Wolf Sebastian I, Alimusaj Merkur, Rettig Oliver, Döderlein Leonhard
Department of Orthopedic Surgery, University of Heidelberg, Germany.
Gait Posture. 2008 Jul;28(1):175-7. doi: 10.1016/j.gaitpost.2007.11.012. Epub 2008 Feb 5.
Patients with calf muscle insufficiency and a calcaneus gait are often dependent on ankle-foot orthoses (AFO). The orthosis is intended to improve walking and posture and should prevent structural deformities. AFOs are often manufactured with a dorsiflexion stop. The design of this type of orthosis has been investigated in several previous studies. In the current study, orthoses with a dorsal carbon fiber spring were compared with the classic design. Five patients with Spina Bifida took part in the current study. All participants underwent a 3D gait analysis including kinematic (VICON infrared cameras) and kinetic (Kistler force plates) data collection. The measurements showed that the carbon spring was able to support the patient during the complete stance phase. It was found that the use of a carbon fiber spring significantly increases the energy return during the 3rd rocker, simulating the natural push-off action (p<0.05). Via a simple mechanical test, the contribution of the carbon spring to the overall kinetics could be estimated proving that the spring does assist the patient for push-off. The more physiological ankle and knee kinematics implies a functional improvement from the carbon springs compared to classic orthosis. This investigation showed, further, that in the fitting process a neutral alignment with the shoe wear has to be carefully checked since the spring kinematics and kinetics during stance phase were influenced significantly by the alignment. Further studies are needed to assess the clinical outcome and to prove the functional benefit of this kind of orthosis.
患有小腿肌肉功能不全且呈跟骨步态的患者通常依赖踝足矫形器（AFO）。该矫形器旨在改善行走和姿势，并应防止结构畸形。AFO通常制造有背屈止动装置。此前已有多项研究对这类矫形器的设计进行了调查。在本研究中，将带有背侧碳纤维弹簧的矫形器与经典设计的矫形器进行了比较。五名脊柱裂患者参与了本研究。所有参与者都接受了三维步态分析，包括运动学（VICON红外摄像机）和动力学（Kistler测力板）数据采集。测量结果表明，碳纤维弹簧能够在整个站立期为患者提供支撑。研究发现，使用碳纤维弹簧在第三摆动期显著增加了能量回返，模拟了自然蹬离动作（p<0.05）。通过一项简单的力学测试，可以估算出碳纤维弹簧对整体动力学的贡献，证明该弹簧确实有助于患者蹬离。与经典矫形器相比，更符合生理的踝关节和膝关节运动学意味着碳纤维弹簧在功能上有所改善。此外，这项研究表明，在适配过程中，必须仔细检查与鞋类穿戴的中立对线情况，因为站立期弹簧的运动学和动力学受对线的影响很大。需要进一步研究来评估这种矫形器的临床效果并证明其功能益处。
