Gholizadeh Hossein, Lemaire Edward D, Sinitski Emily H
Ottawa Hospital Research Institute, Centre for Rehabilitation Research and Development, Ottawa, Canada; Prosthetics & Orthotics, Ottawa Hospital Rehabilitation Centre, Ottawa, Canada.
Ottawa Hospital Research Institute, Centre for Rehabilitation Research and Development, Ottawa, Canada; Faculty of Medicine, University of Ottawa, Canada.
Gait Posture. 2018 Sep;65:205-212. doi: 10.1016/j.gaitpost.2018.07.059. Epub 2018 Jul 26.
People with lower limb amputation may experience walking limitations on slopes because of missing musculoskeletal and neuromuscular systems. Elevated vacuum suspension could benefit transtibial amputee gait for slope walking, but research is lacking to inform clinical practice.
Twelve people with unilateral transtibial amputation were fitted with the Unity elevated vacuum suspension system (Össur) and Pro-Flex XC foot. 3D motion analysis was performed for 7° incline, 7° decline, and level walking within a CAREN-Extended system virtual Park environment. Randomized and blinded walking trials were completed with the vacuum active or inactive.
Statistically significant differences (p < 0.05) were found between vacuum conditions when walking uphill or downhill for temporal spatial, kinematic, and kinetic gait parameters; however, effect sizes were small (r≤0.35). Prosthetic step length decreased for both vacuum conditions on downhill compared to uphill walking. Symmetry index was <10% for step length, step time, and stance time for both vacuum condition during downhill walking, indicating acceptable symmetry. During incline walking, step length was only symmetrical with active vacuum. Knee range of motion was not restricted, for both conditions.
Active vacuum improved gait symmetry for incline walking, but the other differences between vacuum conditions were small and may not be clinically significant. Therefore, the Unity system approach for elevated vacuum suspension had a positive, but small, effect on walking and should maintain appropriate walking even with vacuum failure, until limb volume changes adversely affect socket fit (i.e., elevated vacuum helps control limb volume fluctuations over time).
下肢截肢患者由于肌肉骨骼和神经肌肉系统缺失，在斜坡行走时可能会遇到行走限制。升高真空悬吊系统可能有益于经胫截肢者在斜坡行走时的步态，但缺乏相关研究为临床实践提供参考。
12名单侧经胫截肢患者安装了Unity升高真空悬吊系统（奥索公司）和Pro-Flex XC假脚。在CAREN扩展系统虚拟公园环境中，对7°上坡、7°下坡和平地行走进行三维运动分析。在真空开启或关闭的情况下完成随机双盲行走试验。
在上坡或下坡行走时，真空条件之间在时空、运动学和动力学步态参数方面存在统计学显著差异（p<0.05）；然而，效应量较小（r≤0.35）。与上坡行走相比，下坡时两种真空条件下的假肢步长均减小。下坡行走时，两种真空条件下的步长、步时和站立时的对称指数均<10%，表明对称性可接受。在上坡行走时，仅在真空开启时步长对称。两种情况下，膝关节活动范围均未受限。
开启真空可改善上坡行走时的步态对称性，但真空条件之间的其他差异较小，可能不具有临床意义。因此，Unity系统的升高真空悬吊方法对行走有积极但较小的影响，即使真空失效也应能保持适当行走，直到肢体体积变化对接受腔适配产生不利影响（即升高真空有助于控制肢体体积随时间的波动）。
