踝关节骨折术后持续功能缺陷：长期步态和功能分析

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics Pub Date : 2025-05-25 DOI:10.1016/j.jor.2025.05.045

Firat Tan , Sibel Bozgeyik Bagdatli , Gizem Irem Kinikli , Semra Topuz , Hande Guney Deniz

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引用次数: 0

摘要

踝关节骨折是最常见的下肢骨折之一，尤其是在50岁以上的人群中。尽管手术干预，长期的功能损害，如关节僵硬和步态异常，可能会持续存在。本研究旨在评估踝关节骨折手术后的长期步态和功能结果。目的探讨手术治疗踝关节骨折患者的时空步态参数、脚跟上升性能和踝关节背屈活动能力。研究设计：横断面观察性研究。方法术后平均随访4.5年，对14例患者（平均年龄53.7岁）进行评估。使用GAITRite®系统评估时空步态参数。通过足跟上升测试和负重弓步测试（WBLT）以及经过验证的临床量表（包括美国矫形足踝学会踝关节-后足量表（AOFAS）和Olerud-Molander踝关节评分（OMAS））来检查功能表现。功能试验的内部信度采用类内相关系数（ICCs）确定。结果手术侧步长明显增加（p = 0.016），双支时间明显减少（p = 0.043）。跟高测试（p = 0.020）和WBLT （p = 0.006）显示手术侧与非手术侧相比存在显著缺陷。尽管AOFAS（86.5）和OMAS（80）得分很高，但功能限制仍然存在。信度分析显示，跟高测试（ICC = 0.98）和WBLT （ICC = 0.99）具有良好的内部一致性，SEM和MDC值较低。结论：长期的功能缺陷，特别是踝关节背屈和跖屈力量，持续存在，尽管看似良好的临床评分。这些发现强调需要有针对性的康复策略来改善踝关节骨折手术后的软组织活动和肌肉功能。证据等级：III级。

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Persistent functional deficits after ankle fracture surgery: A long-term gait and functional analysis

Introduction

Ankle fractures are among the most common lower limb fractures, particularly in individuals over 50 years of age. Despite surgical interventions, long-term functional impairments, such as joint stiffness and gait abnormalities, may persist. This study aimed to evaluate long-term gait and functional outcomes following ankle fracture surgery.

Objective

To investigate spatiotemporal gait parameters, heel-rise performance, and ankle dorsiflexion mobility in individuals who underwent surgical treatment for ankle fractures.

Study design

A cross-sectional observational study.

Methods

Fourteen participants (mean age 53.7 years) were evaluated at a mean follow-up of 4.5 years post-surgery. Spatiotemporal gait parameters were assessed using the GAITRite® system. Functional performance was examined with the Heel Rise Test and Weight-Bearing Lunge Test (WBLT), along with validated clinical scales, including the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS) and the Olerud-Molander Ankle Score (OMAS). Intrarater reliability of the functional tests was determined using intraclass correlation coefficients (ICCs).

Results

Step length was significantly greater on the surgical side (p = 0.016), while double support time was reduced (p = 0.043). The Heel Rise Test (p = 0.020) and WBLT (p = 0.006) demonstrated significant deficits on the surgical side compared to the non-surgical side. Despite high AOFAS (86.5) and OMAS (80) scores, functional limitations persisted. Reliability analysis showed excellent intrarater consistency for the Heel Rise Test (ICC = 0.98) and WBLT (ICC = 0.99), with low SEM and MDC values.

Conclusions

Long-term functional deficits, particularly in ankle dorsiflexion and plantarflexion strength, persist despite seemingly favorable clinical scores. These findings underscore the need for targeted rehabilitation strategies to improve soft tissue mobility and muscle function after ankle fracture surgery.

Level of evidence

Level III.

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来源期刊

Journal of orthopaedics ORTHOPEDICS-

CiteScore

3.50

自引率

6.70%

发文量

202

审稿时长

56 days

期刊介绍： Journal of Orthopaedics aims to be a leading journal in orthopaedics and contribute towards the improvement of quality of orthopedic health care. The journal publishes original research work and review articles related to different aspects of orthopaedics including Arthroplasty, Arthroscopy, Sports Medicine, Trauma, Spine and Spinal deformities, Pediatric orthopaedics, limb reconstruction procedures, hand surgery, and orthopaedic oncology. It also publishes articles on continuing education, health-related information, case reports and letters to the editor. It is requested to note that the journal has an international readership and all submissions should be aimed at specifying something about the setting in which the work was conducted. Authors must also provide any specific reasons for the research and also provide an elaborate description of the results.