Fraisse N, Martinet N, Kpadonou T-J, Paysant J, Blum A, André J-M
Institut régional de médecine physique et de réadaptation, 75, boulevard Lobau, CS 34209, 54042 Nancy cedex, France.
Ann Readapt Med Phys. 2008 Apr;51(3):218-27. doi: 10.1016/j.annrmp.2008.01.012. Epub 2008 Feb 27.
The objective of this article is to review anatomical, histological and physiological muscle changes following below-knee amputation.
We searched the PubMed and Reedoc databases for studies evaluating modifications of the below-knee stump and changes over time in its anatomy, volume and histology. We also looked at postamputation modifications in gait and balance.
Below-knee amputees show muscular atrophy on both the amputated side and nonamputated side, with fewer and smaller muscle fibres (particularly slow-twitch fibres). This amyotrophy varies in magnitude and distribution and can reach about 25% for the quadriceps (predominantly on the medial side), but is nonsignificant for the hamstrings. This amyotrophy results from the anatomical consequences of the surgical act. The loss of one or more of a muscle's insertions or reimplantation into a nonphysiological site prompts greater atrophy. Changes in muscle activation patterns also lead to atrophy. The hamstrings replace the triceps as the main muscles for propulsion and the remaining stump muscles contract so as to ensure a good fit with the prosthesis. The below-knee amputee must adapt to a new muscular state: gait symmetry is altered, energy expenditure for walking is higher and training is needed in order to achieve optimal balance control.
本文旨在综述膝下截肢术后肌肉在解剖学、组织学和生理学方面的变化。
我们在PubMed和Reedoc数据库中检索了评估膝下残肢改变及其解剖结构、体积和组织学随时间变化的研究。我们还研究了截肢术后步态和平衡的改变。
膝下截肢者在截肢侧和非截肢侧均出现肌肉萎缩，肌纤维数量减少且变细（尤其是慢肌纤维）。这种肌萎缩在程度和分布上存在差异，股四头肌的萎缩程度可达约25%（主要在内侧），但腘绳肌的萎缩不明显。这种肌萎缩是手术操作的解剖学后果所致。肌肉一个或多个附着点的丧失或重新植入非生理部位会导致更严重的萎缩。肌肉激活模式的改变也会导致萎缩。腘绳肌取代三头肌成为主要的推进肌肉，残肢其余肌肉收缩以确保与假肢良好适配。膝下截肢者必须适应新的肌肉状态：步态对称性改变，行走能量消耗增加，需要进行训练以实现最佳平衡控制。
