Nakajima Hiroshi, Yamamoto Sumiko, Katsuhira Junji
Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Ibaraki 300-0395, Japan.
International University of Health and Welfare, 1-3-3 Minami-Aoyama, Minato-ku, Tokyo 107-0062, Japan.
Clin Biomech (Bristol). 2018 Jul;56:84-89. doi: 10.1016/j.clinbiomech.2018.05.005. Epub 2018 May 9.
Patients with diabetes often develop diabetic peripheral neuropathy, which is a distal symmetric polyneuropathy, so foot function on the non-amputated side is expected to affect gait in vascular trans-tibial amputees. However, there is little information on the kinematics and kinetics of gait or the effects of diabetic peripheral neuropathy in vascular trans-tibial amputees. This study aimed to clarify these effects, including the biomechanics of the ankle on the non-amputated side.
Participants were 10 vascular trans-tibial amputees with diabetic peripheral neuropathy (group V) and 8 traumatic trans-tibial amputees (group T). Each subject's gait was analyzed at a self-selected speed using a three-dimensional motion analyzer and force plates.
Ankle plantarflexion angle, heel elevation angle, and peak and impulse of anterior ground reaction force were smaller on the non-amputated side during pre-swing in group V than in group T. Center of gravity during pre-swing on the non-amputated side was lower in group V than in group T. Hip extension torque during loading response on the prosthetic side was greater in group V than in group T.
These findings suggest that the biomechanical function of the ankle on the non-amputated side during pre-swing is poorer in vascular trans-tibial amputees with DPN than in traumatic trans-tibial amputees; the height of the center of gravity could not be maintained during this phase in vascular trans-tibial amputees with diabetic peripheral neuropathy. The hip joint on the prosthetic side compensated for this diminished function at the ankle during loading response.
糖尿病患者常发生糖尿病周围神经病变，这是一种远端对称性多神经病变，因此预计非截肢侧的足部功能会影响血管性经胫截肢者的步态。然而，关于血管性经胫截肢者步态的运动学和动力学或糖尿病周围神经病变的影响，相关信息较少。本研究旨在阐明这些影响，包括非截肢侧踝关节的生物力学。
参与者为10名患有糖尿病周围神经病变的血管性经胫截肢者（V组）和8名创伤性经胫截肢者（T组）。使用三维运动分析仪和测力板以自选速度分析每个受试者的步态。
在V组中，摆动前期非截肢侧的踝关节跖屈角度、足跟抬高角度以及前向地面反作用力的峰值和冲量均小于T组。V组摆动前期非截肢侧的重心低于T组。V组假肢侧在负重反应期间的髋关节伸展扭矩大于T组。
这些发现表明，与创伤性经胫截肢者相比，患有糖尿病周围神经病变的血管性经胫截肢者在摆动前期非截肢侧踝关节的生物力学功能较差；患有糖尿病周围神经病变的血管性经胫截肢者在此阶段无法维持重心高度。假肢侧的髋关节在负重反应期间补偿了踝关节功能的减弱。
