Page 88 - 2022-32-中国全科医学

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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

关节挛缩是临床上极其常见的疾病，通常并发于关 将产生相应的参数改变，从而影响足底压力参数 ［11］ 。
节创伤、关节炎及中枢神经系统损伤等疾病 ［1-2］ 。以膝 本研究通过分析创伤性伸直型膝关节挛缩患者动态足底
关节挛缩最为常见，多由膝关节创伤及其周围组织损伤 压力的分布规律，在与正常步态的健康成年人进行比较
所致 ［3-4］ 。膝关节创伤后的变化主要包括两个方面，一 的基础上，探讨创伤性伸直型膝关节挛缩对步行时足底
是膝关节本身及其周围组织的破坏，二是损伤后的固定 动态压力参数的影响，并简要阐述其变化机制，为临床
导致关节的挛缩 ［5］ 。对于膝关节创伤患者，这两种因 该类患者的康复评估与治疗提供借鉴。
素常同时存在，且创伤的程度、固定的方式和时间均是 1 资料与方法
挛缩程度的重要影响因素 ［6］ 。膝关节挛缩根据关节活 1.1 一般资料 选择 2020 年 12 月至 2021 年 12 月在
动受限的方向分为伸直型挛缩和屈曲型挛缩，因膝关节 安徽医科大学第二附属医院康复医学科接受治疗的创伤
创伤后固定于完全伸直位，常并发膝关节屈曲活动受限 性伸直型膝关节挛缩患者 35 例为研究组，选取同时期
导致伸直型挛缩。膝关节伸直型挛缩被定义为膝关节最 志愿参与本研究的步态正常的健康者30例作为对照组。
大屈曲角度小于正常活动范围 ［7-8］ 。膝关节一旦发生伸 本研究经过安徽医科大学第二附属医院医学研究伦理管
直型挛缩，将会严重影响患者的负重及步行能力。临床 理委员会审批（编号：YX2020-072）。
上，创伤性伸直型膝关节挛缩的功能评估主要依赖体格 研究组入选标准：（1）符合创伤性伸直型膝关节
检查和膝关节相关的评估量表，但这些评估常仅局限于 挛缩的诊断标准 ［12］ ；（2）初次损伤且均为单侧损伤；（3）
膝关节本身。足底压力分析作为步态分析的重要方法， 能够充分理解治疗师的要求并遵照执行，无认知障碍；
能简便、快捷、客观地量化步行过程中下肢生物力学负 （4）黄种人；（5）签署康复治疗知情同意书。排除标准：
荷的特征，为步行训练提供一定的指导 ［9-10］ 。有文献 （1）既往由于非创伤后关节制动因素造成的关节挛缩；
报道，随着膝关节运动学和力学指标的变化，踝关节也 （2）屈曲型膝关节挛缩；（3）合并其他影响步态疾病；