Hobara Hiroaki, Kobayashi Yoshiyuki, Nakamura Takashi, Yamasaki Nobuya, Nakazawa Kimitaka, Akai Masami, Ogata Toru
Research Institute, National Rehabilitation Centre for Persons with Disabilities, Tokorozawa, Saitama, Japan.
Prosthet Orthot Int. 2011 Dec;35(4):467-72. doi: 10.1177/0309364611425564. Epub 2011 Oct 19.
Stair ascent is a very demanding task for transfemoral amputees (TFAs). The purpose of this study was to investigate the lower extremity joint kinematics of TFAs who can climb stairs using a step-over-step gait pattern without an active artificial prosthetic knee joint or handrail use.
Case series. Participants were two traumatic TFAs and 10 control participants. Both TFAs used a single-axis prosthetic knee joint in daily living. Sagittal plane joint kinematics were recorded at 60 Hz using an eight-camera motion analysis system and digital video camera.
From the instant of touchdown, the prosthetic knee joint was rapidly extended and remained fully extended until toe-off. In the latter half of the stance phase, the knee and ankle joints of the sound limb simultaneously showed rapid joint flexion during continuous extension. Further, the ankle joint of the sound limb showed greater plantarflexion at the end of the stance phase.
These results suggest that the TFA in the present study would (1) extend the prosthetic knee joint to prevent the knee flexion generated by the bodyweight (plus ground reaction force and/or joint moment), and (2) lift the whole body in an upward direction using strong counter-movements and greater joint extension during the stance phase.
对于经股截肢者（TFA）而言，上楼梯是一项极具挑战性的任务。本研究的目的是调查能够采用一步跨越一步的步态模式上楼梯且不使用主动式人工膝关节或扶手的TFA的下肢关节运动学。
病例系列研究。参与者包括两名创伤性TFA患者和10名对照参与者。两名TFA患者在日常生活中均使用单轴人工膝关节。使用八台摄像机运动分析系统和数字摄像机以60赫兹的频率记录矢状面关节运动学数据。
从着地瞬间起，假膝关节迅速伸展并保持完全伸展直至离地。在支撑期的后半段，健侧肢体的膝关节和踝关节在持续伸展过程中同时出现快速的关节屈曲。此外，健侧肢体的踝关节在支撑期结束时表现出更大的跖屈。
这些结果表明，本研究中的TFA患者会（1）伸展假膝关节以防止因体重（加上地面反作用力和/或关节力矩）产生的膝关节屈曲，以及（2）在支撑期利用强烈的反向运动和更大的关节伸展向上提升整个身体。
