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首页> 外文期刊>Clinical biomechanics >Stability and variability of knee kinematics during gait in knee osteoarthritis before and after replacement surgery.
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Stability and variability of knee kinematics during gait in knee osteoarthritis before and after replacement surgery.

机译：置换手术前后膝盖骨关节炎的步态中膝盖运动学的稳定性和变异性。

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BACKGROUND: Patients with knee osteoarthritis often feel unstable, suffering from buckling (giving way) or even falling. This study aimed at characterising such instability, and following it over time. METHODS: We investigated treadmill walking in knee osteoarthritis, focusing on angular velocity of sagittal plane knee movements. Knee osteoarthritis patients were followed 1 year after replacement surgery, and were compared to healthy peers. Subjects walked at increasing speeds, and maximum speed was registered. To quantify stability, we calculated short-term (lambda(S)) and long-term (lambda(L)) Lyapunov exponents (the exponential rate of divergence, in state space, of trajectories originating from nearest neighbours), as well as the variability of knee movements, the latter just after heel contact. At each measurement session, patients reported how often they had fallen in the preceding period. FINDINGS: Patients had lower maximum walking speed than controls, and walked with reduced variability, post-operatively even more so. Variability was positively related to number of falls. Pre-operatively, patients had higher lambda(S) at the unaffected side, which post-operatively normalized. INTERPRETATION: Slow walking may serve being more cautions. Reducing variability of sagittal knee kinematics appears to reduce fall risk, perhaps involving paying more attention and/or using cocontraction. The pre-operatively higher unaffected side lambda(S) could result from attempts to reduce the kinematic demands on the affected leg, "letting go" the unaffected leg. One year after the operation, this problem with unaffected lambda(S) had disappeared, suggesting recovery. Further study should include short-term and long-term stability, as well as a quantitative measure of perceived instability.
机译：背景：膝关节骨关节炎患者通常会感到不稳定，屈曲（屈服）甚至跌倒。这项研究旨在表征这种不稳定性，并随着时间的推移对其进行追踪。方法：我们研究了在膝骨关节炎中的跑步机行走方式，重点是矢状面膝关节运动的角速度。膝关节置换术后1年随访膝关节骨关节炎患者，并与健康的同龄人进行比较。受试者以增加的速度行走，并记录了最大速度。为了量化稳定性，我们计算了短期（lambda（S））和长期（lambda（L））Lyapunov指数（在状态空间中，源自最近邻域的轨迹的指数发散率）以及膝盖运动的变异性，后者刚好在脚跟接触后发生。在每次测量期间，患者报告他们在前一个时期跌倒的频率。结果：患者的最大行走速度低于对照组，并且行走时变异性降低，术后更为明显。变异性与跌倒次数呈正相关。术前，患者未受影响侧的λ更高，术后恢复正常。解释：慢速行走可能会更谨慎。减少矢状膝运动学的变异性似乎可以降低跌倒的风险，可能涉及更多的注意力和/或使用共收缩。术前较高的未受影响侧lambda（S）可能是由于尝试减少对患肢的运动要求而导致的，即“放开”未患肢。手术一年后，未受影响的lambda（S）问题消失了，表明已康复。进一步的研究应包括短期和长期稳定性，以及对不稳定性的定量度量。

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