Russell Esposito Elizabeth, Wilken Jason M
Center for the Intrepid, Brooke Army Medical Center, Ft. Sam Houston, TX 78234, USA; DoD-VA Extremity Trauma and Amputation Center of Excellence (EACE), USA.
Center for the Intrepid, Brooke Army Medical Center, Ft. Sam Houston, TX 78234, USA; DoD-VA Extremity Trauma and Amputation Center of Excellence (EACE), USA.
Clin Biomech (Bristol). 2014 Dec;29(10):1186-92. doi: 10.1016/j.clinbiomech.2014.09.005. Epub 2014 Sep 18.
Gait compensations following transtibial amputation negatively affect sound limb loading and increase the risk of knee osteoarthritis. Push-off assistance provided by new powered prostheses may decrease the demands on the sound limb. However, their effects in a young population in the early stages of prosthetic use are still unknown. The purpose of this study was to compare limb loading between 1. passive and powered ankle-foot prostheses, 2. sound and amputated limbs, and 3. individuals with amputations in the relatively early stages of prosthetic use and controls.
Ten young, active individuals with unilateral transtibial amputation and 10 controls underwent biomechanical gait analysis at three speeds. The peak external knee flexor and adductor moments, adductor moment's angular impulse, peak vertical ground reaction force and loading rate were calculated. Repeated measures ANOVAs compared between limbs, prostheses, and groups.
The powered prosthesis did not decrease the sound limb's peak adduction moment or its impulse, but did decrease the external flexor moment, peak vertical force and loading rate as speed increased. The powered prosthesis decreased the loading rate from controls. The sound limb did not display a significantly greater risk for knee osteoarthritis than the intact limb or than controls in either device.
In the early stages of prosthetic use, young individuals with transtibial amputation display few biomechanical risk factors for knee osteoarthritis development. However, a powered ankle-foot prosthesis still offers some benefits and may be used prophylactically to mitigate potential increases of these variables with continued prosthetic use over time.
经胫骨截肢后的步态代偿会对健全肢体的负重产生负面影响，并增加患膝骨关节炎的风险。新型动力假肢提供的蹬离辅助可能会减少对健全肢体的需求。然而，它们在假肢使用早期的年轻人群中的效果仍不明确。本研究的目的是比较：1. 被动和动力踝足假肢之间、2. 健全肢体和截肢肢体之间、3. 处于假肢使用相对早期阶段的截肢个体与对照组之间的肢体负重情况。
10名年轻、活跃的单侧经胫骨截肢个体和10名对照组人员以三种速度进行了生物力学步态分析。计算了膝关节外侧屈肌和内收肌力矩峰值、内收肌力矩的角冲量、垂直地面反作用力峰值和负重率。采用重复测量方差分析比较肢体、假肢和组间差异。
动力假肢并未降低健全肢体的内收力矩峰值或其冲量，但随着速度增加，确实降低了外侧屈肌力矩、垂直力峰值和负重率。动力假肢降低了与对照组相比的负重率。在使用任何一种装置时，健全肢体患膝骨关节炎的风险均未显著高于完整肢体或对照组。
在假肢使用的早期阶段，经胫骨截肢的年轻个体显示出很少的膝骨关节炎发展的生物力学风险因素。然而，动力踝足假肢仍然具有一些益处，可预防性使用以减轻随着假肢使用时间延长这些变量可能出现的增加。
