全人工膝關節置換術後降低步行速度之研究

The Study of Reduction in Walking Speed after Total Knee Arthroplasty

全人工膝關節置換手術後，預防跌倒是臨床的重要議題。軟墊上站立與周邊視覺遮蔽兩種情境會改變感覺輸入，而進一步影響平衡反應。本研究檢測不同情境下全膝關節置換手術個案的步行速度：2種地面情境：一般路面與軟墊路面；與2種視覺情境：正常視線與戴周邊視覺遮蔽眼鏡。實驗組收入條件：雙側人工膝關節置換手術後1年以上、每週有30分鐘以上運動習慣、沒有影響步行功能相關的診斷。控制組：年齡與性別配對沒有接受人工膝關節置換手術者，與實驗組有相同運動習慣且沒有影響行走平衡之相關診斷。研究方法：測試在4種不同情境下之步行速度。4種情境分別為：一般路面與正常視線、軟墊路面與正常視線、一般路面與周邊視覺遮蔽、軟墊路面與周邊視覺遮蔽。以重複測量變異數分析兩組受試者四種環境下步行速度的差異性。結果發現置換組的步行速度明顯比控制組慢（<0.05），且比控制組明顯受地面與視覺環境改變的影響。臨床運用：全膝關節置換手術後個案，可給予不同地面材質與視覺情境來加強行走功能訓練。

The prevention of falls following total knee arthroplasty (TKA) is a critical issue in clinical practice. Standing on a foam pad surface and visual occlusion are two scenarios that alter peripheral sensory input, subsequently affecting balance responses. This study examines walking speed under different conditions in patients after TKA. The conditions include two surface scenarios: standard ground and foam pad; and two visual scenarios: normal vision and peripheral vision restriction using goggles. The experimental group included criteria: (1) underwent bilateral TKA more than one year prior; (2) engaged in regular physical activity for at least 30 minutes per week; and (3) had no diagnoses affecting walking function. The control group comprised individuals without a history of TKA, matched to the experimental group by age and sex, with similar exercise habits and no diagnoses impacting walking balance. Walking speed was tested under four conditions:1. standard ground with normal vision, 2.foam pad surface with normal vision, 3. standard ground with peripheral vision restriction, and 4. foam pad surface with peripheral vision restriction. A repeated measures ANOVA was used to analyze differences in walking speed across the four conditions between the two groups. The findings revealed that the TKA group exhibited significantly slower walking speeds compared to the control group (p< 0.05). Furthermore, the TKA group was more affected by changes in walking surface and visual environments. Clinical Implications: Post-TKA patients could benefit from functional walking training incorporating varied walking surface and visual scenarios to enhance gait performance.