Schnall Barri L, Baum Brian S, Andrews Anne M
Center for Performance and Clinical Research, Military Advanced Training Center, Walter Reed Army Medical Center, 6900 Georgia Ave NW, Washington, DC 20307, USA.
Phys Ther. 2008 Dec;88(12):1568-77. doi: 10.2522/ptj.20070337. Epub 2008 Oct 10.
No reports have analyzed the temporal-spatial, kinematic, or kinetic components of gait coupled with a metabolic analysis of patients with hip disarticulations. Most of the research on this population is based on older adults. As a result, guidelines for reasonable functional outcomes for patients with hip disarticulations who are young, premorbidly fit, and goal oriented are lacking. This report describes quantitative measures of energy cost and gait characteristics of a young soldier with a unilateral traumatic hip disarticulation.
One patient, a soldier with a unilateral hip disarticulation, was evaluated in the Gait and Motion Analysis Laboratory at 3 months and 38 months postinjury.
The patient progressed from use of crutches at 3 months postinjury to independent ambulation at the follow-up visit at 38 months postinjury. At 38 months postinjury, he wore his prosthesis 12 hours per day and achieved step-length symmetry, and his oxygen consumption was 14.49 mL/kg/min at self-selected walking speed. Self-selected walking speed increased from 0.57 m/s at 3 months to 0.86 m/s at 38 months postinjury. During both visits, support time remained greater on the intact limb (72%) than the involved limb (57%), compensatory trunk and pelvic motions were used to advance the prosthetic limb, and the vertical ground reaction force profile was within 2 standard deviations of the data for an uninjured comparison group on the prosthetic side and plateaued on the sound limb.
Young individuals with traumatic hip disarticulations can achieve and maintain functional independent ambulation with gait deviations. However, metabolic demands may not be as great as previously expected.
尚无报告对髋关节离断患者的步态进行时空、运动学或动力学分析，并结合代谢分析。关于这一人群的大多数研究都基于老年人。因此，缺乏针对年轻、病前健康且目标明确的髋关节离断患者合理功能结局的指南。本报告描述了一名单侧创伤性髋关节离断年轻士兵的能量消耗定量指标和步态特征。
一名单侧髋关节离断的士兵患者，在受伤后3个月和38个月在步态与运动分析实验室接受评估。
患者从受伤后3个月使用拐杖，进展到受伤后38个月随访时独立行走。受伤后38个月，他每天佩戴假肢12小时，步长对称，自选步行速度下的耗氧量为14.49 mL/kg/min。自选步行速度从受伤后3个月的0.57 m/s增加到受伤后38个月的0.86 m/s。在两次评估期间，健侧肢体的支撑时间（72%）仍长于患侧肢体（57%），通过代偿性躯干和骨盆运动来推进假肢，假肢侧垂直地面反作用力曲线在未受伤对照组数据的2个标准差范围内，健侧肢体则趋于平稳。
创伤性髋关节离断的年轻人可以通过步态偏差实现并维持功能性独立行走。然而，代谢需求可能不如先前预期的那么大。
