前交叉韧带重建术后不同阶段的步态特征比较

摘要(中文译文)

目的：描述前交叉韧带（ACL）重建术后不同阶段的步态特征，为康复评估提供依据。方法：本横断面研究纳入100例接受单侧ACL重建术并使用自体腘绳肌腱移植的患者，按术后阶段分为五组（每组n=20）：A组（1.5~3个月）、B组（3~6个月）、C组（6~9个月）、D组（9~12个月）和E组（≥12个月）。另选取20名年龄和性别匹配的健康志愿者作为对照组（F组）。采用Zebris FDM-T系统测量时空参数、步态周期各时相、压力中心轨迹及足底压力分布。根据数据分布情况，采用相应的参数检验和非参数检验进行肢体间及组间统计学比较。结果：（1）在患侧，A组的步长、跨步长和步速显著低于其他各组，而E组与对照组相比无显著差异。A组的步宽显著大于C~F组。（2）A~C组存在显著的肢体间不对称，而D~E组未观察到。A组负重反应期和双支撑期延长，而站立中期缩短。E组与对照组相比无显著差异。（3）在患侧，A~E组的步态线长度和单支撑线长度均显著短于健侧。与C~F组相比，A组的参数值显著更短，内外侧位移更大。E组的压力中心轨迹参数与对照组相比差异明显减小。（4）在患侧，A~E组的后足压力均显著低于健侧。A组所有区域足底压力测量值均显著低于C~F组。相反，E组的足底压力分布与对照组相当。结论：ACL重建术后步态特征在1.5~3个月时最为显著，至12个月时基本恢复正常，但压力中心轨迹和后足压力不对称仍然存在，可为术后恢复的临床评估提供参考。试验注册：中国临床试验注册中心ChiCTR2400087325。注册日期：2024年7月25日。

Abstract

OBJECTIVE: To characterize gait characteristics at different phases after anterior cruciate ligament (ACL) reconstruction and inform rehabilitation assessment. METHODS: This cross-sectional study enrolled 100 patients following unilateral ACL reconstruction with autologous hamstring tendon grafts, stratified into five postoperative phases (n = 20 each): Group A (1.5–3 months), Group B (3–6 months), Group C (6–9 months), Group D (9–12 months), and Group E (≥ 12 months). Twenty age- and sex-matched healthy volunteers constituted the control group (Group F). Spatiotemporal parameters, gait cycle phases, center of pressure trajectory, and plantar pressure distribution were measured using the Zebris FDM-T system. Interlimb and intergroup statistical comparisons were conducted using appropriate parametric and non-parametric tests as indicated by data distribution. RESULTS: (1) On the involved side, Group A demonstrated significantly reduced step length, stride length, and gait velocity compared to all other groups, whereas Group E showed no significant differences relative to controls. Step width in Group A was significantly greater than in Groups C–F. (2) Significant interlimb asymmetry was observed in Groups A–C but not in Groups D–E. In Group A, loading response and double support phases were prolonged, whereas the mid-stance phase was shortened. Group E demonstrated no significant differences compared to controls. (3) On the involved side, gait line length and single support line length were significantly shorter compared to the uninvolved side across Groups A–E. Group A exhibited significantly shorter parameter values and greater mediolateral displacement compared to Groups C–F. COP trajectory parameters in Group E showed substantially attenuated differences relative to controls. (4) Rearfoot pressure on the involved side was significantly lower than on the uninvolved side across Groups A–E. All regional plantar pressure measurements in Group A were significantly reduced compared to Groups C–F. Conversely, Group E exhibited plantar pressure profiles equivalent to controls. CONCLUSION: Gait characteristics after ACL reconstruction peak at 1.5–3 months and largely normalize by 12 months, though COP trajectory and rearfoot pressure asymmetry persist, informing clinical assessment of postoperative recovery. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2400087325. Registered on 25/07/2024.

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