Center for the Intrepid, Department of Orthopaedics and Rehabilitation, Brooke Army Medical Center, Ft. Sam Houston, TX, USA.
Center for the Intrepid, Department of Orthopaedics and Rehabilitation, Brooke Army Medical Center, Ft. Sam Houston, TX, USA.
Gait Posture. 2014 Sep;40(4):640-6. doi: 10.1016/j.gaitpost.2014.07.019. Epub 2014 Jul 29.
Low back pain (LBP) is common in individuals with transfemoral amputation and may result from altered gait mechanics associated with prosthetic use. Inter-segmental coordination, assessed through continuous relative phase (CRP), has been used to identify specific patterns as risk factors. The purpose of this study was to explore pelvis and trunk inter-segmental coordination across three walking speeds in individuals with transfemoral amputations with and without LBP. Nine individuals with transfemoral amputations with LBP and seven without pain were compared to twelve able-bodied subjects. Subjects underwent a gait analysis while walking at slow, moderate, and fast speeds. CRP and CRP variability were calculated from three-dimensional pelvis and trunk segment angles. A two-way ANOVA and post hoc tests assessed statistical significance. Individuals with transfemoral amputation demonstrated some coordination patterns that were different from able-bodied individuals, but consistent with previous reports on persons with LBP. The patient groups maintained transverse plane CRP consistent with able-bodied participants (p = 0.966), but not sagittal (p < 0.001) and frontal plane CRP (p = 0.001). Sagittal and frontal CRP may have been re-optimized based on new sets of constraints, such as protective rigidity of the segments, muscular strength limitations, or prosthesis limitations. Patients with amputations and without LBP exhibited few differences. Only frontal and transverse CRP shifted toward out-of-phase as speed increased in the patient group with LBP. Although a cause and effect relationship between CRP and future development of back pain has yet to be determined, these results add to the literature characterizing biomechanical parameters of back pain in high-risk populations.
下肢截肢者常患有下腰痛（LBP），这可能是由于使用假肢导致步态力学改变所致。节段间协调（通过连续相对相位（CRP）评估）已被用于确定特定模式作为风险因素。本研究旨在探讨下肢截肢者伴或不伴 LBP 在下腰痛高危人群中，三种行走速度下骨盆和躯干节段间的协调情况。将 9 名伴有 LBP 的下肢截肢者和 7 名无痛患者与 12 名健康受试者进行比较。受试者在慢、中、快三种行走速度下进行步态分析。从三维骨盆和躯干节段角度计算 CRP 和 CRP 变异性。采用双因素方差分析和事后检验评估统计学意义。下肢截肢者表现出一些与健康人不同的协调模式，但与之前关于 LBP 患者的报告一致。患者组保持与健康参与者一致的横断面上的 CRP（p=0.966），但不在矢状面（p<0.001）和额状面上（p=0.001）。矢状面和额状面 CRP 可能已经根据新的约束条件进行了重新优化，例如节段的保护刚性、肌肉力量限制或假体限制。无 LBP 的截肢患者组表现出很少的差异。只有在伴有 LBP 的患者组中，随着速度的增加，CRP 才从前向和横向转向相位相反。尽管 CRP 与未来腰痛发展之间的因果关系尚未确定，但这些结果增加了描述高危人群腰痛生物力学参数的文献。
