Thomson J D, Ounpuu S, Davis R B, DeLuca P A
Gait Laboratory, Connecticut Children's Medical Center, Hartford 06106, USA.
J Pediatr Orthop. 1999 Jan-Feb;19(1):27-33.
The purpose of this study was to determine the effects of the ankle-foot orthosis (AFO) on gait patterns in patients with low-level myelomeningocele and to identify any abnormal gait patterns that may lead to future knee instability and pain. A total of 28 children (26 L4-level sides, 18 L5-level sides, and 10 S1-2-level sides) underwent a three-dimensional gait analysis when ambulating barefoot and with AFOs. Results show significant improvements in sagittal plane function with reductions in excessive ankle dorsiflexion, increases in peak plantar flexor moment, and reductions in crouch and knee extensor moment in the L4 and L5 groups. The only improvement in the S1-2 group was a reduction in excessive dorsiflexion, but there was a reduction in power generation at the ankle. The S1-2 group had normal transverse plane knee motion in stance during barefoot walking that increased significantly (p < 0.01) with the AFO. Both the L5 and L4 groups showed greater-than-normal transverse plane knee motion in stance during barefoot walking that also increased significantly (p < 0.01) with the AFO. The results suggest that excessive knee transverse plane rotation may contribute to knee instability more than coronal plane abnormalities. The AFO in S1-2-level patients may be more detrimental for the knee than barefoot walking.
本研究的目的是确定踝足矫形器（AFO）对低位脊髓脊膜膨出症患者步态模式的影响，并识别任何可能导致未来膝关节不稳定和疼痛的异常步态模式。共有28名儿童（26例L4水平侧、18例L5水平侧和10例S1 - 2水平侧）在赤脚行走和佩戴AFO时接受了三维步态分析。结果显示，L4和L5组在矢状面功能上有显著改善，过度踝关节背屈减少，跖屈肌峰值力矩增加，蹲伏和膝关节伸肌力矩减少。S1 - 2组唯一的改善是过度背屈减少，但踝关节的发力减少。S1 - 2组在赤脚行走时站立期膝关节在水平面的运动正常，佩戴AFO后显著增加（p < 0.01）。L5和L4组在赤脚行走时站立期膝关节在水平面的运动均大于正常，佩戴AFO后也显著增加（p < 0.01）。结果表明，膝关节在水平面的过度旋转可能比冠状面异常更易导致膝关节不稳定。S1 - 2水平患者佩戴AFO对膝关节可能比赤脚行走更有害。
