Distribution Pattern of Dynamic Plantar Pressure in Patients with Traumatic Extension Knee Contracture

doi:10.12114/j.issn.1007-9572.2022.0546

Chinese General Practice ›› 2022, Vol. 25 ›› Issue (32): 4052-4058.DOI: 10.12114/j.issn.1007-9572.2022.0546

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Distribution Pattern of Dynamic Plantar Pressure in Patients with Traumatic Extension Knee Contracture

1. Department of Rehabilitation Medicine, Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
2. The Second Clinical College of Anhui Medical University, Hefei 230601, China
3. Department of Hygiene Toxicology, School of Public Health, Anhui Medical University, Hefei 230032, China

Received:2022-04-19 Revised:2022-08-12 Published:2022-11-15 Online:2022-08-18
Contact: ZHOU Yun
About author:
XIONG B, ZHOU Y, WANG H, et al. Distribution pattern of dynamic plantar pressure in patients with traumatic extension knee contracture [J]. Chinese General Practice, 2022, 25 (32) : 4052-4058.

创伤性伸直型膝关节挛缩患者动态足底压力分布规律研究

1．230601　安徽省合肥市，安徽医科大学第二附属医院康复医学科
2．230601　安徽省合肥市，安徽医科大学第二临床医学院
3．230032　安徽省合肥市，安徽医科大学公共卫生学院卫生毒理学教研室

通讯作者: 周云
作者简介:
熊斌，周云，王华，等.创伤性伸直型膝关节挛缩患者动态足底压力分布规律研究[J].中国全科医学，2022，25（32）：4052-4058. [www.chinagp.net] 作者贡献：熊斌提出研究思路，设计研究步骤，撰写论文；周云进行论文的修订；王华进行文章的质量控制；熊斌、张全兵、刘奕进行病例的入选筛查；熊斌、李凯进行数据的统计与分析；熊斌、郑浩然、王婧收集数据；王取南进行论文的审校；熊斌负责最终版本修订，对论文负责。
基金资助:
安徽省重点研究和开发计划项目（人口健康领域）(201904a07020067); 安徽医科大学2022年临床医学学科建设项目（临床与前期共建学科项目）(2022 lcxkEFY010); 安徽医科大学2021年临床医学学科建设项目(2021 lcxk031); 安徽省2020年高等学校省级质量工程项目(2020jyxm0903)

Abstract

Abstract:

Background

Traumatic extensor knee contracture is very common in clinic, and most patients have gait abnormalities. In clinical rehabilitation, the assessment of gait is mostly performed using scales and balance instruments. Dynamic plantar pressure test, as a scientific and objective assessment method, has been widely used in the assessment of lower limb diseases. The use of dynamic plantar pressure test in patients with traumatic extensor knee contracture is less common both nationally and internationally.

Objective

To investigate the distribution pattern of dynamic plantar pressure in patients with traumatic extensor knee contracture, and to provide data support for guiding rehabilitation assessment and gait training.

Methods

From December 2020 to December 2021, 35 patients with traumatic extensor knee contracture who were treated in the Department of Rehabilitation Medicine of the Second Affiliated Hospital of Anhui Medical University were selected as the study group, and 30 healthy individuals with normal gait who volunteered to participate in this study during the same period were selected as the control group. ByGait-G6060-5 gait analysis system measuring instrument was used to collect the plantar pressure parameters of the two groups of subjects. The step length, step width, step speed, foot angle, total touchdown time, the proportion of plantar pressure in each area〔hallux toe (T1 area), second to fifth toe (T2 area), first metatarsal (M1 area), second metatarsal (M2 area), third metatarsal (M3 area), fourth metatarsal (M4 area), fifth metatarsal (M5 area), middle plantar (MF area), medial heel (MH area), lateral heel (LH area) 〕, the total plantar pressure Ad value, the maximum deviation distance (COP-X deviation) of plantar pressure center in the lateral (left-right body direction) and the maximum deviation distance (COP-Y deviation) of plantar pressure center in the longitudinal (anterior-posterior body direction) of the two groups were compared and analyzed.

