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距骨合并骨软骨损伤影响慢性踝关节不稳患者的体内踝关节动力学。

Concomitant osteochondral lesion of the talus affects in vivo ankle kinetics in patients with chronic ankle instability.

作者信息

Cao Shengxuan, Chen Yungu, Zhu Yunchao, Jiang Shuyun, Yu Yan, Wang Xu, Wang Chen, Ma Xin

机构信息

Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China.

Academy for Engineering and Technology, Fudan University, Shanghai, China.

出版信息

Bone Joint Res. 2024 Dec 4;13(12):716-724. doi: 10.1302/2046-3758.1312.BJR-2023-0217.R2.

Abstract

AIMS

This cross-sectional study aimed to investigate the in vivo ankle kinetic alterations in patients with concomitant chronic ankle instability (CAI) and osteochondral lesion of the talus (OLT), which may offer opportunities for clinician intervention in treatment and rehabilitation.

METHODS

A total of 16 subjects with CAI (eight without OLT and eight with OLT) and eight healthy subjects underwent gait analysis in a stair descent setting. Inverse dynamic analysis was applied to ground reaction forces and marker trajectories using the AnyBody Modeling System. One-dimensional statistical parametric mapping was performed to compare ankle joint reaction force and joint moment curve among groups.

RESULTS

The patients with OLT showed significantly increased dorsiflexion moment in the ankle joint compared with healthy subjects during 38.2% to 40.9% of the gait cycle, and increased eversion moment in the ankle joint compared with patients without OLT during 25.5% to 27.6% of the gait cycle. Compared with healthy subjects, the patients with OLT showed increased anterior force during 42% to 43% of the gait cycle, and maximal medial force (p = 0.005, ηp2 = 0.399).

CONCLUSION

The patients with concomitant CAI and OLT exhibit increased dorsiflexion and eversion moment, as well as increased anterior and medial ankle joint reaction force during stair descent, compared with patients with CAI but without OLT and healthy subjects, respectively. Thus, a rehabilitative regimen targeting excessive ankle dorsiflexion and eversion moment may help to reduce ankle joint loading.

摘要

目的

本横断面研究旨在调查合并慢性踝关节不稳(CAI)和距骨骨软骨损伤(OLT)患者的体内踝关节动力学改变,这可能为临床医生在治疗和康复干预中提供机会。

方法

共有16例CAI患者(8例无OLT,8例有OLT)和8例健康受试者在楼梯下行场景中接受步态分析。使用AnyBody建模系统对地面反作用力和标记轨迹进行逆动力学分析。进行一维统计参数映射以比较各组之间的踝关节反应力和关节力矩曲线。

结果

与健康受试者相比,OLT患者在步态周期的38.2%至40.9%期间踝关节背屈力矩显著增加,与无OLT患者相比,在步态周期的25.5%至27.6%期间踝关节外翻力矩增加。与健康受试者相比,OLT患者在步态周期的42%至43%期间前向力增加,最大内侧力(p = 0.005,ηp2 = 0.399)。

结论

与分别患有CAI但无OLT的患者和健康受试者相比,合并CAI和OLT的患者在楼梯下行过程中表现出背屈和外翻力矩增加,以及踝关节前向和内侧反应力增加。因此,针对踝关节过度背屈和外翻力矩的康复方案可能有助于减轻踝关节负荷。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6437/11614499/a02c0d704f64/BJR-2023-0217.R2-galleyfig1.jpg

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