能是 CAI 的起源。本研究强调了 CAI 在早期站立阶段的脆弱性,强调了步态再教育的必要性,因为当患者恢复行走时,临床医生应关注旨在减少 CAI 患者后足内翻的治疗方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/678e/11488138/c42add4bb564/12984_2024_1478_Fig1_HTML.jpg

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