Brown Starr E, Russell Esposito Elizabeth, Ikeda Andrea J, Wilken Jason M, Fatone Stefania
Center for the Intrepid, San Antonio Military Medical Center.
US Army Med Dep J. 2018 Jul-Dec(2-18):38-47.
Ischial containment sockets are the current standard of care for military service members with transfemoral amputation. However, they fit intimately with the ischium, which may limit hip motion and contribute to proximal socket discomfort, a common complaint among prosthesis users. Subischial sockets, such as the newly described Northwestern University Flexible Subischial Vacuum (NU-FlexSIV) Socket technique, do not interact with the ischium, potentially increasing hip motion and improving comfort.
To transfer the NU-FlexSIV Socket technique to military prosthetists and evaluate performance among military service members with transfemoral amputation.
case series.
Four of the 11 enrolled subjects completed the study protocol comparing the NU-FlexSIV Socket to the ischial containment socket. Gait kinematics (over ground and on stairs), physical performance measures (Four-Square Step Test, T-test of Agility, and an obstacle course), limb-socket motion, and socket comfort were assessed after accommodation time in each socket.
While wearing the NU-FlexSIV Socket, sagittal plane hip motion generally increased while coronal plane trunk motion and walking speed remained largely unaffected during over ground walking. During stair ascent, sagittal plane hip motion increased while wearing the NU-FlexSIV Socket, with minimal changes in walking speed for all subjects. Pre- and post-walking fluoroscopy measures suggest fit of the NU-FlexSIV Socket was less affected by activity. Most subjects reported that the NU-FlexSIV Socket was more comfortable for sitting but some found it less comfortable for walking and running. Performance measure results were mixed. Although attempts were made to consistently implement the NU-FlexSIV Socket technique, some challenges were experienced.
The NU-FlexSIV Socket provided greater hip motion across a variety of tasks without adversely affecting other movement mechanics but did not consistently improve socket comfort. Variability in the liners and socket materials used may have contributed to variability in results. Overall, the design was a viable alternative to traditional ischial containment sockets for some individuals with transfemoral amputation.
坐骨包容式接受腔是目前为经股骨截肢的军人提供护理的标准方式。然而，它们与坐骨紧密贴合，这可能会限制髋关节活动，并导致近端接受腔不适，这是假肢使用者常见的抱怨。坐骨下接受腔，如新描述的西北大学柔性坐骨下真空（NU-FlexSIV）接受腔技术，不与坐骨相互作用，有可能增加髋关节活动并提高舒适度。
将NU-FlexSIV接受腔技术传授给军队假肢技师，并评估经股骨截肢军人的使用性能。
病例系列。
11名入选受试者中的4名完成了将NU-FlexSIV接受腔与坐骨包容式接受腔进行比较的研究方案。在每个接受腔适应一段时间后，评估步态运动学（在平地和楼梯上）、身体性能指标（四方步测试、敏捷性T测试和障碍课程）、肢体与接受腔的运动以及接受腔舒适度。
在佩戴NU-FlexSIV接受腔时，在平地行走过程中，矢状面髋关节活动通常会增加，而冠状面躯干活动和步行速度在很大程度上保持不变。在爬楼梯时，佩戴NU-FlexSIV接受腔时矢状面髋关节活动增加，所有受试者的步行速度变化最小。步行前后的荧光透视测量表明，NU-FlexSIV接受腔的适配受活动影响较小。大多数受试者报告说，NU-FlexSIV接受腔坐着时更舒适，但有些人发现走路和跑步时不太舒服。性能指标结果不一。尽管已尝试一致地实施NU-FlexSIV接受腔技术，但仍遇到了一些挑战。
NU-FlexSIV接受腔在各种任务中提供了更大的髋关节活动度，而不会对其他运动力学产生不利影响，但并未始终如一地提高接受腔舒适度。所用衬垫和接受腔材料的差异可能导致了结果的差异。总体而言，对于一些经股骨截肢的个体，该设计是传统坐骨包容式接受腔的可行替代方案。
