Impact of subject-specific step width modification on the knee and hip adduction moments during gait
Impact of subject-specific step width modification on the knee and hip adduction moments during gait
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DOI：
10.1016/j.gaitpost.2021.07.008
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发表时间：
2021-07-21
期刊：
影响因子：
2.4
通讯作者：
Wilke, Jan
中科院分区：
文献类型：
--
作者：
Stief, Felix;Holder, Jana;Wilke, Jan
背景资料：髋关节骨关节炎（OA）患者在全髋关节置换术前和术后2年内行走时步宽（SW）增加。更广泛的SW与减少外膝内收力矩（KAM），但有一个缺乏关于SW对髋内收力矩（HAM）的影响的研究。研究问题：更广泛的SW是一个有效的补偿机制，以减少髋关节的负荷？我们假设，（1）增加SW减少，（2）减少SW增加KAM/HAM，（3）二次运动步态的变化有影响的KAM/HAM.Methods：20名健康人（24.0 +/- 2.5岁）进行仪器步态分析与4个不同的主题特定的SW修改（习惯，减半，双，三重SW）。使用统计参数映射（SPM）比较所得到的外部KAM和HAM。事后检验表明，两个双（p < 0.001，站立阶段的15- 31%和61- 98%）和三重SW（p < 0.001，与习惯SW相比，1- 36%和58- 98%）。HAM在第一和第二峰的降低程度相当与KAM的第二个峰（19- 28%降低）相比，KAM的第一个峰（9- 11%降低）较不明显。相比之下，与习惯性SW相比，将SW减半不会导致KAM或HAM的显著变化（p > 0.009）。意义：SW的增加是减少额面膝关节和髋关节力矩的有效且简单的步态机制。然而，假设2无法得到证实，因为将SW减半不会导致KAM或HAM发生显著变化。鉴于本研究的结果，关于增加SW的步态再训练可能是治疗髋关节OA患者的适当的非侵入性选择。
Background: Patients with hip osteoarthritis (OA) exhibit an increased step width (SW) during walking before and up to 2 years after total hip arthroplasty. Wider SW is associated with a reduction in the external knee adduction moment (KAM), but there is a lack of research regarding the effect of SW on the hip adduction moment (HAM).Research question: Is a wider SW an effective compensatory mechanism to reduce the hip joint loading? We hypothesized that (1) an increased SW reduces, (2) a decreased SW increases the KAM/HAM, and (3) secondary kinematic gait changes have an effect on the KAM/HAM.Methods: Twenty healthy individuals (24.0 +/- 2.5 years of age) underwent instrumented gait analyses with 4 different subject-specific SW modifications (habitual, halved, double, and triple SW). The resulting external KAMs and HAMs were compared using statistical parametric mapping (SPM).Results: Post hoc testing demonstrated significantly lower HAM for both the double (p < 0.001, 15-31 % and 61-98 % of the stance phase) and the triple SW (p < 0.001, 1-36 % and 58-98 %) compared to the habitual SW. The extent of the reduction at the first and second peak was comparable for HAM (15-25 % reduction) and less pronounced at the first peak of KAM (9-11 % reduction) compared to the second peak of KAM (19-28 % reduction). In contrast, halving the SW did not lead to a significant change in KAM or HAM compared to the habitual SW (p > 0.009).Significance: An increase in SW is an effective and simple gait mechanism to reduce the frontal plane knee and hip joint moments. However, hypothesis 2 could not be confirmed, as halving the SW did not cause a significant change in KAM or HAM. Given the results of the present study, gait retraining with regard to an increased SW may be an adequate, noninvasive option for the treatment of patients with hip OA.