临床步态分析-膝关节.ppt

* Study methods The 3-D motion analysis using the Motion Analysis System (Motion Analysis Co., USA) Oxygen analysis using the gas analyzer (Cosmed K4b) * Experimental conditions On-site study Free walking with KAFO AFO Barefoot * Adaptation of AFO wearing All polio subjects asked to make an AFO adaptation wearing more than 30 min/day for 3 weeks * Parameters Time-spatial parameters Step length, stride length, step width, stance phase, swing phase, step width, foot angle Segmental parameters Joint angles of Foot, ankle, knee, hip, pelvis, trunk and shoulders Oxygen cost OC=VO2 (ml/kg/min)/walking distance (m) * Findings: Walking speed 0 20 40 60 80 100 KAFO AFO Barefoot Normal * # speed（m/min） * # # All conditions in polio is slower than the normal group (p<0.05) KAFO and barefoot are slower than AFO (p<0.05). Polio * Findings: Oxygen Cost 0 0.05 0.1 0.15 0.2 0.25 0.3 0.35 0.4 0.45 0.5 KAFO AFO Barefoot Normal Oxygen Cost （ml/m.kg） * # *# # All conditions in polio are higher than the normal group (p<0.05) KAFO and barefoot are higher than AFO (p<0.05). * Oxygen Cost 氧价 步态异常治疗的金标准 正常步态=自然步态 要素：省力、安全、有效 定量步行时的最低OC=最省力的步行=最安全的步行=最有效的步行 * Findings: Step length (cm) with the normal leg * Findings: Single leg support % * Findings: Hip extension at mid stance * Findings: Knee angle at mid stance * Quadriceps are not activated during mid stance in normal gait If the knee joint always behind of the central gravity, quadriceps may not play a role in maintaining knee stability at the stance phase. * 膝关节不稳的代偿机制 膝过伸 支撑相时间缩短 对侧拐杖 踝关节稳定（AFO） 膝关节固定（KAFO） 支撑相中期髋关节屈曲，重心前移 股四头肌/膕绳肌收缩 * * 支撑相早期-儿麻的困难时期 * 代偿性步态 全脚掌触地，减少支撑相早期的屈膝角度 缩短健侧步长，从而缩短患肢支撑相时间 患肢膝过伸，依赖腘韧带稳定膝关节 髋过伸或者屈曲（用拐），改变人体重心 * * * Compensation=Compromise The compromised approaches to adjust the central gravity during walking for this patient group are: AFO wearing Minor knee extension and hip flexion at the mid stance reduction of step length * AFO对膝关节稳定的价值 人体重心位于膝关节前 阻止胫骨前移 阻止胫骨后移 保证重心稳定 * Review the demo case * C