歩行様式よりみた慢性関節リウマチ患者への膝人工関節置換術の検討

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The characteristics of the rheumatoid gait was studied kinesiologically. Sixteen patients with rheumatoid arthritis constituted the clinical material. They were all females, with ages ranging 25 to 60,with a mean of 43 years old. Arthoplasties were done in twelve knees to use the tibial plateau plate, Geometric type and Yoshino type I. Four knees were subjected to synovectomy and sixteen knees had not been operated. The normal females, with ages ranging 21 to 25,were studied for the comparison. Three kinds of kinesiological techniques, the force plate, cinematography and electromyography (EMG), were employed simultaneously.The patient walks more slowly and powerlessly than the normal woman does. A walking pattern of a patient is compared with that of a normal woman. The both knees of the patient were replaced with knee prostheses. The cadence and the peak value of the accelerating force component are shown in a scatter diagram. Almost all legs of patients are out of the 95% critical ellipse of the normal free walking. The flexion-extension ranges of the knee and ankle are less in the patient than in the normal woman. The maximum hip extension, the maximum flexion and extension of the knee and the maximum ankle plantal flexion are small in the patient. The hip and knee joints have difficulties fully to extend in the stance phase. In the swing phase, the tiptoe is not elevated enough. The EMG patterns of the gastrocnemius and the rectus femoris are rather weak in the patient. On the other hand, the biceps femoris muscle works strongly. The characteristics of the rheumatoid gait may be caused mainly by 1) the small range of joint movements and the pain of joints, 2) the weakness of the muscles, and 3) the different patterns of the right and left legs of the same patient.Only the patients who have difficulties in walking underwent the knee arthroplasties. That will be the reason why the legs arthroplasty showed more abnormal gait patterns than the legs without operation. A patient were studied twice. The second evaluation was 13 months after the first one. The walking pattern recovered in many points in this case. The operated knees were painless than the knees without operation. Two years after the arthroplasty, the legs seem to be able to perform stronger acceleration. Because the pain and contracture of the knee improved, the knee arthroplasty recovers the gait pattern to a certain extent. The treatment of other joints and recovery of the musle activity are also important for the better walking.
社団法人日本リハビリテーション医学会の論文
1978-01-18

歩行様式よりみた慢性関節リウマチ患者への膝人工関節置換術の検討

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