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Muskuläre Biomechanik in der Sprunggelenkprothetik

Muscle biomechanics in total ankle replacement

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Zusammenfassung

Das Ziel dieser orthopädisch-biomechanischen Studie war die Evaluation der Muskelfunktion von Patienten, bei welchen infolge unilateraler, schwerer Arthrose am oberen Sprunggelenk (OSG) eine Prothese eingesetzt wurde.

Bei 10 Patienten wurde vor und 1 Jahr nach Implantation einer OSG-Prothese eine orthopädische und biomechanische Untersuchung durchgeführt. Dabei wurden der Schmerzscore, der „American Orthopaedic Foot and Ankle Society“- (AOFAS-)Ankle-Score, der Bewegungsumfang (ROM) des Sprunggelenks und der Unterschied zwischen dem Umfang des Unterschenkels des betroffenen und des kontralateralen gesunden Beins gemessen. Die biomechanische Beurteilung bestand aus einer simultanen Messung des maximal willkürlichen, isometrischen Drehmoments bei Plantarflexion und Dorsalextension des OSG sowie aus einem Oberflächenelektromyogramm (EMG; mittlere Frequenz und Intensität) von 4 Unterschenkelmuskeln: Tibialis anterior (TA), Gastrocnemius medialis (GM), Soleus (SO) und Peroneus longus (PL).

Im Vergleich zur präoperativen Evaluation verbesserten sich der Schmerzscore von 6,7 auf 0,8 Punkte, der AOFAS-Ankle-Score von 35,6 auf 92,3 Punkte und der ROM nach Implantation der OSG-Prothese signifikant. Die mittlere Differenz des Unterschenkelumfangs zwischen den beiden Beinen nahm von 2,2 cm auf 1,4 cm ab. Dies war jedoch nicht signifikant. Das mittlere Drehmoment des betroffenen Sprunggelenks bei Dorsalextension stieg von 17,0 auf 25,8 Nm und bei Plantarflexion von 15,7 auf 24,6 Nm signifikant an. Bei der 1-Jahres-Nachkontrolle war die mittlere EMG-Frequenz in allen atrophischen Muskeln tiefer als bei den gesunden Muskeln der kontralateralen Seite. Ein Unterschied der mittleren EMG-Intensität zur kontralateralen gesunden Seite konnte nicht verifiziert werden.

Daraus kann gefolgert werden, dass Patienten mit symptomatischer OSG-Arthrose mit einer Prothese eine bessere Funktion erlangen; 1 Jahr nach der Operation entspricht dies jedoch nicht dem Ausmaß derjenigen des kontralateralen gesunden Beins.

Abstract

The purpose of this orthopaedic-biomechanical study was to evaluate the muscle function in total ankle replacement (TAR) patients 1 year after surgery.

Ten patients underwent a combined clinical and muscle biomechanical assessment prior to implantation and at the 1-year follow-up. Pain score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle score, ankle range of motion (ROM), and calf circumference difference between the affected leg and contralateral healthy leg were assessed. Biomechanically, isometric maximal voluntary torque for ankle dorsiflexion and plantar flexion was measured simultaneously with surface electromyography of four lower leg muscles.

At follow-up, a significant improvement of the pain score (from 6.7 to 0.8 points), AOFAS ankle score (from 35.6 to 92.3 points), and ROM could be shown. Not significantly, the mean calf circumference difference between legs decreased from 2.2 to 1.4 cm. However, a significant increase was seen in the mean dorsiflexion (from 17.0 to 25.8 Nm) and plantar flexion torque (15.7 to 24.6 Nm) of the TAR-treated ankle. The mean EMG frequency content of the affected lower leg at TAR follow-up was lower than in the muscles of the contralateral healthy side. In contrast, the mean EMG intensity at TAR follow-up in side-comparison was statistically the same for all muscles.

Ankle OA patients have better muscle function with TAR than under the arthritic condition, but they do not reach the normal level of the contralateral healthy leg 1 year after surgery.

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Danksagung

Diese Studie wurde durch den Schweizerischen Nationalfonds unterstützt (SNF Nr. PBZHB-106269).

Interessenkonflikt

Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

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Authors and Affiliations

  1. Orthopädische Universitätsklinik, Universitätsspital Basel, 4031, Basel, Schweiz

    V. Valderrabano, B. Hintermann & W. Dick

  2. Human Performance Laboratory and Orthopaedic Department, University of Calgary, 2500 University Drive, NW T2N1N4, Calgary, Kanada, Alberta

    V. Valderrabano, V. von Tscharner & B. M. Nigg

  3. Labor für Orthopädische Biomechanik, Universität Basel, Basel, Schweiz

    B. Göpfert

Authors
  1. V. Valderrabano
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  2. B. Hintermann
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  3. V. von Tscharner
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  4. B. Göpfert
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  5. W. Dick
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  6. B. M. Nigg
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Correspondence to V. Valderrabano.

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Dieser Beitrag wurde als Originalpublikation erstellt und begutachtet und ist aus formalen Gründen in das Leitthema dieser Ausgabe eingeordnet.

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Valderrabano, V., Hintermann, B., von Tscharner, V. et al. Muskuläre Biomechanik in der Sprunggelenkprothetik. Orthopäde 35, 513–520 (2006). https://doi.org/10.1007/s00132-006-0938-6

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  • DOI: https://doi.org/10.1007/s00132-006-0938-6

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