[1]李存祥,李德思,张学波,等.膝骨关节炎患者腓骨小段截骨术后步态参数特征分析[J].中医正骨,2023,35(03):25-30.
　LI Cunxiang,LI Desi,ZHANG Xuebo,et al.An analysis of characteristics of gait parameters in patients with knee osteoarthritis after small segmental fibular osteotomy[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2023,35(03):25-30.
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膝骨关节炎患者腓骨小段截骨术后步态参数特征分析()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第35卷
期数:
2023年03期
页码:
25-30
栏目:
临床研究
出版日期:
2023-03-20

文章信息/Info

Title:
An analysis of characteristics of gait parameters in patients with knee osteoarthritis after small segmental fibular osteotomy
作者:
李存祥1; 李德思2; 张学波3; 降文豪3
(1.河北省宁晋县医院,河北 宁晋 055550; 2.河北医科大学第三医院,河北 石家庄 050051; 3.河北省宁晋县中西医结合医院,河北 宁晋 055550)
Author(s):
LI Cunxiang1; LI Desi2; ZHANG Xuebo3; JIANG Wenhao3
1.Ningjin County Hospital,Ningjin 055550,Hebei,China 2.The Third Hospital of Hebei Medical University,Shijiazhuang 050021,Hebei,China 3.Ningjin County Hospital of Integrated Traditional Chinese and Western Medicine,Ningjin 055550,Hebei,China
关键词:
骨关节炎; 膝;  截骨术;  腓骨;  步态分析
Keywords:
osteoarthritis; knee;  osteotomy;  fibula;  gait analysis
摘要:
目的:分析膝骨关节炎(knee osteoarthritis,KOA)患者腓骨小段截骨术后步态参数特征。方法:纳入46例采用腓骨小段截骨术治疗的KOA患者。男18例,女28例。年龄58～72岁,中位数65岁。分别于术前及术后3个月、1年、3年、5年采用IDEEA3穿戴式智能化步态分析仪采集患者步态参数,分析患者的步态参数特征。结果:6例患者退出随访,最终纳入40例患者进行步态参数特征分析。①患肢支撑时间。不同时间点的患肢支撑时间呈先上升后下降趋势[(421.02±90.49)ms,(449.04±72.02)ms,(477.34±136.40)ms,(488.31±57.99)ms,(432.26±45.18)ms,F=9.672,P=0.000]。术后3个月、1年、3年,患肢支撑时间均长于术前(P=0.001,P=0.001,P=0.000); 术后5年,患肢支撑时间短于术后1年、3年(P=0.020,P=0.000),但与术前、术后3个月比较,差异均无统计学意义(P=0.394,P=0.098); 术后1年、3年,患肢支撑时间均长于术后3个月(P=0.047,P=0.000); 术后3年,患肢支撑时间与术后1年比较,差异无统计学意义(P=0.553)。②肢体摆动时间和患侧单步时间。不同时间点的肢体摆动时间、患侧单步时间均呈下降趋势[(461.78±72.53)ms,(432.24±53.78)ms,(430.97±46.98)ms,(402.71±28.27)ms,(411.01±42.78)ms,F=8.521,P=0.000;(700.44±162.84)ms,(615.03±94.18)ms,(588.90±71.76)ms,(551.88±49.91)ms,(566.18±38.20)ms,F=22.102,P=0.000]。术后3个月、1年、3年、5年,肢体摆动时间、患侧单步时间均短于术前(P=0.037,P=0.018,P=0.000,P=0.000; P=0.000,P=0.000,P=0.000,P=0.000); 术后1年、3年、5年,患侧单步时间均短于术后3个月(P=0.036,P=0.000,P=0.005); 术后1年、5年,肢体摆动时间与术后3个月比较,差异均无统计学意义(P=0.892,P=0.084); 术后3年,肢体摆动时间短于术后3个月(P=0.008); 术后3年,肢体摆动时间、患侧单步时间均短于术后1年(P=0.004,P=0.005); 术后5年,肢体摆动时间、患侧单步时间与术后1年、3年比较,差异均无统计学意义(P=0.060,P=0.281; P=0.086,P=0.152)。③步速、步频、步长、步幅。不同时间点的步速、步频、步长、步幅均呈上升趋势[(41.19±15.71)m·min-1,(48.92±13.15)m·min-1,(56.04±15.50)m·min-1,(61.89±13.15)m·min-1,(58.33±10.66)m·min-1,F=19.652,P=0.000;(90.10±16.17)步·min-1,(99.83±12.17)步·min-1,(104.09±11.20)步·min-1,(110.44±8.89)步·min-1,(107.59±7.24)步·min-1,F=26.333,P=0.000;(0.45±0.11)m,(0.49±0.10)m,(0.53±0.10)m,(0.57±0.09)m,(0.56±0.08)m,F=14.302,P=0.000;(0.87±0.24)m,(0.97±0.20)m,(1.05±0.18)m,(1.12±0.17)m,(1.09±0.16)m,F=15.307,P=0.000]。术后3个月、1年、3年、5年,步速均快于术前(P=0.000,P=0.000,P=0.000,P=0.000); 术后1年、3年、5年,步速均快于术后3个月(P=0.003,P=0.000,P=0.000); 术后3年,步速快于术后1年(P=0.013); 术后5年,步速与术后1年、3年比较,差异均无统计学意义(P=0.495,P=0.215)。术后3个月、1年、3年、5年,步频均高于术前(P=0.000,P=0.000,P=0.000,P=0.000); 术后1年、3年、5年,步频均高于术后3个月(P=0.017,P=0.000,P=0.002); 术后3年,步频高于术后1年(P=0.003); 术后5年,步频与术后1年、3年比较,差异均无统计学意义(P=0.130,P=0.137)。术后3个月、1年、3年、5年,步长、步幅均长于术前(P=0.007,P=0.000,P=0.000,P=0.000; P=0.002,P=0.000,P=0.000,P=0.000); 术后1年、3年、5年,步长、步幅均长于术后3个月(P=0.008,P=0.000,P=0.003; P=0.014,P=0.000,P=0.010); 术后3年,步长、步幅均长于术后1年(P=0.012; P=0.015); 术后5年,步长、步幅与术后1年、3年比较,差异均无统计学意义(P=0.293,P=0.492; P=0.326,P=0.352)。结论:腓骨小段截骨术后5年内,KOA患者患肢支撑时间呈先上升后下降趋势,肢体摆动时间、患侧单步时间均呈下降趋势,步速、步频、步长、步幅均呈上升趋势,提示患者膝关节功能获得改善。