Results

The step length of the study group was shorter than that of the control group, the step width and total touchdown time were longer than those of the control group, the step speed was slower than that of the control group, and the foot angle was higher than that of the control group (P<0.05). The proportions of plantar pressure in T2, M4 and M5 areas in the study group were higher than those in the control group, and the proportions of plantar pressure in MH and LH areas were lower than those in the control group (P<0.05). The total pressure Ad value on the affected side was lower than that on the healthy side in the study group (P<0.01). The difference was not statistically significant when comparing the percentage of total pressure Ad values on the left side with the right side in the control group (P>0.05). The deviation values in both the COP-X direction and COP-Y direction were higher in the study group than in the control group (P<0.05) .

Conclusion

The patients with traumatic extensor knee contracture have short stride length, wide based gait, slow pace, large foot angle and long total touchdown time of both feet, less weight-bearing of the affected side of the lower extremity during walking, and predominantly weight-bearing of the forefoot and lateral edge of the foot, with a greater lateral and longitudinal displacement of center of pressure trajectories across both feet, large sloshing and poor stability during walking.

Key words: Knee contractures, Wounds and injuries, Dynamic plantar pressure, Gait, Weight-bearing, Case-control studies

摘要：

背景

创伤性伸直型膝关节挛缩在临床上十分常见，绝大部分患者存在步态异常。在临床康复中，对于步态的评估多采用量表及平衡仪进行。动态足底压力测试作为科学、客观的评估方法已广泛应用于下肢疾病的评估。但国内外对于动态足底压力测试在创伤性伸直型膝关节挛缩患者中的应用较少。

目的

探讨创伤性伸直型膝关节挛缩患者动态足底压力的分布规律，为指导康复评估和步态训练提供数据支持。

方法

选择2020年12月至2021年12月在安徽医科大学第二附属医院康复医学科接受治疗的创伤性伸直型膝关节挛缩患者35例为研究组，选取同时期志愿参与本研究的步态正常的健康者30例作为对照组。应用ByGait-G6060-5步态分析系统测量仪分别采集两组受试者足底压力参数，对比分析两组受试者步长、步宽、步速、足角、总触地时长、足底各分区〔踇趾（T1区），第二至第五脚趾（T2区），第一跖骨（M1区），第二跖骨（M2区），第三跖骨（M3区），第四跖骨（M4区），第五跖骨（M5区），足底中部（MF区），足后跟内侧（MH区），足后跟外侧（LH区）〕压力占比、足底压力Ad值、足底压力中心在横向（身体左右方向）的最大偏移距离（COP-X偏移）、足底压力中心在纵向（身体前后方向）的最大偏移距离（COP-Y偏移）。

结果

研究组步长短于对照组，步宽、总触地时长长于对照组，步速慢于对照组，足角高于对照组（P<0.05）。研究组T2区、M4区、M5区足底压力占比高于对照组，MH区、LH区足底压力占比低于对照组（P<0.05）。研究组患侧足底压力Ad值占比低于健侧（P<0.01）。对照组左侧与右侧足底压力Ad值占比比较，差异无统计学意义（P>0.05）。研究组在COP-X方向、COP-Y方向的偏移值均高于对照组（P<0.05）。

结论

创伤性伸直型膝关节挛缩患者步长短、步宽大、步速慢、足角大、双足总触地时长长，步行时患侧下肢负重较少，且主要以前足和足外侧缘负重，双足压力中心轨迹在横向和纵向的偏移均增大，步行时晃动大，稳定性差。

关键词: 膝关节挛缩, 创伤和损伤, 动态足底压力, 步态, 负重, 病例对照研究

XIONG Bin,ZHOU Yun,WANG Hua, et al. Distribution Pattern of Dynamic Plantar Pressure in Patients with Traumatic Extension Knee Contracture[J]. Chinese General Practice, 2022, 25(32): 4052-4058. DOI: 10.12114/j.issn.1007-9572.2022.0546.
熊斌,周云,王华等. 创伤性伸直型膝关节挛缩患者动态足底压力分布规律研究[J]. 中国全科医学, 2022, 25(32): 4052-4058. DOI: 10.12114/j.issn.1007-9572.2022.0546.

