Computational assessment of combinations of gait modifications for knee osteoarthritis rehabilitation.
Computational assessment of combinations of gait modifications for knee osteoarthritis rehabilitation.
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DOI：
10.1109/tbme.2008.921171
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发表时间：
2008-08
期刊：
影响因子：
--
通讯作者：
Fregly BJ
中科院分区：
文献类型：
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作者：
Fregly BJ
步态改良是减少内侧间隔性膝骨性关节炎患者膝关节外收扭矩的一种非侵入性策略。最近，一种新的“内侧推力”步态模式，其特征是在站立阶段膝关节内化，显著减少了两个内收力矩峰值。虽然脚部路径的改变(即脚趾外露角度和站立宽度)也会影响内收力矩峰值，但足部路径的变化可能会在多大程度上改变内侧推力步态的效果尚不清楚。这项研究使用了经过验证的特定于患者的计算模型来研究这一问题。对动态优化框架进行了修改，以预测这两个因素的同时作用，该框架可以准确地预测特定患者因膝关节内化或足部路径改变而导致的内收扭矩变化。然后对同一患者进行内侧推力步态优化，采用强制的足道改变，包括三个脚趾外倾角(标称±15°)和三个站立宽度(标称±50 mm)的所有可能组合。总体而言，预测的内收扭矩减少由内侧推力步态产生，对足部路径的改变相对不敏感。两个峰值在标称步道上达到的32%到34%的降幅最多增加了9%，而改变后的步道最多减少了3%。当与膝关节中性化相结合时，对于这个特殊的患者，足部路径改变可能只会对膝关节内收扭矩的减少产生次要的影响。
Gait modification is a non-invasive strategy for reducing the external knee adduction torque in patients with medial compartment knee osteoarthritis. Recently, a novel “medial thrust” gait pattern characterized by knee medialization during stance phase has been shown to reduce both adduction torque peaks significantly. While changes in foot path (i.e., toe out angle and stance width) also affect the adduction torque peaks, the extent to which foot path changes may alter the effectiveness of medial thrust gait is unknown. This study used a validated patient-specific computational model to investigate this issue. A dynamic optimization framework that accurately predicted adduction torque changes caused by knee medialization or foot path alteration for a specific patient was modified to predict the simultaneous effect of both factors. Medial thrust gait optimizations were then performed for the same patient using imposed foot path alterations consisting of all possible combinations of three toe out angles (nominal ± 15°) and three stance widths (nominal ± 50 mm). Overall, predicted adduction torque reductions produced by medial thrust gait were relatively insensitive to foot path alterations. The 32 to 34% reduction in both peaks achieved with the nominal foot path was augmented by at most 9% and reduced by at most 3% for the altered foot paths. When combined with knee medialization, foot path alterations would likely have only a secondary effect on knee adduction torque reductions for this particular patient.