标题：平衡障碍康复机器人对全膝关节置换术后患者早期步态分析的研究

      作者：李波 1，2，李开南 1，2，贾子善 3，龙涛 2，王郑浩 2，冯昱宁 2，袁博 1，2    1.遵义医科大学，贵州 遵义 563000；2.成都大学附属医院骨科，四川 成都 610081；3.中国人民解放军总医院301医院康复医学科，北京 100853

      卷次： 2023年34卷11期

      【摘要】 目的 运用平衡障碍康复机器人对全膝关节置换(TKA)术后早期患者进行步态分析，从步态分析角度研究TKA术后步态变化特点，以评估手术疗效。方法 采用我国自主设计的平衡障碍康复机器人，对比分析2021年7月至2022年7月在中国人民解放军总医院治疗且符合纳入和排除标准的68例TKA术后康复1周时患者术侧和健侧的步态特征，包括步态运动学参数、动力学参数和时空参数。结果 患者术侧矢状面活动度、冠状面活动度和水平面活动度分别为(40.1±10.4)°、(13.2±6.5)°和(10.6±4.3)°，均小于健侧的(49.3±6.9)°、(19.6±4.5)°和(12.9±3.4)°，差异均有统计学意义(P<0.05)；患者术侧屈曲力矩、伸展力矩 、外翻力矩 和外旋力矩峰值均小于健侧，而术侧内翻力矩和内旋力矩大于健侧，差异均有统计学意义(P<0.05)；患者术侧单足支撑百分比为(31.3±8.4)%，明显小于健侧的(35.7±5.6)%，差异有统计学意义(P<0.05)，而步长、步速和步频在术侧和健侧之间比较差异均无统计学意义(P>0.05)。结论 TKA术后早期步态时空参数表明TKA对下肢步行能力改善有积极作用，但运动学活动度、动力学力矩和单足支撑百分比减弱表明患者平衡能力还未恢复，后续TKA患者康复阶段应重点针对平衡能力进行康复训练，以提高康复效果。
      【关键词】 全膝关节置换；平衡障碍；康复；机器人；生物力学；运动；步态分析
      【中图分类号】 R687.4 【文献标识码】 A 【文章编号】 1003—6350（2023）11—1537—06

Gait analysis of the patients after total knee arthroplasty by balance disorder rehabilitation robot in the earlypostoperative period.
LI Bo 1,2, LI Kai-nan 1,2, JIA Zi-shan 3, LONG Tao 2, WANG Zheng-hao 2, FENG Yu-ning 2, YUAN Bo 1,2.1. Zunyi Medical University, Zunyi 563000, Guizhou, CHINA; 2. Department of Orthopedics, Affiliated Hospital of ChengduUniversity, Chengdu 610081, Sichuan, CHINA; 3. Department of Rehabilitation Medicine, Chinese PLA General Hospital(301 Hospital), Beijing 100853, CHINA
【Abstract】 Objective To conduct gait analysis of the patients after total knee arthroplasty (TKA) by balancedisorder rehabilitation robot, and the gait changes after TKA were studied from the perspective of gait analysis to evalu-ate the surgical efficacy. Methods The gait characteristics of the operated side and the healthy side of 68 patients withKTA who met the inclusion and exclusion criteria at 1 week after recovery and were treated in the Chinese PLA GeneralHospital from July 2021 to July 2022 were compared and analyzed by the self-designed balance disorder rehabilitationrobot in China, including gait kinematic parameters, kinetic parameters, and spatiotemporal parameters. Results Thesagittal mobility, coronal mobility, and horizontal mobility in the operated side of the patients were (40.1±10.4)°, (13.2±6.5)°, and (10.6±4.3)°, which were significnatly smaller than (49.3±6.9)°, (19.6±4.5)°, and (12.9±3.4)° in the healthyside (P<0.05). The peak flexion moment, extension moment, valgus moment, and external rotation moment in the operat-ed side were significnatly smaller than those in the healthy side, while the inversion moment and internal rotation mo-ment in the operated side were significantly larger than those in the healthy side, with statistically significant differences(P<0.05). The percentage of unipedal support in the operated side was (31.3±8.4)%, which was significantly smaller than(35.7±5.6)% in the healthy side (P<0.05); however, There was no significant difference in step length, step speed, andstep frequency between the operated side and the healthy side (P>0.05). Conclusion The early gait time-space parame-ters after TKA indicate that TKA has a positive effect on the improvement of lower limb walking ability. However, thedecrease of kinematic mobility, dynamic torque and single foot support percentage indicates that the patient 's balanceability has not yet recovered. In the subsequent rehabilitation stage of TKA patients, rehabilitation training should be fo-cused on the balance ability to improve the rehabilitation effect.
      【Key words】 Total knee arthroplasty; Balance disorder; Rehabilitation; Robot; Biomechanics; Motion; Gait analysis