Matsubara Kohki, Kuroyanagi Gen, Imamura Atsushi, Mizuno Yuichiro, Tsukada Shintaro, Ida Ruido, Tokuda Haruhiko, Murakami Hideki, Okamoto Hideki, Ueki Yoshino
Department of Rehabilitation Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Department of Rehabilitation Medicine, Northern Mie Medical Center Inabe, Inabe, Japan.
Front Rehabil Sci. 2025 Jun 12;6:1527825. doi: 10.3389/fresc.2025.1527825. eCollection 2025.
While factors affecting gait post-surgery for proximal femoral fracture (PFF) have been studied, the prognostic value of objective gait analysis during acute postoperative rehabilitation remains unclear. Microsoft Kinect for Windows v2® (Kinect) is a noninvasive, low-cost, and easy-to-implement posture estimation device. However, its application in analyzing gait for these patients is underreported. This study aims to analyze gait during acute postoperative rehabilitation using Kinect, identifying key gait evaluation metrics and prognostic indicators.
This study included 17 patients who were admitted to our hospital with PFF and underwent surgery. Rehabilitation began the day after surgery, with weekly Kinect-recorded gait videos from postoperative weeks 1 to 4. Gait parameters were analyzed thereafter. Participants were divided into two groups: those unable to walk with a walker one week after surgery were classified as having a poor prognosis ( = 7), while those who could were classified as having a good prognosis ( = 10). Various gait parameters were then compared between the groups to examine factors predicting gait prognosis. Furthermore, the hip joint pain/activities of daily living (ADL) index Oxford Hip Score (OHS) and the dynamic balance indicator timed up and go test (TUG) were evaluated, and the correlation with each gait parameter was examined. Key gait parameters were analyzed in both groups after equivalent rehabilitation periods.
Increased gait velocity, decreased gait cycle time, increased swing phase, decreased stance phase, and increased maximum hip joint flexion angle were observed during the postoperative rehabilitation in both study groups. Compared with the good prognosis group, the poor gait prognosis group showed worse swing/stance phases of either healthy or affected limb, TUG, and OHS. The mean TUG value and OHS correlated with each gait parameter. Even after the same rehabilitation gait training period, the good prognosis group showed greater improvements in gait velocity, swing phase, stance phase, hip and knee joint flexion angles, and OHS compared to the poor prognosis group.
During the acute phase of rehabilitation after PFF surgery, adequate hip pain control and early weight bearing of the operated limb are important for favorable gait prognosis.
虽然已经对影响股骨近端骨折（PFF）术后步态的因素进行了研究，但术后急性康复期间客观步态分析的预后价值仍不明确。微软Kinect for Windows v2®（Kinect）是一种无创、低成本且易于实施的姿势估计设备。然而，其在分析这些患者步态方面的应用报道较少。本研究旨在使用Kinect分析术后急性康复期间的步态，确定关键的步态评估指标和预后指标。
本研究纳入了17例因PFF入院并接受手术的患者。术后第一天开始康复治疗，术后第1至4周每周用Kinect记录步态视频，此后分析步态参数。参与者分为两组：术后一周无法借助助行器行走的患者被归类为预后不良（n = 7），而能够借助助行器行走的患者被归类为预后良好（n = 10）。然后比较两组之间的各种步态参数，以检查预测步态预后的因素。此外，评估髋关节疼痛/日常生活活动（ADL）指数牛津髋关节评分（OHS）和动态平衡指标计时起立行走测试（TUG），并检查其与每个步态参数的相关性。在等效康复期后，对两组的关键步态参数进行分析。
两个研究组在术后康复期间均观察到步态速度增加、步态周期时间缩短、摆动期增加、站立期缩短以及最大髋关节屈曲角度增加。与预后良好组相比，步态预后不良组的健侧或患侧肢体的摆动/站立期、TUG和OHS更差。平均TUG值和OHS与每个步态参数相关。即使在相同的康复步态训练期后，与预后不良组相比，预后良好组在步态速度、摆动期、站立期、髋关节和膝关节屈曲角度以及OHS方面的改善更大。
在PFF手术后的急性康复阶段，充分控制髋关节疼痛和早期对手术肢体进行负重对良好的步态预后很重要。
