全膝关节置换前后的三维步态分析

目的：通过三维步态分析的生物力学方法对全膝关节置换患者进行步态分析。方法：选择2005-11/2006-11大连大学附属中山医院全膝关节置换患者53例,年龄42~82岁,平均59.2岁。男33例,平均身高(172±13) cm, 体质量（64±11） kg; 女20例,平均身高(155±11) cm, 体质量（45±1l） kg。术前和术后1，6，12个月应用东方新锐DVMC-8801三维运动分析系统进行步态分析，每次测量要求至少有3个步长长度,步速恒定。将髋、膝、踝关节共设置16个点，并连接成面，建成三维动态图像。结果：置换后行走速度、步频、步长及患肢站立相均有明显改善（P < 0.01），置换后1年步态分析各参数基本达到正常水平。置换前髋关节最大曲度为15°，后伸为8°，膝关节最大屈曲度70°，踝关节最大屈曲度15°。置换后6个月髋关节最大屈曲度为27°，后伸17°，膝关节最大屈曲度50°，踝关节最大屈曲度14°；各指标与置换前相比差异有显著性（P < 0.01）。结论：运用三维步态分析对行全膝置换的患者进行功能量化评价,可以更准确的了解膝关节的生物力学变化,进而探索最佳的治疗手段和置换后的康复方法。

Three-dimensional gait analysis before and after total knee arthroplasty

AIM: To analyze gait of patients undergoing total knee arthroplasty by three-dimensional (3D) biomechanical approach.METHODS: Fifty-three patients undergoing total knee arthroplasty were selected from Zhongshan Hospital of Dalian University between November 2005 and November 2006, with average age of 59.2 years (range, 42-82 years). The subjects consisted of 33 males with average height of (172±13) cm and body mass of (64±11) kg, and 20 females with average height of (155±11) cm and body mass of (45±1l) kg. All patients were evaluated by 3D gait analysis motion analysis system (DVMC-8801), of which three step lengths at constant gait speed were measured. Sixteen points were set up around hip, knee and ankle and connected to build up 3D dynamic image. RESULTS: Gait speed, gait frequency, step length and affected limb standing phase were all significantly improved postoperatively (P < 0.01). All parameters for gait analysis restored to normal levels postoperative 1 year. Preoperative hip maximum flexion was improved from 15° to 27°, backward extension from 8° to 17°; knee maximum flexion was from 70° to 50°; ankle maximum flexion was from 15° to 14° 6 months after surgery. All indicators were improved significantly before and after treatment (P < 0.01). CONCLUSION: 3D gait analysis for assessment of patients undergoing total knee arthroplasty can precisely reflect knee biomechanical changes, and assist to explore optimal treatment approach and postoperative rehabilitation methods.