李亚强,张峻,顾冬云,曾一鸣.内侧半月板损伤患者关节镜手术前后三维步态特征差异[J].医用生物力学,2019,34(3):300-306
内侧半月板损伤患者关节镜手术前后三维步态特征差异
Differences in Three-Dimensional Gait Characteristics of Patients with Medial Meniscus Injury before and after Arthroscopic Surgery
投稿时间:2019-02-01  修订日期:2019-04-24
DOI:
中文关键词:  半月板  关节镜  步态分析  动力学
英文关键词:meniscus  arthroscopy  gait analysis  kinetics
基金项目:互联网+肩关节镜登记系统的开发与应用(YG2017MS05),上海市临床医学中心(2017ZZ01023),上海市临床重点专科
作者单位
李亚强 上海交通大学医学院附属第九人民医院 骨科 上海市骨科内植物重点实验室 
张峻 上海交通大学医学院附属第九人民医院 骨科 上海市骨科内植物重点实验室 
顾冬云 上海交通大学医学院附属第九人民医院 骨科 上海市骨科内植物重点实验室 
曾一鸣 上海交通大学医学院附属第九人民医院 骨科 上海市骨科内植物重点实验室 
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中文摘要:
      目的 比较膝关节内侧半月板损伤患者关节镜手术前后的三维步态特征。方法 纳入15名内侧半月板损伤患者和15名健康人群作为研究对象,采集损伤组术前、术后及健康对照组的三维步态参数,包括步态时空参数、运动学以及动力学参数。结果 (1)损伤组术前步速和步长与对照组相比显著下降(P<0.05),损伤组术后步速、步长与对照组相比无显著差异。(2)矢状面,损伤组术前膝关节屈曲伸展活动范围、承重反应期和摆动相膝关节最大弯曲度较对照组显著下降(P<0.001);术后承重反应期膝关节弯曲度较术前明显增加(P<0.05),但术后摆动相膝关节最大弯曲角度和屈曲伸展活动范围仍显著低于对照组(P<0.05)。冠状面,损伤组术前内收外展活动范围和最大内收角度较对照组显著下降(P<0.001);术后内收外展活动范围和最大内收角度较术前显著增加(P<0.05),但也显著低于对照组(P<0.001)。(3)矢状面,损伤组术后膝关节屈曲力矩第1、第2峰值较术前增加(P>0.05),但仍显著低于对照组(P<0.05)。冠状面,损伤组术后内收力矩第1、第2峰值较术前增加,但也显著低于对照组(P<0.05)。结论 半月板损伤患者有其独特的步态特征,通常采取僵硬步态来降低膝关节负荷。关节镜下半月板成形术能显著改善膝关节步态特征,但患者步态仍不能在短期内恢复正常。
英文摘要:
      Objective To compare the three-dimensional (3D) gait characteristics of patients with medial meniscus injury of the knee before and after arthroscopic surgery. Methods Fifteen patients with medial meniscus injury and fifteen healthy subjects were included in the study. The 3D gait parameters were collected, including spatiotemporal parameters, kinematic parameters and kinetic parameters. Results (1) The preoperative walking speed and step length of the injury group were significantly lower than those of the control group. There was no significant difference in walking speed and step length after surgery between the injury group and the control group. (2) In the sagittal plane, the preoperative knee flexion-extension range of motion (ROM), the maximum flexion angle in load-bearing phase and swinging phase were significantly lower than those in the control group (P<0.001). The maximum knee flexion in load-bearing response phase was significantly increased after surgery (P<0.05), but the maximum flexion angle in swing phase and the knee flexion-extension ROM after surgery were still significantly lower than those of the control group (P<0.05). In the coronal plane, the preoperative knee adduction-abduction ROM and the maximum adduction angle in gait cycle were significantly lower than those of the control group (P<0.001). The postoperative parameters significantly increased compared with the preoperative ones (P<0.05), but they were still significantly lower than those of the control group (P<0.001). (3) In the sagittal plane, the postoperative first and second peaks of knee flexion moment in stance phase of the injury group increased, compared with the preoperative ones (P>0.05), but they were still significantly lower than those of the control group (P<0.05). In the coronal plane, the postoperative first and second peaks of knee adduction moment in stance phase of the injury group increased, compared with preoperative ones, but they were also significantly lower than those of the control group (P<0.05). Conclusions Patients with medial meniscus injury have their own unique gait patterns, usually with stiffening gait to reduce the knee load. Arthroscopic meniscusplasty can significantly improve knee gait characteristics, but patients still cannot return to normal gait in a short period of time.
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