摘要
背景:前交叉韧带断裂是常见运动损伤之一,一般采用前交叉韧带重建治疗,术后常出现平衡及步行能力下降,目前缺少相关的全面对比研究。目的:探究前交叉韧带重建后患者静态站立和步行时的平衡及步态特征,并与健康人做全面对比分析,为康复方案的制定提供科学指导。方法:选择前交叉韧带重建后6-8周患者和健康人(健康对照组)各23例,利用足底压力平板采集静态站立时足底压力中心95%置信椭圆面积、路径长度、平均移动速度及长短轴长度,同时采集步行时的足底压力中心位移、步态线长度、最大移动速度、步态时相占比以及三足区的最大压力。结果与结论:(1)静态站立平衡:前交叉韧带重建组的足底压力中心95%椭圆面积、路径长度、平均移动速度、长短轴长度较健康对照组明显增加(P<0.05),同时站立时前交叉韧带重建组前足负重大于健康对照组(P<0.05);(2)步行平衡特征:前交叉韧带重建组与健康对照组比较,足底压力中心内外侧位移显著变大(P<0.05),前后方向位移和最大移动速度无明显差异;前交叉韧带重建组患侧与健侧、患侧与健康对照组、健侧与健康对照组相比,前者的步态线和单支撑线长度均小于后者(P<0.05);(3)步态周期特征:前交叉韧带重建组的步宽及双支撑期均大于健康对照组(P<0.05),跨步长小于健康对照组(P<0.05);前交叉韧带重建组患侧与健侧比较,站立相、单腿支撑期、摆动前期及足跟到前足时间均减少(P<0.05),而承重反应期和摆动期增加(P<0.05);患侧与健康对照组相比,足偏角、承重反应期和摆动前期增加,单腿支撑期降低(P<0.05);健侧与健康对照组相比,站立相、承重反应期、摆动前期及足跟到前足时间均明显增加,摆动期减少(P<0.05);(4)三足区最大压力:患侧与健侧比较,前足、足弓和足跟的最大压力均显著降低(P<0.05);患侧与健康对照组比较,三足最大压力也明显减少(P<0.05);健侧与健康对照组比较,前足最大压力降低明显(P<0.05),而足弓与足跟无显著差异;(5)结果表明,前交叉韧带重建后6-8周患者的静态及动态平衡能力均明显低于健康人,且健侧的平衡功能也显著下降;在步行中患者出现跨步长缩短、步宽增加,患侧支撑期减少、摆动期增加等步态问题;提示术后康复时要注重患者双侧的平衡及步态训练。
BACKGROUND:Anterior cruciate ligament rupture is one of the common sports injuries,which is generally treated by anterior cruciate ligament reconstruction.Balance and walking abilities are often decreased after surgery,and there is a lack of comprehensive comparative study.OBJECTIVE:To explore the balance and gait characteristics of patients after anterior cruciate ligament reconstruction during static standing and walking,and make a comprehensive comparative analysis with the healthy group to provide scientific guidance for rehabilitation treatment.METHODS:Totally 23 patients 6-8 weeks after anterior cruciate ligament reconstruction and 23 healthy controls were selected.The plantar pressure plate was used to collect 95%confidence elliptical area,path length,average velocity and major and minor axis length of the plantar center of pressure during static standing.Simultaneously,the center of pressure displacement,gait line length,maximum velocity,gait phase ratio and maximum pressure in the tripod area were collected.RESULTS AND CONCLUSION:(1)Static standing balance:The center of pressure 95%confidence ellipse area,path length,average moving speed and length of major and minor axes in the anterior cruciate ligament reconstruction group were significantly higher than those in the healthy control group(P<0.05).Simultaneously,the weight-bearing of the forefoot in the anterior cruciate ligament reconstruction group was higher than that in the healthy control group(P<0.05).(2)Characteristics of walking balance:Compared with the healthy control group,the medial and lateral displacement of the center of pressure in the anterior cruciate ligament reconstruction group was significantly larger(P<0.05),and there was no significant difference in anterior and posterior displacement and maximum movement speed.Compared with the affected side and the healthy side in the anterior cruciate ligament reconstruction group,the affected side and the healthy control group,and the healthy side and the healthy control group,the gait line and single support line length of the former in the three groups were smaller than those of the latter(P<0.05).(3)Gait cycle characteristics:The stride width and double support period of the anterior cruciate ligament reconstruction group were larger than those of the healthy control group(P<0.05).Stride length was smaller in the anterior cruciate ligament reconstruction group than that in the healthy control group(P<0.05).Compared with the healthy side,the standing phase,single leg support period,pre-swing period and heel to the forefoot time on the affected side of the anterior cruciate ligament reconstruction group decreased(P<0.05),while the load-bearing response period and swing period increased(P<0.05).Compared with the healthy control group,the foot deviation angle,load-bearing response period and pre-swing period increased,and the single leg support period decreased on the affected side(P<0.05).Compared with the healthy control group,the standing phase,load-bearing response period,pre-swing period and the time from heel to the forefoot were significantly increased,and the swing period decreased on the healthy side(P<0.05).(4)The maximum pressure of the tripod area:Compared with the healthy side,the maximum pressure of the forefoot,arch and heel of the affected side decreased significantly(P<0.05).Compared with the healthy control group,the maximum pressure of the tripod area of the affected side also decreased significantly(P<0.05).Compared with the healthy control group,the maximum pressure of the forefoot of the healthy side decreased significantly(P<0.05),but there was no significant difference between the arch and the heel.(5)The results showed that the static and dynamic balance ability of the patients 6-8 weeks after anterior cruciate ligament reconstruction was significantly lower than that of the healthy subjects,and the balance function of the healthy side also decreased significantly.During walking,the patients had gait problems such as a shortening of stride length,an increase of stride width,a decrease of support period and increase of swing period.It is suggested that attention should be paid to bilateral balance and gait training during postoperative rehabilitation.
作者
马圣楠
柯竟悦
董洪铭
沈双
丁浩
李建萍
李古强
Ma Shengnan;Ke Jingyue;Dong Hongming;Shen Shuang;Ding Hao;Li Jianping;Li Guqiang(School of Rehabilitation,Binzhou Medical University,Yantai 264003,Shandong Province,China;Rehabilitation Engineering Research Institute,Binzhou Medical University,Yantai 264003,Shandong Province,China;Second Clinical Medical College,Binzhou Medical University,Yantai 264003,Shandong Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2023年第36期5784-5789,共6页
Chinese Journal of Tissue Engineering Research
基金
山东省自然科学基金面上项目(ZR2022MA047),项目负责人:沈双
2021年山东省本科教学改革研究面上项目《假肢矫形工程医工融合产学研协同育人探索》(M2021213),项目负责人:李古强。
关键词
前交叉韧带重建
静态平衡
步态周期
足底压力中心
步态线长度
前后方向位移
内外侧位移
最大移动速度
足底压力
anterior cruciate ligament reconstruction
static balance
gait cycle
center of pressure
length of gait line
forward and backward displacement
medial and lateral displacement
maximum velocity
plantar pressure