Abstract:
Objective:To analyze the characteristics of gait parameters in patients with knee osteoarthritis(KOA)after small segmental fibular osteotomy.Methods:Forty-six KOA patients who underwent small segmental fibular osteotomy were enrolled,including 18 males and 28 females,and the age ranged from 58 to 72 years,with a median of 65 years.The gait parameters of patients were collected by IDEEA3,a wearable intelligent device for gait analysis,before surgery and at 3 months,1 year,3 years,and 5 years after surgery,respectively,and the characteristics of gait parameters were analyzed.Results:Six patients dropped out as a result of loss to follow-up,and 40 patients were eventually included for characteristics analysis of gait parameters.①Support time of the affected leg.The support time of the affected leg increased first and then decreased at different time points(421.02±90.49,449.04±72.02,477.34±136.40,488.31±57.99,432.26±45.18 ms,F=9.672,P=0.000).At 3 months,1 year,and 3 years after surgery,the support time of the affected leg was longer than that before surgery(P=0.001,P=0.001,P=0.000).At 5 years after surgery,the support time of the affected leg was shorter than that at 1 year and 3 years after surgery(P=0.020,P=0.000),but compared with the support time before surgery and at 3 months after surgery,the difference was not statistically significant(P=0.394,P=0.098).At 1 year and 3 years after surgery,the support time of the affected leg was longer than that at 3 months after surgery(P=0.047,P=0.000).There was no significant difference in the support time of the affected leg at 3 years after surgery compared with that at 1 year after surgery(P=0.553).②Limb swing time and one-step time of the affected side.The limb swing time and the one-step time of the affected side showed a decreasing trend at different time points(461.78±72.53,432.24±53.78,430.97±46.98,402.71±28.27,411.01±42.78 ms,F=8.521,P=0.000; 700.44±162.84,615.03±94.18,588.90±71.76,551.88±49.91,566.18±38.20 ms,F=22.102,P=0.000).At 3 months,1 year,3 years,and 5 years after surgery,the limb swing time and the one-step time of the affected side were shorter than those before surgery(P=0.037,P=0.018,P=0.000,P=0.000; P=0.000,P=0.000,P=0.000,P=0.000).At 1 year,3 years,and 5 years after surgery,the one-step time of the affected side was shorter than that at 3 months after surgery(P=0.036,P=0.000,P=0.005).Compared with the limb swing time at 3 months after surgery,there was no significant difference in that at 1 year and 5 years after surgery(P=0.892,P=0.084).At 3 years after surgery,the limb swing time was shorter than that at 3 months after surgery(P=0.008).At 3 years after surgery,the limb swing time and the one-step time of the affected side were shorter than those at 1 year after surgery(P=0.004,P=0.005).Compared with the limb swing time and the one-step time of the affected side at 1 year and 3 years after surgery,there was no significant difference in that at 5 years after surgery(P=0.060,P=0.281; P=0.086,P=0.152).