Joint torques and powers are reduced during ambulation for both limbs in patients with unilateral claudication
Joint torques and powers are reduced during ambulation for both limbs in patients with unilateral claudication
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DOI：
10.1016/j.jvs.2009.07.117
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发表时间：
2010-01-01
影响因子：
4.3
通讯作者：
Johanning, Jason M.
中科院分区：
文献类型：
--
作者：
Koutakis, Panagiotis;Pipinos, Iraklis I.;Johanning, Jason M.
目的：有症状的外周动脉疾病（PAD）会导致严重的步态障碍。为了全面描述和量化这些步态改变，我们分析了单侧跛行的 PAD 患者受影响和未受影响的腿的关节运动学、扭矩（旋转力）和功率（旋转力乘以角速度）。方法：12 名单侧 PAD 患者（年龄，61.69 +/- 10.53 岁，踝肱指数 [ABI]：受影响肢体0.59 +/- 0.25；未受影响的肢体 0.93 +/- 0.12) 10 名健康对照者（年龄，67.23 +/- 12.67 岁，ABI > 1.0 所有受试者）走过力平台以获取步态动力学，同时记录关节运动学。在无痛（PAD-PF）和疼痛诱导（PAD-P）试验期间收集受影响和未受影响肢体的数据。结合动力学和运动学来量化站立期间髋关节、膝关节和踝关节的扭矩和功率。结果：在 PAD-PF 和 PAD-P 试验中，与对照组相比，受影响的肢体在站立后期的踝关节跖屈扭矩显着降低 (P < .05)。在 PAD-PF 和 PAD-P 试验中，与对照组相比，受影响肢体 (P < .05) 和非受影响肢体 (P < .05) 在站立后期的踝关节跖屈发电量显着减少。与 PAD-PF 和 PAD-P 条件下的未受影响肢体相比，在整个站立阶段控制膝关节和髋关节的扭矩没有显着差异。与对照组相比，PAD 患者双肢早期站立时的膝关节功率吸收和中期站立时膝关节发电量均显着降低 (P < .05)。结论：单侧跛行的 PAD 患者双肢均表现出明显的步态障碍，甚至在出现任何跛行症状之前就已存在。总体而言，我们的数据表明，受影响肢体在站立后期的踝关节跖屈扭矩和功率显着降低，而在站立早期和中期的膝关节功率也显着降低。需要进一步的研究来确定这些结果是否取决于下肢缺血的位置和严重程度，以及未受影响肢体的变化是否是潜在 PAD 的结果，还是受影响肢体功能障碍的代偿性变化的结果。 （花瓶外科杂志 2010 年；51:80-8。）
Objectives: Symptomatic peripheral arterial disease (PAD) results in significant gait impairment. In an attempt to fully delineate and quantify, these gait alterations, we analyzed joint kinematics, torques (rotational forces), and powers (rotational forces times angular velocity) in patients with PAD with unilateral claudication for both the affected and nonaffected legs.Methods: Twelve patients with unilateral PAD (age, 61.69 +/- 10.53 years, ankle-brachial index [ABI]: affected limb 0.59 +/- 0.25; nonaffected limb 0.93 +/- 0.12) mid 10 healthy controls (age, 67.23 +/- 12.67 years, ABI >1.0 all subjects) walked over a force platform to acquire gait kinetics, while joint kinematics were recorded simultaneously. Data were collected for the affected and nonaffected limbs during pain free (PAD-PF) and pain induced (PAD-P) trials. Kinetics and kinematics were combined to quantify torque and powers during the stance period from the hip, knee, and ankle joints.Results: The affected limb demonstrated significantly (P < .05) reduced ankle plantar flexion torque compared to controls during late stance in both PAD-PF and PAD-P trials. There were significant reductions in ankle plantar flexion power generation during late stance for both the affected (P < .05) and nonaffected limbs (P < .05) compared to control during PAD-PF and PAD-P trials. No significant differences were noted in torque comparing the nonaffected limbs in PAD-PF and PAD-P conditions to control for knee and hip joints throughout the stance phase. Significant reductions were found in knee power absorption in early stance and knee power generation during mid stance for both limbs of the patients with PAD as compared to control (P < .05).Conclusion: Patients with PAD with unilateral claudication demonstrate significant gait impairments in both limbs that are present even before they experience any claudication symptoms. Overall, our data demonstrate significantly reduced ankle plantar flexion torque and power during late stance with reduced knee power during early and mid stance for the affected limb. Further studies are needed to determine if these findings are dependent on the location and the severity of lower extremity ischemia and whether the changes in the nonaffected limb are the result of underlying PAD or compensatory changes from the affected limb dysfunction. (J Vase Surg 2010;51:80-8.)