Vrieling A H, van Keeken H G, Schoppen T, Otten E, Halbertsma J P K, Hof A L, Postema K
Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Gait Posture. 2008 Aug;28(2):235-42. doi: 10.1016/j.gaitpost.2007.12.006. Epub 2008 Feb 1.
To study adjustment strategies in unilateral amputees in uphill and downhill walking.
Observational cohort study.
Seven transfemoral, 12 transtibial unilateral amputees and 10 able-bodied subjects.
In a motion analysis laboratory the subjects walked over a level surface and an uphill and downhill slope. Gait velocity and lower limb joint angles were measured.
In uphill walking hip and knee flexion at initial contact and hip flexion in swing were increased in the prosthetic limb of transtibial amputees. In downhill walking transtibial amputees showed more knee flexion on the prosthetic side in late stance and swing. Transfemoral amputees were not able to increase prosthetic knee flexion in uphill and downhill walking. An important adjustment strategy in both amputee groups was a smaller hip extension in late stance in uphill and downhill walking, probably related with a shorter step length. In addition, amputees increased knee flexion in early stance in the non-affected limb in uphill walking to compensate for the shorter prosthetic limb length. In downhill walking fewer adjustments were necessary, since the shorter prosthetic limb already resulted in lowering of the body.
Uphill and downhill walking can be trained in rehabilitation, which may improve safety and confidence of amputees. Prosthetic design should focus on better control of prosthetic knee flexion abilities without reducing stability.
研究单侧截肢者在上坡和下坡行走时的调整策略。
观察性队列研究。
7名经股截肢者、12名经胫单侧截肢者和10名健全受试者。
在运动分析实验室中，受试者在平坦表面以及上坡和下坡斜坡上行走。测量步态速度和下肢关节角度。
在上坡行走时，经胫截肢者假肢侧在初始接触时的髋部和膝部屈曲以及摆动时的髋部屈曲增加。在下坡行走时，经胫截肢者在支撑后期和摆动期假肢侧表现出更多的膝部屈曲。经股截肢者在上坡和下坡行走时无法增加假肢膝部屈曲。两个截肢者组的一个重要调整策略是在上坡和下坡行走的支撑后期减小髋部伸展，这可能与步长较短有关。此外，截肢者在上坡行走时在非患侧肢体的支撑早期增加膝部屈曲，以补偿假肢肢体较短的长度。在下坡行走时，所需调整较少，因为较短的假肢肢体已经导致身体下降。
上坡和下坡行走可在康复中进行训练，这可能提高截肢者的安全性和信心。假肢设计应注重在不降低稳定性的情况下更好地控制假肢膝部屈曲能力。
