Dynamic Reaction Force of Feet after Unilateral Total Knee Arthroplasty

基本上，臨床上的研究，所得到的新的觀念或技術，在被廣泛地應用前，通常都要先複查很長的一段時間。一項前瞻性研究，以測量足部動態式反應力道，來監控人工全膝關節置換術後病患；被稍加過度調整軸線，比較臨床進展及步態功能。如此，一項比較優秀的複查技術可能被闡明。一項改進自電腦化動態圖譜，名為動態式足壓量測單位的裝備，被用於評估單側人工全膝關節置換術後病患的臨床結果。38處膝關節被調整稍為外翻，而定期複查至少一年。在術前、出院前，一個月、三個月、一年時，以此裝備去評估步態分析。結果顯示：在一年時，手術側的單足步伐的承受力道比率以及單足步伐的衝量比率，比術前有意義的進展。此進展，與對側正常膝關節足部對照時，已到達正常層次。此外，依據膝關節組織的功能評比，比術前也有顯著改進（86分對52分）。使用助行器時，最適當的高度，應訂在上肢自然下垂時，扶手與手腕皮膚皺紋齊高處。據此結論：測量足部動態式反應力道，可能被用來監控臨床上治療的結果。因而，比當前更好的觀念或技術，便可能被早日應用於正常醫療上。
Objective: The follow-up period before implementing a new concept or technique introduced in a clinical study generally takes a long period. The present study is an attempt to shorten the follow-up period. A prospective study with measuring dynamic reaction force of feet to monitor the relationship between the clinical outcome and gait function in TKA patients following slightly valgus overcorrection was conducted. Theoretically, slightly valgus overcorrection for patients who underwent TKA might achieve more benefits. Methods: A device of the Dynamic Foot Pressure Assessment Unit (DFPAU), which was revised from the Computer Dyno Graphy (CDG), was used to investigate the clinical outcome in patients with unilateral total knee arthroplasty. Thirty-eight knees were overcorrected with slight valgus position (3° on the mechanical axis) and regularly followed for at least 1 year. Evaluation of gait analysis with the described device was performed preoperatively, before discharge, 1 month, 3 months, and 1 year postoperatively. Results: At 1 year, the ratio of force for single leg stance (RFL) and the ratio of impulse for single leg stance (RIL) had significant improvement as compared with the preoperative status. The improvements even reached normal levels as compared with the contralateral knee. In addition, the Knee Society (KS) functional scores also showed significant improvement as compared with the preoperative status (86 versus 52 points). The optimal height of the handgrip of a walker was found to be at the level of the wrist crease when the upper extremity hung down. Conclusions: Assessment of dynamic reaction force of feet might be used to monitor the outcomes of clinical treatment.