Kirby R L, Chari V R
Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Arch Phys Med Rehabil. 1990 Feb;71(2):125-7.
The hypothesis that prostheses improve the forward reach of sitting lower-limb amputees was tested. While sitting with only ischial support, ten unilateral below-knee (BK) amputees could reach farther when they wore their prostheses than when they did not, when reaching at 45 degrees toward or away from the side of the amputation, with mean differences (+/- 1 SD) of 10.7cm (+/- 6.9, p less than 0.0001) and 4.4cm (+/- 4.1, p less than 0.01), respectively. With ten unilateral above-knee (AK) amputees, the differences were not statistically significant. Seven bilateral amputees (mixed levels) were able to reach farther with their prostheses on than off, with mean differences of 41.2cm (+/- 9.5) and 31.5cm (+/- 7.9) for reaches at 0 degrees and 45 degrees, respectively (p less than 0.0001). With the prostheses off, their reach was significantly greater when their thighs were supported than when they were sitting with only ischial support. These findings suggest that (1) prostheses improve the anterolateral reach of unilateral BK amputees, and the straight forward and anterolateral reach of bilateral amputees; (2) when prostheses are not being worn, a sitting surface which provides support through the residual limbs improves forward reach; and (3) the design of AK prostheses should reflect the patient's needs, both standing and sitting.
对假肢能否改善坐下的下肢截肢者前伸距离这一假设进行了测试。仅以坐骨支撑就坐时，10名单侧膝下（BK）截肢者在佩戴假肢时向截肢侧或远离截肢侧呈45度伸展时，其伸展距离比不佩戴假肢时更远，平均差异（±1标准差）分别为10.7厘米（±6.9，p<0.0001）和4.4厘米（±4.1，p<0.01）。对于10名单侧膝上（AK）截肢者，差异无统计学意义。7名双侧截肢者（不同截肢平面）佩戴假肢时比不佩戴时伸展得更远，在0度和45度伸展时平均差异分别为41.2厘米（±9.5）和31.5厘米（±7.9）（p<0.0001）。不佩戴假肢时，当大腿得到支撑时他们的伸展距离明显大于仅以坐骨支撑就坐时。这些结果表明：（1）假肢可改善单侧BK截肢者的前外侧伸展距离以及双侧截肢者的正前方和前外侧伸展距离；（2）不佩戴假肢时，通过残肢提供支撑的坐面可改善前伸距离；（3）AK假肢的设计应反映患者站立和就坐时的需求。
