MOVE Center, College of Engineering and Applied Science, Wisconsin Institute for Biomedical Health Technology, University of Wisconsin Milwaukee, Milwaukee, WI, USA.
J Biomech. 2010 Mar 22;43(5):871-8. doi: 10.1016/j.jbiomech.2009.11.013. Epub 2010 Jan 4.
The design, construction, and fitting of artificial limbs remain to this day an art, dependent on the accumulated expertise of the practitioner/prosthetist. Socket fitting is cost ineffective, time consuming, and a source of inconvenience for the amputee. Stump-skin slippage within the socket can cause discomfort, internal limb pain, and eventually skin ulcers as a result of excessive pressure and shear within the socket. This study presents a new method of assessment of three-dimensional (3D) socket-stump kinematics/slippage of strenuous activities using Biplane Dynamic Roentgen Stereogrammetric Analysis instrumentation. Ten below knee amputees participated in the study. A more holistic representation of the downward slippage trend of all proximal side skin markers with respect to the socket, and an even more characteristic and of higher magnitude downward-and anterioposterior slippage (maximum slippage: 151 mm for the fast-stop task and 19 mm for the step-down task) between the distal markers after impact, was possible for both tasks for all amputees. Displacement between skin-to-skin marker pairs reached maximum values of approximately 10mm for the step-down trials and up to 24 mm for the fast stop trials. Maximum skin strain was dependent on the position of the skin markers. Distally positioned skin marker pairs demonstrated mainly anterioposterior displacement between each other (maximum relative strain: 13-14%). Maximum relative strain for the proximal markers was 8-10%. This highly accurate, in-vivo, patient-specific, unobtrusive dynamic information, presented using 3D visualization tools that were up to now unavailable to the clinician-prosthetist, can significantly impact the iterative cycle of socket fitting and evaluation.
时至今日，义肢的设计、制造和适配仍然是一门艺术，依赖于从业者/假肢技师的经验积累。接受腔适配既不经济，又耗时，而且会给截肢者带来不便。残肢在接受腔内的皮肤滑动会引起不适、内部肢体疼痛，最终还会导致皮肤溃疡，这是由于接受腔内的压力和剪切力过大。本研究提出了一种新的方法，使用双平面动态射线立体照相分析仪器评估三维（3D）接受腔-残肢的运动/剧烈活动中的滑动。 10 名膝下截肢者参与了这项研究。对于所有截肢者，这种方法能够更全面地描述所有近端侧皮肤标记相对于接受腔的向下滑动趋势，并且更具特征性，而且在冲击后远端标记之间的向下和前后向滑动（最大滑动：快速停止任务为 151mm，步下任务为 19mm）更大。皮肤对皮肤标记对之间的位移在步下试验中达到了大约 10mm 的最大值，在快速停止试验中达到了 24mm 的最大值。皮肤应变的最大值取决于皮肤标记的位置。位于远端的皮肤标记对彼此之间主要表现为前后向位移（最大相对应变：13-14%）。近端标记的最大相对应变为 8-10%。这种高精度、体内、患者特异性、非侵入性的动态信息，使用迄今为止临床医生-假肢技师无法使用的 3D 可视化工具呈现，可以显著影响接受腔适配和评估的迭代周期。
