自体髌腱与腘绳肌腱重建前交叉韧带后的步态分析

目的 观察膝关节前交叉韧带(ACL)损伤不同重建方式术后步态运动学变化规律.方法 应用三维运动捕捉步态分析系统(东方新锐DVMC-8801三维运动分析系统),对2006年3月至2007年3月因单侧前交叉韧带损伤应用自体中1/3骨-髌腱-骨(髌腱组)或四股胴绳肌腱(胭绳肌腱组)进行重建的各19例患者进行步态分析,分别于术前、术后3、6、9、12个月采集步态数据,同期采集19名健康人的步态数据并与之比较.受试对象按恒定速度(1.9 km/h)在运动平板上行走120 s,测量0°和15°时的步态数据,测量时空参数包括:步长、步宽;运动学数据包括:膝关节运动角度、膝关节角加速度.结果 两组38例前交叉韧带损伤患者术前及术后3个月均出现股四头肌逃避步态,术后6个月15°倾斜运动平板的时空参数与正常比较差异无统计学意义,术后9个月15°倾斜运动平板的运动学指标与正常比较差异无统计学意义;髌腱组术后6个月15°运动平板伸膝角加速度明显小于腘绳肌腱组,屈膝角加速度明显大于腘绳肌腱组.结论 腘绳肌腱或髌腱移植前交叉韧带重建,膝关节正常的步态模式表现与术后时间有相关性;两种重建方式术后早期存在的膝关节生物力学差异与移植物取材部位相关.

Gait analysis after anterior cruciate ligament reconstruction with different methods

Objective To examine and compare the gait patterns of subjects with hamstring and patellar tendon graft reconstructions of anterior cruciate ligament ( ACL). Methods Three groups were compared: 19 patellar tendon anterior cruciate ligament reconstruction patients (a mean of 11. 8 weeks after injury) , 19 hamstring tendon anterior cruciate ligament reconstruction patients (a mean of 10. 4 weeks after injury) and 19 matched controls. Gait analysis was performed using the DorealSoft DVMC-8801 three-dimensional motion capture system. Kinematic data were recorded for the lower limb prior to and 3,6,9 and 12 months after ACL reconstructive surgery. Each subject was asked to walk on a motorized treadmill with different slopes and perform - after 6 minutes of familiarization time - at least 2 minutes of walking at a constant speed of 1.9 km/h. Results All the ACL-deficient patients exhibited a quadriceps avoidance pattern prior to and 3 months post-operation. In the operated individuals, the spatial-temporal parameters and the knee angle had already regained a normal pattern for the ACL-deficient limb during gait at 6 months post-operation. However, the angular acceleration showed no significant statistical difference with the values of healthy control group at just 9 months post-operation. The flexion angular acceleration at 15°treadmill was significantly smaller than that in the hamstring tendon group and the extension angular acceleration was significantly smaller than that in the patellar tendon group at 6 months post-operation. Conclusion ACL surgical repair significantly alters the lower-extremity gait patterns and the establishment of pre-injury gait patterns takes at least 9 months to occur. The graft-specific differences in knee biomechanics after anterior cruciate ligament reconstruction appear to be related with the donor site.