1.Huangshan University;2.China University of Mining and Technology
目的 系统研究单侧全膝置换前后女性患者双侧下肢步态特征。方法 基于三维步态采集和独立样本T检验，对比10例女性患者术前术后双侧下肢的步态参数，并分别与10例健康对照组比较，分析女性患者双侧步态差异及分别与正常步态的差异。结果 术前患者非手术侧支撑期、内收角度峰值、冠状面活动度和屈曲力矩峰值显著大于手术侧 (P<0.05)，术后无统计学差异；与对照组比较，术前患者步速、步长较小，双支撑期较长，手术侧膝关节伸展和内收角度峰值、冠状面活动度、屈曲和外展力矩峰值较小，内收力矩峰值较大，非手术侧膝关节伸展角度峰值较小，屈曲和内收力矩峰值较大，均存在统计学差异 (P<0.05)，术后双侧伸展角度和内收力矩峰值与对照组的显著差异持续存在 (P<0.05)。结论 单侧全膝置换术能减轻患者疼痛，改善双侧下肢步态偏差，但与对照步态仍存在差异，肌力及本体感受等关节功能尚未恢复，病理步态与不良体态持续存在，应针对性加强患侧肌力锻炼及步态矫正，女性患者同时应注意步速控制及本体感受的训练。本文研究对女性患者术前评估、预防及术后康复等具有参考价值。
Objective To investigate gait characteristics of both lower limbs in female patients before and after unilateral total knee arthroplasty (TKA). Methods Gait parameters of 10 female patients were compared in both lower limbs, and compared to those of 10 healthy subjects based on three-dimensional motion analysis system and independent Student’s t test. Results The preoperative stance phase, peak adduction angle, adduction-abduction range of motion (ROM) and peak flexion moment of the uninvolved knee were significantly higher than those of the involved side (P<0.05), while postoperative gait parameters were similar in both sides. The patients had significantly lower speed and stride length, longer double support time than the control group before TKA (P<0.05). Moreover, the involved knee demonstrated significantly lower peak extension and adduction angles, adduction-abduction ROM, peak flexion and abduction moments, while higher peak adduction moment, and the uninvolved knee revealed significantly lower peak extension angle, higher peak flexion and adduction moments than the control group before TKA (P<0.05). However, peak extension angles and adduction moments in both sides were still different with those of the control group after TKA (P<0.05). Conclusions Patients had pain relief and improved gait in both sides after TKA. However, there were gait differences compared to the control group, because of the deficits in joint function, such as muscle strength and proprioception, and pathological gait and posture still existing. Therefore, patients should enhance muscle strength of the involved limb, and take gait correction training. Female patients should also reduce walking speed and improve proprioception. The conclusion presents important references for pre-operative evaluation, prevention and post-operative recovery for female patients.