解耦速度至关重要：通过健康腿的分带适应训练优化前交叉韧带重建后的步态力学
简介
该研究探讨了分带跑步机训练对ACL重建术后患者患侧膝关节负荷的影响。25例ACL重建术后患者（术后平均8个月）在仪器化跑台上行走，通过调节健侧履带速度（30%-170%基准速度），分析不同速度差对矢状面膝关节力矩、角度及垂直地面反作用力的影响。关键发现：存在剂量-反应关系——健侧履带速度加快可增加患侧膝关节在整个站立相的负荷，速度减慢则降低负荷；健侧自身则表…
英文摘要
BACKGROUND: Knee and limb underloading are common problems after anterior cruciate ligament (ACL) reconstruction associated with early-onset osteoarthritis. Split-belt treadmill training is a promising method to address knee/limb underloading, but the dose-response relationship and its efficacy to target underloading after reconstruction remain unknown. Here, we examined if split-belt treadmill training of the healthy limb (i.e., modifying belt speed under this limb) affects ACL knee/limb loading. METHODS: Twenty-five participants with ACL reconstruction (Age: 23.24 ± 6.48 yr, Height: 1.73 ± 0.08 m, Mass: 76.08 ± 13.72 kg, Postoperative Time: 8.04 ± 1.78 months) were evaluated utilizing an instrumented treadmill synced with a 12-camera motion capture system. Participants completed 5 min of baseline walking with belts tied at 1.1 m/s. Belt speed under the healthy limb was then manipulated with eight, randomized 5-min decoupled speed configurations (30-170% of 1.1 m/s in 20% increments) with 2 min of tied-belt walking after each speed. Sagittal plane knee moments, angles, and vertical ground reaction forces were measured, and one-dimensional statistical parametric mapping was used to compare dependent variables between legs and decoupling speeds during stance. FINDINGS: A dose-response relationship was found where faster speeds increased ACL knee/limb loads throughout stance and slower speeds decreased them. In the healthy limb, faster speeds led to increased early stance and decreased midstance loading, with the opposite effect at slower speeds. INTERPRETATION: Our findings suggest that split-belt treadmill training of the healthy limb at faster speeds may improve ACL knee/limb loading, but further research is needed to obtain a clear understanding of how this transfers to overground walking.