Roessingh Research and Development, Enschede, The Netherlands.
Arch Phys Med Rehabil. 2011 Aug;92(8):1311-25. doi: 10.1016/j.apmr.2011.01.017. Epub 2011 Jun 29.
To describe adaptation strategies in terms of joint power or work in the amputated and intact leg of patients with a transtibial (TT) or transfemoral (TF) amputation.
MEDLINE, CINAHL, Physiotherapy Evidence Database, Embase, and the Cochrane Register of Controlled Trials were searched. Studies were collected up to November 1, 2010. Reference lists were additionally scrutinized.
Studies were included when they presented joint power or work and compared (1) the amputated and intact legs, (2) the amputated leg and a referent leg, or (3) the intact leg and a referent leg. Eligibility was independently assessed by 2 reviewers. A total of 13 articles were identified.
Data extraction was performed using standardized forms of the Cochrane Collaboration. Methodologic quality was independently assessed using the Downs and Black instrument by 2 reviewers. The possibility of data pooling was examined. Significant differences found in studies that could not be pooled are also presented.
Significant results (P<.05). For work TT, for the concentric work total stance phase knee, the amputated was less than the intact/referent side, and the referent was less than the intact side. For the eccentric knee extensor (K1) phase, the amputated was less than the intact side, and the intact was greater than the referent side. For the concentric knee extensor (K2) phase, the amputated/referent was less than the intact side. For the concentric work total stance phase hip, the amputated/intact was greater than the referent side. For the concentric hip extensor (H1) phase, the amputated/intact was greater than the referent side. For power TT, for the peak power generation stance phase knee, the amputated was less than the referent side. For peak power generation swing phase knee, the amputated was less than the referent side. For the eccentric knee flexor (K4) phase, the amputated was less than the intact side. For the eccentric hip flexor (H2) phase, the amputated was greater than the intact side. For work TF, for the concentric plantar flexor (A2) phase, the referent was less than the intact side. For the H1 phase, the referent was less than the intact side. For the H2 phase, the amputated was greater than the intact/referent side, and the referent was greater than the intact side. For power TF, for the K2 phase, the referent was less than the intact side. Sensitivity analysis did not alter the conclusions.
Adaptations were seen in the amputated and intact legs. TT and TF use remarkably similar adaptation strategies at the level of the hip to compensate for the loss of plantar flexion power and facilitate forward progression. At the knee level, adaptations differed between TT and TF.
描述在胫骨（TT）或股骨（TF）截肢患者截肢和未截肢腿的关节功率或功方面的适应策略。
检索了 MEDLINE、CINAHL、Physiotherapy Evidence Database、Embase 和 Cochrane 对照试验注册中心。研究结果收集截止到 2010 年 11 月 1 日。此外，还仔细审查了参考文献列表。
如果研究报告了关节功率或功，并进行了（1）截肢和未截肢腿之间、（2）截肢腿和参考腿之间、或（3）未截肢腿和参考腿之间的比较，则纳入研究。由 2 名评审员独立评估入选标准。共确定了 13 篇文章。
使用 Cochrane 协作组的标准化表格进行数据提取。由 2 名评审员使用 Downs 和 Black 仪器独立评估方法学质量。还检查了数据合并的可能性。对于无法合并的研究中发现的显著差异也进行了呈现。
有显著差异（P<.05）。对于工作 TT，在同心工作总站立阶段的膝关节中，截肢侧小于未截肢/参考侧，而参考侧小于未截肢侧。在离心膝关节伸肌（K1）阶段，截肢侧小于未截肢侧，未截肢侧大于参考侧。在同心膝关节伸肌（K2）阶段，截肢/参考侧小于未截肢侧。在同心工作总站立阶段髋关节中，截肢/未截肢侧大于参考侧。在同心髋关节伸肌（H1）阶段，截肢/未截肢侧大于参考侧。对于功率 TT，在站立阶段膝关节的峰值功率生成中，截肢侧小于参考侧。在摆动阶段膝关节的峰值功率生成中，截肢侧小于参考侧。在离心膝关节屈肌（K4）阶段，截肢侧小于未截肢侧。在离心髋关节屈肌（H2）阶段，截肢侧大于未截肢侧。对于工作 TF，在跖屈（A2）阶段的同心足底屈肌中，参考侧小于未截肢侧。在 H1 阶段，参考侧小于未截肢侧。在 H2 阶段，截肢侧大于未截肢/参考侧，参考侧大于未截肢侧。在功率 TF 中，在 K2 阶段，参考侧小于未截肢侧。敏感性分析没有改变结论。
在截肢和未截肢腿中观察到了适应性变化。TT 和 TF 在髋关节水平上使用非常相似的适应策略来补偿跖屈力量的丧失，并促进向前推进。在膝关节水平上，TT 和 TF 的适应策略不同。