Figures/Tables 7

References 37

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组别	例数	性别（男/女）	年龄（岁）	身高（cm）	体质量（kg）
对照组	30	15/15	35.2±10.6	167.6±9.8	64.5±11.8
研究组	35	17/18	35.3±9.1	166.6±7.0	65.0±9.7
t（χ²）值		0.013^a	0.021	-0.549	0.210
P值		0.909	0.983	0.585	0.834

组别	例数	性别（男/女）	年龄（岁）	身高（cm）	体质量（kg）
对照组	30	15/15	35.2±10.6	167.6±9.8	64.5±11.8
研究组	35	17/18	35.3±9.1	166.6±7.0	65.0±9.7
t（χ²）值		0.013^a	0.021	-0.549	0.210
P值		0.909	0.983	0.585	0.834

组别	例数	步长（m）	步宽（m）	步速（m/s）	足角	触地时长（s）
对照组	30	0.83±0.17	0.14±0.04	0.81±0.20	14.37°±6.08°	1.09±0.26
研究组	35	0.59±0.23	0.17±0.04	0.62±0.29	20.10°±10.60°	1.31±0.41
t值		-4.840	2.340	-2.900	2.620	2.550
P值		<0.001	0.023	0.005	0.011	0.013

组别	例数	步长（m）	步宽（m）	步速（m/s）	足角	触地时长（s）
对照组	30	0.83±0.17	0.14±0.04	0.81±0.20	14.37°±6.08°	1.09±0.26
研究组	35	0.59±0.23	0.17±0.04	0.62±0.29	20.10°±10.60°	1.31±0.41
t值		-4.840	2.340	-2.900	2.620	2.550
P值		<0.001	0.023	0.005	0.011	0.013

组别	例数	T1区	T2区	M1区	M2区	M3区	M4区	M5区	MH区	LH区	MF区
对照组	30	5.30±1.99	5.96±1.87	11.58±2.36	9.18±1.78	8.63±2.10	6.39±1.00	3.34±0.86	21.13±2.86	18.40±2.30	10.07±2.85
研究组	35	5.69±2.27	7.27±2.19	10.69±2.86	8.80±2.02	8.93±1.70	7.81±2.00	4.31±1.45	18.55±4.14	16.31±3.78	11.61±4.81
t值		0.732	2.572	-1.348	-0.794	0.654	3.566	3.211	-2.874	-2.644	1.537
P值		0.467	0.012	0.183	0.430	0.515	0.001	0.002	0.006	0.010	0.129

Distribution Pattern of Dynamic Plantar Pressure in Patients with Traumatic Extension Knee Contracture

创伤性伸直型膝关节挛缩患者动态足底压力分布规律研究

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组别	例数	COP-X	COP-Y
对照组	30	6.60±2.22	9.97±3.85
研究组	35	8.37±2.41	12.97±3.82
t值		3.069	3.150
P值		0.003	0.002

