Golyski Pawel R, Hendershot Brad D
Research & Development Service, Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA.
Research & Development Service, Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA; DoD-VA Extremity Trauma and Amputation Center of Excellence, USA; Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Hum Mov Sci. 2018 Apr;58:41-54. doi: 10.1016/j.humov.2018.01.006. Epub 2018 Jan 30.
Prior work has identified alterations in trunk-pelvic dynamics with lower limb amputation (LLA) during in-line walking; however, evaluations of other ambulatory tasks are limited. Turns are ubiquitous in daily life but can be challenging for individuals with LLA, prompting additional or unique proximal compensations when changing direction, which over time may lead to development of low back pain. We hypothesized such proximal kinematic differences between persons with and without LLA would exist in the sagittal and frontal planes. Three-dimensional trunk and pelvic kinematics, translational and rotational momenta, and coordination phase/variability were compared among eight persons with unilateral LLA (4 with transfemoral amputation and 4 with transtibial amputation), and five uninjured controls, who performed 90-degree turns to the left (n = 10) and right (n = 10). Participants self-selected the turn strategy (i.e., step vs. spin) and pivot limb in response to verbal cues regarding when and which direction to turn. Coordination variability and translational angular momenta did not differ between groups in either turn type. During spin turns, frontal rotational angular momenta were larger and frontal trunk-pelvis range of motion was smaller among persons with vs. without LLA. During step turns, pelvis leading transverse coordination was more frequent, frontal trunk rotational angular momentum was smaller, and sagittal pelvis range of motion was larger among persons with vs. without LLA. Altered and task-dependent modulation of trunk-pelvic dynamics among persons with LLA provides additional support for a potential link between repeated exposures to altered trunk-pelvic dynamics with elevated low back pain risk.
先前的研究已经确定，在直线行走过程中，下肢截肢（LLA）会导致躯干-骨盆动力学发生改变；然而，对其他移动任务的评估却很有限。转身在日常生活中很常见，但对于LLA患者来说可能具有挑战性，在改变方向时会促使他们进行额外的或独特的近端代偿，随着时间的推移，这可能会导致下背部疼痛。我们假设，有和没有LLA的人在矢状面和额状面会存在这种近端运动学差异。我们比较了8名单侧LLA患者（4名大腿截肢患者和4名小腿截肢患者）和5名未受伤的对照组在向左（n = 10）和向右（n = 10）进行90度转身时的三维躯干和骨盆运动学、平移和旋转动量以及协调相位/变异性。参与者根据关于何时以及向哪个方向转身的语言提示自行选择转身策略（即步转与自旋）和枢轴肢体。在两种转身类型中，两组之间的协调变异性和平移角动量没有差异。在自旋转身过程中，与没有LLA的人相比，有LLA的人额状面旋转角动量更大，额状面躯干-骨盆运动范围更小。在步转过程中，与没有LLA的人相比，有LLA的人骨盆领先的横向协调更频繁，额状面躯干旋转角动量更小，矢状面骨盆运动范围更大。LLA患者中躯干-骨盆动力学的改变和任务依赖性调节为反复暴露于改变的躯干-骨盆动力学与下背部疼痛风险增加之间的潜在联系提供了额外支持。
