为明确前交叉韧带（anterior crucitate ligament，ACL）断裂后患者的跑步步态以及合并内侧半月板后角撕裂对其进一步的影响，基于三维运动捕捉分析方法，定量化分析了前交叉韧带断裂患者（8名单纯ACL断裂患者，8名ACL断裂合并内侧半月板后角撕裂患者，22名健康志愿者）的跑步步态改变。研究表明，慢跑时ACL断裂的膝关节主要表现为外源性屈曲力矩显著降低，这不仅与ACL断裂侧伸肌力量减弱有关，且与神经肌肉控制模式改变有关。ACL断裂合并内侧半月板撕裂患者膝关节在慢跑时表现出显著的外旋不稳，分析与内侧半月板后角撕裂降低了对旋转稳定性的控制功能有关。研究提示，ACL断裂患者的康复训练方案应关注并参考其跑步步态的异常，加强屈伸肌及旋转稳定肌群的训练，结合神经肌肉训练，改善其跑步步态异常，降低继发损伤风险。
任爽
,
印钰
,
张思
,
梁子轩
,
于媛媛
,
时会娟
,
苗欣
,
李玳
,
胡晓青
,
黄红拾
,
敖英芳
. 膝关节前交叉韧带断裂者跑步时的步态分析特征及指导意义[J]. 科技导报, 2021
, 39(22)
: 43
-48
.
DOI: 10.3981/j.issn.1000-7857.2021.22.005
This paper identifies the changes of the running gait after the ACL rupture and the further effects of the concomitant medial meniscus tear on the running gait changes after the ACL rupture. Based on the 3D motion capture analysis method, quantitative analyses are made for the changes of the running gait in the ACL-deficient patients (22 healthy controls, 8 isolated ACL-deficient patients, 8 ACL-deficient concomitant with medial meniscus tear patients). The results show that for the ACL-deficient knee joint, a significant decrease of the exogenous flexion moment is observed during jogging, which is not only related to the weakening of the extensor muscle strength of the ACL-deficient side, but also related to the change of the neuromuscular control mode. For the patients with ACL rupture combined with the medial meniscus tear, a significant external rotation instability of the knee is observed during jogging, which may be related to the reduced control of rotation stability caused by the medial meniscus posterior horn tear. It is suggested that in the rehabilitation training program for the ACL rupture patients, one should pay attention to their abnormal running gait and intensify the training of flexor and extensor muscles and rotational muscle group and the neuromuscular training to improve their abnormal running gait and reduce the risk of the secondary injury after the ACL rupture.
[1] 徐雁, 敖英芳. 前十字韧带断裂继发半月板损害的临床研究[J]. 中华骨科杂志, 2002, 22(4):216-219.
[2] Louboutin H, Debarge R, Richou J, et al. Osteoarthritis in patients with anterior cruciate ligament rupture:A review of risk factors[J]. Knee, 2009, 16(4):239-244.
[3] Wellsandt E, Gardinier E S, Manal K, et al. Decreased knee joint loading associated with early knee osteoarthritis after anterior cruciate ligament injury[J]. The American Journal of Sports Medicine, 2016, 44(1):143-151.
[4] Shabani B, Bytyqi D, Lustig S, et al. Gait changes of the ACL-deficient knee 3D kinematic assessment[J]. Knee Surgery Sports Traumatology Arthroscopy, 2015, 23(11):3259-3265.
[5] 时会娟, 丁立, 任爽, 等. 前交叉韧带重建术后步行过程中的生物力学特征[J]. 科技导报, 2020, 38(6):25-33.
[6] Shi H J, Ren S, Miao X, et al. The effect of cognitive loading on the lower extremity movement coordination variability in patients with anterior cruciate ligament reconstruction[J]. Gait & Posture, 2021, 84:141-147.
[7] Ren S, Yu Y, Shi H J, et al. Three dimensional knee kinematics and kinetics in ACL-deficient patients with and without medial meniscus posterior horn tear during level walking[J]. Gait & Posture, 2018, 66:26-31.
[8] Harato K, Niki Y, Kudo Y, et al. Effect of unstable meniscal injury on three-dimensional knee kinematics during gait in anterior cruciate ligament-deficient patients[J]. Knee, 2015, 22(5):395-399.
[9] Zhang Y, Huang W, Yao Z, et al. Anterior cruciate ligament injuries alter the kinematics of knees with or without meniscal deficiency[J]. American Journal of Sports Medicine, 2016, 44(12):3132-3139.
[10] Ren S, Shi H J, Yu Y, et al. Dynamic between-leg differences while walking in anterior cruciate ligament-deficient patients with and without medial meniscal posterior horn tears[J]. Orthopaedic Journal of Sports Medicine, 2020, 8(5):2325967120919058.
[11] Hart H F, Culvenor A G, Collins N J, et al. Knee kinematics and joint moments during gait following anterior cruciate ligament reconstruction:A systematic review and meta-analysis[J]. British Journal of Sports Medicine, 2016, 50(10):597-612.
[12] Sigward S M, Lin P G, Pratt K. Knee loading asymmetries during gait and running in early rehabilitation following anterior cruciate ligament reconstruction:A longitudinal study[J]. Clinical Biomechanics, 2016, 32:249-254.
[13] Kuenze C, Hertel J, Weltman A, et al. Jogging biomechanics after exercise in individuals with ACL-reconstructed knees[J]. Medicine and Science in Sports and Exercise, 2014, 46(6):1067-1076.
[14] 黄宗成. 百米技术——缓冲与后蹬[J]. 体育科学, 1984, 4(2):59-63.
[15] Pairot-de-Fontenay B, Willy R W, Elias A R C, et al. Running biomechanics in individuals with anterior cruciate ligament reconstruction:A systematic review[J]. Sports Medicine, 2019, 49(9):1411-1424.
[16] Montgomery W H, Pink M, Perry J. Electromyographic analysis of hip and knee musculature during running[J]. The American Journal of Sports Medicine, 1994, 22(2):272-278.
[17] Chmielewski T L, Rudolph K S, Fitzgerald G K, et al. Biomechanical evidence supporting a differential response to acute ACL injury[J]. Clinical Biomechanics, 2001, 16(7):586-591.
[18] Rudolph K S, Axe M J, Buchanan T S, et al. Dynamic stability in the anterior cruciate ligament deficient knee[J]. Knee Surg Sports Traumatol Arthrosc, 2001, 9(2):62-71.
[19] Miao X, Huang H, Hu X, et al. The characteristics of EEG power spectra changes after ACL rupture[J]. PloS One, 2017, 12(2):e0170455.
[20] Perraton L G, Hall M, Clark R A, et al. Poor knee function after ACL reconstruction is associated with attenuated landing force and knee flexion moment during running[J]. Knee Surgery Sports Traumatology Arthroscopy, 2018, 26(2):391-398.
[21] Bohn M B, Petersen A K, Nielsen D B, et al. Three-dimensional kinematic and kinetic analysis of knee rotational stability in ACL-deficient patients during walking, running and pivoting[J]. Journal of Experimental Orthopaedics, 2016, 3(1):27.