③Gait velocity,step frequency,step length,and stride length.Gait velocity,step frequency,step length,and stride length showed an upward trend at different time points(41.19±15.71,48.92±13.15,56.04±15.50,61.89±13.15,58.33±10.66 m/min,F=19.652,P=0.000; 90.10±16.17,99.83±12.17,104.09±11.20,110.44±8.89,107.59±7.24 steps/min,F=26.333,P=0.000; 0.45±0.11,0.49±0.10,0.53±0.10,0.57±0.09,0.56±0.08 m,F=14.302,P=0.000; 0.87±0.24,0.97±0.20,1.05±0.18,1.12±0.17,1.09±0.16 m,F=15.307,P=0.000).At 3 months,1 year,3 years,and 5 years after surgery,the gait velocity was greater than that before surgery(P=0.000,P=0.000,P=0.000,P=0.000).At 1 year,3 years,and 5 years after surgery,the gait velocity was greater than that at 3 months after surgery(P=0.003,P=0.000,P=0.000).At 3 years after surgery,the gait velocity was greater than that at 1 year after surgery(P=0.013).The gait velocity at 5 years after surgery was not significantly different from that at 1 year and 3 years after surgery(P=0.495,P=0.215).At 3 months,1 year,3 years,and 5 years after surgery,the step frequency was higher than that before surgery(P=0.000,P=0.000,P=0.000,P=0.000).At 1 year,3 years,and 5 years after surgery,the step frequency was higher than that at 3 months after surgery(P=0.017,P=0.000,P=0.002).At 3 years after surgery,the step frequency was higher than that at 1 year after surgery(P=0.003).There was no significant difference in step frequency at 5 years after surgery compared with that at 1 year and 3 years after surgery(P=0.130,P=0.137).At 3 months,1 year,3 years,and 5 years after surgery,the step length and stride length were greater than those before surgery(P=0.007,P=0.000,P=0.000,P=0.000; P=0.002,P=0.000,P=0.000,P=0.000).At 1 year,3 years,and 5 years after surgery,the step length and stride length were greater than those at 3 months after surgery(P=0.008,P=0.000,P=0.003; P=0.014,P=0.000,P=0.010).At 3 years after surgery,the step length and stride length were greater than those at 1 year after surgery(P=0.012; P=0.015).The step length and stride length at 5 years after surgery were not significantly different from those at 1 year and 3 years after surgery(P=0.293,P=0.492; P=0.326,P=0.352).Conclusion:Within 5 years after small segmental fibular osteotomy,the support time of the affected leg in KOA patients shows an upward-downward trend,the limb swing time and the one-step time of the affected side shows a decreasing trend,and the gait velocity,step frequency,step length,and stride length shows an increasing trend,suggesting that the knee function of the patients is improved.

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备注/Memo

备注/Memo:
基金项目:邢台市重点研发计划自筹项目(2020ZC235) 通讯作者:李存祥 E-mail:krab63@163.com
更新日期/Last Update: 1900-01-01