PubMed · 11601401
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V E Kokhan, O Iu Gorbachev, N V Tret'iakov, F N Stupin. 2001. [The spine functional capability].. https://pubmed.ncbi.nlm.nih.gov/11601401/
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BACKGROUND: It is difficult to identify objective parameters for assessing the joint function when dealing with the evaluation of orthopaedic procedures, especially endoprosthetic hip replacement. Clinical gait analysis enables parameters of force and movement to be quantified. However, the influence of gait speed on these parameters has hardly been taken into consideration so far. The objective of the present study was therefore to investigate the effect of gait speed on gait parameters and to simplify the clinical conditions in patients with osteoarthritis of the hip by determining a standardised gait speed. METHODS: A total of 28 patients with severe unilateral osteoarthritis of the hip were investigated at different gait speeds. The gait analysis equipment used consisted of an infinitely adjustable treadmill with force plates and an infrared video system. A special control mechanism permitted adjustment of the treadmill speed to a patient's self-determined pace. RESULTS: The mean gait speed of all patients with osteoarthritis of the hip was set at 2.20 km/h (0.61 m/s). Eight of the 10 gait parameters assessed increased significantly with changing gait speed. Pathological changes in gait patterns were found at the three gait speeds investigated, with the changes more accentuated at higher speeds. CONCLUSIONS: Dependence of gait parameters on gait speed could be concluded for a group of patients and for control subjects. Use of a force-instrumented treadmill is necessary for the setting of a standard gait speed, which should be set as high as achievable by patients without inducing pain and problems of coordination or balance. With the usage of standardised speeds, clinical gait analysis becomes easier to perform. Furthermore, one can assess the expected biomechanical advantages of newer prostheses, thus providing the surgeon with a basis for further decisions.
Facetectomy and laminectomy are techniques for decompressing lumbosacral spinal stenosis. Resections of posterior bony or ligamentous parts normally lead to a decrease in stability. The degree of instability depends on the extent of resection, the loading situation and the condition of the intervertebral discs. The correlation between these parameters is not well understood. In order to investigate how these parameters relate to one another, a three-dimensional, non-linear finite element model of the lumbosacral spine was created. Intersegmental rotations, intradiscal pressures, stresses, strains and forces in the facet joints were calculated while simulating an intact spine as well as different extents of resection (left and bilateral hemifacetectomy, hemilaminectomy and bilateral laminectomy, two-level laminectomy), disc conditions (intact and degenerated) and loading situations (pure moment loads, standing and forward bending). The results of the modelling showed that a unilateral hemifacetectomy increases intersegmental rotation for the loading situation of axial rotation. Expanding the resection to bilateral hemifacetectomy increases intersegmental rotation even more, while further resection up to a bilateral laminectomy has only a minor additional effect. Hemilaminectomy and laminectomy only differ in their effect for ventriflexion and muscle-supported forward bending. Two-level laminectomy increases the intersegmental rotation only for standing. Degenerated discs result in smaller intersegmental rotations and higher disc stresses at the respective levels. Decompression procedures affect the examined biomechanical parameters less markedly in degenerated than in intact discs. Resection of posterior bony or ligamentous elements has a stronger influence on the amount than on the distribution of stresses and deformations in a disc. It has only a minor effect on the biomechanical behaviour of the adjacent region. Spinal stability is decreased after a laminectomy for forward bending, and after a two-level laminectomy for standing. For axial rotation, spinal stability is decreased even after a hemifacetectomy. Patients should therefore avoid excessive axial rotation after such a treatment.
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