退化性膝關節炎病患接受全人工關節置換前後之步態分析

Gait Analysis of Knee Osteoarthritis before and after Total Knee Arthroplasty

蔡文基(Wen-Chi Tsai)

指導教授 ： 呂東武

共同指導教授 ： 劉華昌(Hwa-Chang Liu)

國立臺灣大學/工學院/醫學工程學研究所/博士(2009年)

https://doi.org/10.6342/NTU.2009.02715

摘要

研究設計 利用步態分析方法，Vicon-512 紅外線攝影系統、測力板、肌電圖所構成電腦系統，由三度空間立體而動態擷取健康成年人日常活動的膝關節運動學及動力學資料，分別檢查人體下肢在平路行走、上下樓梯、蹲下、跪下及坐下時的關節運動情形及肌肉作用狀態。
研究目的 建立年輕人及老年人的膝關節運動學及動力學的資料庫，以作為診斷膝關節障礙，協助治療計畫的擬定，以及改進手術方法的參考。
背景簡介 全人工膝關節置換有良好的受手術後結果，傳統的治療結果評估常以靜態影像檢查，不負重狀態下以量角器測量關節活動度，以及問卷等方法去判斷關節功能好壞。此外許多膝關節障礙的表現常是在動態及負重的條件下才能夠表現出來。所以臨床上需要建立動態關節量測的方法。東方人的成人膝關節活動度正常值並無詳細資料庫建立，可以提供診斷及治療結果的參考。所以本研究希望藉由以動作分析的方法量測及建立不同動作時正常成人的膝關節活動度正常值。
材料及方法 使用步態分析工具（Vicon-512）、測力板、肌電圖等設備。檢查正常成年人下肢關節(包括二十至三十歲之間年輕人及五十歲以上老人)，並且利用前述之檢查結果，比較退化性膝關節炎患者或全人工關節整型術的手術前後之差異。此外應用此步態分析的程序，比較其他手術例如下肢延長手術的病人在手術後，和正常人步態有何差異或延長的下肢功能有何改變。
統計方法此用Student-t test 及線性迴歸比較其差異，設定P值小於0.05定義為兩組達到顯著差異程度,
實驗結果 年輕人所量取的動態關節活動度，跪下時為145.9±5.9度，蹲下時為147.7±5.5度，平地行走的平均最大彎曲度為60.1±6.4度，上樓梯時的最大彎曲度為95.1±8.5度，下樓梯時的最大彎曲度為98.2±8.8度，而坐下時不負重下最大彎曲度的活動度為137.2±6.3度。老人及年輕人在不同動作時的最大彎曲度差異，其中平路行走與跪下時老人與年輕人達到顯著差異程度（p<0.05）。老人及退化性膝關節炎患者普遍表現肌力減退情形，但關節活動度卻不一定的年輕人更差。負重時股四頭肌是負責控制膝關節彎曲的作用肌群，而不負重時僅利用膕旁肌即可達成膝關節彎曲的目。
研究結論 靜態量測的關節僅是正常膝關節功能的一小部份而已，需要配合利用步態分析的動態量測方法才可完整呈現膝關節功能全貌。本實驗的價值在於建立了膝關節運動功能參考資料庫。此外膝關節術後功能建立一個客觀的量測方法，能夠有效地進行膝關節的客觀評估。
未來研究 利用本研究的方法，可以比較新的手術方法是否優於傳統方法，新設計的膝關節置入物是否優於傳統人工關節。也可以利用動作分析的方法提供客觀檢查方法以了解關節障礙是否存在或是人為的詐病。

關鍵字

全人工膝關節置換 ； 步態分析 ； 關節活動度 ； 動態功能

並列摘要

Introduction The total knee arthroplasty(TKA) is to resolve associated problems at the end stages osteoarthritis. High satisfactory rate has been reported in terms of pain relief and correction of deformity. However, the dynamic method for assessment of the clinical outcome, such as range of motion (ROM) of TKA has to be confirmed. The purpose of this study is to collect the kinetics and kinematics data of knee joint in health youths and senior, which is helpful for diagnosing the knee disorder, planning the treatment programs, outcome assessment of TKA and advancing the surgical methods.
Materials and Methods The study was done in randomly selected patients who received dynamic measurement of knee function. Twenty healthy youths, thirteen healthy senior and 10 osteoarthritic patients participated in the study. Basic knee functions were evaluated in various dynamic activities, including non-weight bearing status of knee flexion(sitting), level walking, kneeling and squatting, using computerized gait analysis techniques (Vicon 512 system). Non-weight bearing knee range of motion and static alignment were measured using traditional goniometer, physical and neural examination was recorded. Regression analysis and the Student’s t-test were used to analyze the difference between the two groups, and a p-value < 0.05 was considered significant.
Results By Vicon-512 system, the maximum knee flexion angles in youths at kneeling was 145.9±5.9 degrees, squatting 147.7±5.5 degrees, level walking 60.1±6.4 degrees, up stairs 95.1±8.5 degrees and down stairs 98.2±8.8 degrees, sitting without weight bearing in 137.2±6.3 degrees. Senior adult had significant poor than young in level walking and significant better in squatting.
Conclusion During weight bearing the quadriceps muscle dominated the knee flexion. However, in non-weight bearing status, hamstrings muscle was the main controller in knee flexion. By traditional static method in measuring knee function, which only presented a narrow scope of knee function, thus the knee function only unfold by the dynamic methods by gait analysis.

並列關鍵字

total knee arthroplasty ； gait analysis ； range of motion ； dynamic

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