不同背屈角度踝足矫形器对脊髓损伤膝过伸的影响

关键词：脊髓损伤  不同角度踝足矫形器  膝过伸

Keywords:spinal cord injury  ankle-foot orthoses (AFOs)  knee hyperextension

摘要：

      摘要 目的：观察踝足矫形器（ankle-foot orthosis， AFO）对不完全性脊髓损伤（C—D级）膝过伸的影响。 方法：2022年6月—2024年1月我院收治的31例C—D级脊髓损伤伴有不同程度膝过伸患者，共55侧存在膝过伸。按照设定的纳入标准分为轻度组30侧（膝过伸为6°—10°）及中度组25侧（膝过伸为11°—20°），两组均装配3种不同AFO矫正膝过伸，分别为踝关节背屈0°、背屈5°及背屈10°，测量并分析其膝过伸情况，进行组内及组间膝过伸改善情况比较。 结果：在未穿戴矫形器时，两组患者膝过伸角度存在显著差异。穿戴背屈0°、5°、10°的AFO后，两组间的膝过伸角度差异无显著性意义。重复测量方差分析表明，不同组别和穿戴不同角度AFO下的膝过伸改善角度均存在显著性差异，组别与AFO角度的交互效应不显著。进一步简单效应检验显示，两组在穿戴各角度AFO时膝过伸的改善角度均有显著性差异，不同角度AFO对膝过伸的改善效果也均存在显著性差异。多重比较发现，两组穿戴0°、5°、10°的AFO对膝过伸的改善角度依次显著上升。 结论：C—D级脊髓损伤伴有不同程度膝过伸患者，AFO对轻度、中度膝过伸均有效果，且效果相近，此外，踝关节背屈角度越大，矫治膝过伸效果越好，但背屈10°踝足矫形器，可致过度矫正而屈膝。

Abstract:

      Abstract Objective: To observe the effects of ankle-foot orthoses (AFOs) on knee hyperextension in patients with incomplete spinal cord injuries (C-D grades). Method: From June 2022 to January 2024, 31 patients with C-D grade incomplete spinal cord injuries accompanied by varying degrees of knee hyperextension were admitted to our hospital, including 16 males and 15 females aged between 28 and 55 years (mean age: 39.69±11.98). Based on pre-set criteria, patients were divided into a mild group (30 patients with knee hyperextension of 6°—10°) and a moderate group (25 patients with knee hyperextension of 11°—20°). Both groups were fitted with AFOs designed to correct knee hyperextension, featuring three types of ankle joint angles: 0°, 5° dorsiflexion, and 10° dorsiflexion. Knee hyperextension was measured and analyzed after fitting all three types of AFOs in both groups, allowing for within-group and between-group comparisons of improvement. Result: Significant differences in knee hyperextension angles were observed between the two groups before wearing the orthoses. However, these differences became statistically non-significant after wearing AFOs with ankle angles of 0°, 5°, and 10°. Additionally, repeated measures ANOVA revealed significant differences in knee hyperextension improvement among different groups and when wearing AFOs with different ankle angles, but the interaction effect between group and AFO angle was not significant. Further simple effect tests showed significant differences in knee hyperextension improvement when wearing AFOs at various angles within both groups, and there were also significant differences in the effects of different AFO angles on knee hyperextension improvement within the mild and moderate groups. Multiple comparisons revealed that, in both the mild and moderate groups, wearing AFOs with ankle angles of 0°, 5°, and 10° resulted in a significant stepwise increase in knee hyperextension improvement. Conclusion: The results indicate that AFOs are effective in treating knee hyperextension in patients with C-D grade incomplete spinal cord injuries, regardless of the severity (mild or moderate). Moreover, the greater the ankle dorsiflexion angle, the better the correction effect on knee hyperextension. However, it should be noted that AFOs with a 10° dorsiflexion angle may lead to overcorrection and knee flexion.