[1]	YIN Miaomiao, CUI Liling, LI Yaqing, WANG Liqun, ZHANG Yue, WU Jialing. Effect of Dual Task on Walking Ability in Posterior Circulation Ischemic Stroke Patients with Vestibular Symptoms [J]. Chinese General Practice, 2023, 26(33): 4207-4212.
[2]	WEN Wen, ZHANG Kainan, CHEN Yulan, LI Yu, ZHANG Xiangyang. Correlation of Metabolic Indexes as Predictors with Obstructive Sleep Apnea [J]. Chinese General Practice, 2023, 26(30): 3740-3747.
[3]	YAO Junjie, SHANG Qiangqiang, WANG Yufeng, LI Jiahui, LIU Chang, PANG Tingting. Wearable Inertial Sensors-based Efficacy Evaluation of Comprehensive Traditional Chinese Medicine Therapy for Lumbar Disc Herniation Due to Qi-stagnation and Blood-stasis [J]. Chinese General Practice, 2023, 26(27): 3450-3455.
[4]	HE Manlan, YUAN Ping, HE Lei, CHEN Lu. Meta-analysis of Risk Factors for Urinary Tract Infection in Neurogenic Bladder [J]. Chinese General Practice, 2023, 26(21): 2659-2665.
[5]	ZHAI Leilei, ZHAO Shupeng, YAO Ping. Meta-analysis of the Relationship between Dietary Inflammatory Index and Upper Gastrointestinal Cancer Risks [J]. Chinese General Practice, 2023, 26(18): 2286-2292,2300.
[6]	ZHANG Yutong, WANG Qiuqin, XU Yuchen, WENG Heng, LIANG Yongqi, WANG Lulu, WANG Qing, XU Guihua. Factors Affecting Pain in Patients with Parkinson's Disease: a Systematic Review [J]. Chinese General Practice, 2023, 26(14): 1766-1774.
[7]	GE Xuhong, HU Jieyi, BAI Yunrui, WANG Lu, LENG Song. Association between Triglyceride-glucose Index and Its Derivatives Index and the Development of Type 2 Diabetes: a Nested Case-control Study [J]. Chinese General Practice, 2023, 26(12): 1456-1462.
[8]	GUO Yinning, MIAO Xueyi, JIANG Xiaoman, XU Ting, XU Qin. Associated Factors of Frailty in Cancer Patients: a Meta-analysis [J]. Chinese General Practice, 2023, 26(08): 989-996.
[9]	ZHANG Weizong, YUAN Hong, SUN Jindong, YU Huamin, SHI Mingjuan, HU Haiqiang, HE Haiying, YE Li, ZHANG Huihui, BAI Xinghua, SHEN Chaofeng, TU Sijia, WANG Yang, WANG Gang, ZHAO Xiaofeng, YU Tao, LI Cairong, ZHANG Zhi, ZHOU Donglai, CAI Mengyang, NING Le. Risk Factors of In-hospital Death in COVID-19 Patients: a Meta-analysis [J]. Chinese General Practice, 2023, 26(05): 607-620.
[10]	LIU Shuangxue, LI Yanhua, ZHANG Gangwei, ZHAO Lin. Risk Factors for Postmenopausal Hypertension: a Meta-analysis [J]. Chinese General Practice, 2023, 26(04): 512-518.
[11]	YU Zhumei, LIU Annuo, XIAO Juan, TANG Yuxia, YU Li, TONG Huanhuan. Risk Factors for Bronchopulmonary Dysplasia in Premature Infants: a Meta-analysis [J]. Chinese General Practice, 2023, 26(03): 356-366.
[12]	HUANGFU Xiaojuan, LI Xiaojuan, CHEN Min, LIU Jihong, ZHAI Rui, CAI Zhipeng, LI Litao. A Meta-analysis of the Impact of COVID-19 on Stroke Mortality [J]. Chinese General Practice, 2023, 26(03): 348-355.
[13]	CHU Xiaoting, YANG Xiaoming, WAN Qiuping, ZHANG Guohui, XIONG Jianjing, FANG Jialie. Trend Analysis of Life Expectancy and Disease Spectrum in Residents of Jing'an District in Shanghai, 2016-2021 [J]. Chinese General Practice, 2022, 25(36): 4561-4566.
[14]	TANG Chong, ZENG Shufei, LIANG Hanwen, WANG Jiajia, ZOU Hui, CAI Lidan, ZHANG Bin. Comparative Study of Cognitive Function in Inpatients with Generalized Anxiety Disorder and Healthy Controls [J]. Chinese General Practice, 2022, 25(35): 4399-4405.
[15]	YANG Cunmei, SHU Gangming, HU Yixin, MA Hongying, LI Jiadai, ZHANG Tianyi, MAO Xin, WU Bing, YAN Jin, LI Tianzhi. Prevalence and Influencing Factors of Motoric Cognitive Risk Syndrome in the Elderly with Subjective Cognitive Decline in the Community [J]. Chinese General Practice, 2022, 25(34): 4278-4285.