THE INFLUENCE OF TOTAL KNEE-REPLACEMENT DESIGN ON WALKING AND STAIR-CLIMBING
THE INFLUENCE OF TOTAL KNEE-REPLACEMENT DESIGN ON WALKING AND STAIR-CLIMBING
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DOI：
10.2106/00004623-198264090-00008
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发表时间：
1982-01-01
影响因子：
5.3
通讯作者：
FERMIER, RW
中科院分区：
文献类型：
--
作者：
ANDRIACCHI, TP;GALANTE, JO;FERMIER, RW
对26例全膝关节置换术后无症状患者在水平行走和爬楼梯过程中步态与假体设计的关系进行了研究。年龄匹配的14名对照组受试者也进行了研究。全膝关节置换术采用Geomedic、Gunston、全髁、双膝、Cloutier等5种设计。在假肢设计的基础上，步态的差异可以被识别。越有压力的爬楼梯试验在不同设计之间产生了更明显的区分功能。接受限制最少的十字交叉保留假体(Cloutier)设计的患者是唯一一组在上下楼梯时运动范围正常的患者。两组患者在下楼时膝关节屈曲范围低于正常范围，采用半紧张型(全髁型和几何型)设计。其他假体设计的患者在爬楼梯时膝关节活动范围正常。这5种设计之间的运动学和解剖学差异对水平行走时的功能影响不如在爬楼梯时那么大。显然，全膝关节置换术后，即使临床效果良好的无症状患者也会出现步态异常。异常的特征是大多数患者都有共同的特点，包括步长低于正常，中立位膝关节屈曲减少，膝关节外屈伸力矩异常。尽管目前还不能完全解释这些步态异常，但它们似乎与膝关节运动学和周围软组织的相互作用有关。限制较少的十字交叉保留全膝关节置换术的患者在爬楼梯时的步态明显比限制较多的十字交叉牺牲设计的患者更正常。在水平行走中，尽管临床效果良好，但5种不同设计的患者均出现步态异常。
The relationship between gait and prosthetic design was studied during level walking and stair-climbing for 26 asymptomatic patients after total knee replacement. An age-matched group of 14 control subjects was also studied. Five designs of total knee replacement, Geomedic, Gunston, total condylar, duopatellar and Cloutier, were used. Differences in gait could be identified on the basis of prosthetic design. The more stressful stair-climbing test produced more clearly differentiated function among the different designs. Patients who were treated with the least-constrained cruciate-retaining (Cloutier) design of prosthesis were the only group that had a normal range of motion during climbing up and down stairs. Two groups of patients with semiconstrained (total condylar and Geomedic) designs had a lower than normal range of knee flexion while descending stairs. Patients with the other designs of prosthesis had a normal range of knee motion on stair-climbing. Kinematic and anatomical differences among the 5 designs did not have as great an influence on function during level walking as they did during stair-climbing. Apparently, after total knee replacement even asymptomatic patients with excellent clinical results have an abnormality of gait. The features of the abnormality were common to most of the patients in the series, and consisted of a shorter than normal stride length, reduced mid-stance knee flexion, and abnormal patterns of external flexion-extension moment of the knee. Although an explanation of these abnormalities of gait is not completely possible at this time, they appear to be related to the interaction of the kinematics of the knee and surrounding soft tissues. Patients with less constrained cruciate-retaining designs of total knee replacement apparently have a more normal gait during stairclimbing than patients with more constrained cruciate-sacrificing designs. During level walking, patients with 5 quite different designs all had abnormalities of gait in spite of a successful clinical result.