背景:全踝关节置换术(TAA)用于治疗有症状的终末期踝关节关节炎(AA)。然而,关于TAA对步态对称性的影响知之甚少。
目的:使用归一化对称指数(NSI)和统计参数映射(SPM)确定对称性是否从手术前到TAA后两年发生变化。
方法:从先前收集的前瞻性数据库中评估了141例晚期单侧AA患者,每个参与者在手术后两周内接受测试(Pre-Op),TAA后一年和两年。步行速度,髋部伸展角度和力矩,髋部屈曲角度,踝关节足底弯曲角度和力矩,踝关节背屈角度,重量验收(GRF1),并计算了每个肢体的推进(GRF2)垂直地面反作用力。使用NSI评估步态对称性。使用每个步态对称变量具有单个响应的线性混合效应模型来检查随访时间的固定效应(Pre-Op,一年后,2年后)和模型中步态速度作为协变量的参与者的随机效应。完成一维重复测量方差分析(ANOVA)统计参数映射(SPM)以检查时间序列NSI中的差异,以确定随访时间之间的显著差异的区域。
结果:相对于Pre-Op值,GRF1和GRF2在会话中显示出离散指标和时间序列NSI的对称性增加。髋部伸展力矩的对称性改善最大。手术前和手术后2年的踝关节屈角度不同(p=0.010);手术前和手术后各节段的踝关节屈力矩不同(p<0.001)。与2年后相比,在Op前的早期站立阶段,时间序列踝角NSI更大。
结论:TAA后大部分姿势阶段的对称性得到改善,表明TAA成功改善了步态对称性,未来的工作应确定这些改善是否将对称性恢复到与健康年龄匹配对照相当的水平。
BACKGROUND: Total ankle arthroplasty (TAA) is used to treat symptomatic end-stage ankle arthritis (AA). However, little is known about TAA\'s effects on gait
symmetry.
OBJECTIVE: Determine if symmetry changes from before surgery through two years following TAA utilizing the normalized
symmetry index (NSI) and statistical parametric mapping (SPM).
METHODS: 141 patients with end-stage unilateral AA were evaluated from a previously collected prospective database, where each participant was tested within two weeks of surgery (Pre-Op), one year and two years following TAA. Walking speed, hip extension angle and moment, hip flexion angle, ankle plantarflexion angle and moment, ankle dorsiflexion angle, weight acceptance (GRF1), and propulsive (GRF2) vertical ground reaction forces were calculated for each limb. Gait
symmetry was assessed using the NSI. A linear mixed effects model with a single response for each gait symmetry variable was used to examine the fixed effect of follow-up time (Pre-Op, Post-1 yr, Post-2 yr) and the random effect of participant with gait speed as a covariate in the model. A one-dimensional repeated measures analysis of variance (ANOVA) statistical parameter mapping (SPM) was completed to examine differences in the time-series NSI to determine regions of significant differences between follow-up times.
RESULTS: Relative to Pre-Op values, GRF1, and GRF2 showed increased symmetry for discrete metrics and the time-series NSI across sessions. Hip extension moment had the largest
symmetry improvement. Ankle plantarflexion angle was different between Pre-Op and Post-2 yr (p=0.010); and plantarflexion moment was different between Pre- Op and each post-operative session (p<0.001). The time-series Ankle Angle NSI was greater during the early stance phase in the Pre-Op session compared to Post-2 yr.
CONCLUSIONS: Symmetry across most of the stance phase improved following TAA indicating that TAA successfully improves gait symmetry and future work should determine if these improvements restore
symmetry to levels equivalent with health age-match controls.