Varrecchia Tiwana, Serrao Mariano, Rinaldi Martina, Ranavolo Alberto, Conforto Silvia, De Marchis Cristiano, Simonetti Andrea, Poni Ida, Castellano Simona, Silvetti Alessio, Tatarelli Antonella, Fiori Lorenzo, Conte Carmela, Draicchio Francesco
Department of Engineering, Roma TRE University, Via Vito Volterra 62, 00146 Rome, Italy.
Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Via Faggiana 34, 40100 Latina, Italy; Rehabilitation Centre, Policlinico Italia, Rome, Italy.
Hum Mov Sci. 2019 Aug;66:9-21. doi: 10.1016/j.humov.2019.03.008. Epub 2019 Mar 16.
The present study's aim was to identify the kinematic and kinetic gait patterns and to measure the energy consumption in people with amputation according to both the anatomical level of amputation and the type of prosthetic components in comparison with a control group matched for the gait speed. Fifteen subjects with unilateral transtibial amputation (TTA), forty with unilateral transfemoral amputation (TFA) (9 with mechanical, 17 with CLeg and 14 with Genium prosthesis) and forty healthy subjects were recruited. We computed the time-distance gait parameters; the range of angular motion (RoM) at hip, knee and ankle joints, and at the trunk and pelvis; the values of the 2 peaks of vertical force curve; the full width at half maximum (FWHM) and center of activity (CoA) of vertical force; the mechanical behavior in terms of energy recovery (R-step) and energy consumption. The main results were: i) both TTA and TFA show a common gait pattern characterized by a symmetric increase of step length, step width, double support duration, pelvic obliquity, trunk lateral bending and trunk rotation RoMs compared to control groups. They show also an asymmetric increase of stance duration and of Peak1 in non-amputated side and a decrease of ankle RoM in amputated side; ii) only TFA show a specific gait pattern, depending on the level of amputation, characterized by a symmetric reduction of R-step and an asymmetric decrease of stance duration, CoA and FWHM and an increase of Peak1 in the amputated side and of hip and knee RoM, CoA and FWHM in the non-amputated side; iii) people with amputation with Genium prosthesis show a longer step length and increased hip and knee RoMs compared to people with amputation with mechanical prosthesis who conversely show an increased pelvic obliquity: these are specific gait patterns depending of the type of prosthesis. In conclusion, we identified both common and specific gait patterns in people with amputation, either regardless of, or according to their level of amputation and the type of prosthetic component.
本研究的目的是确定截肢者的运动学和动力学步态模式，并根据截肢的解剖学水平和假肢组件类型测量其能量消耗，同时与步态速度匹配的对照组进行比较。招募了15名单侧经胫骨截肢（TTA）患者、40名单侧经股骨截肢（TFA）患者（9名使用机械假肢，17名使用CLeg假肢，14名使用Genium假肢）以及40名健康受试者。我们计算了时间-距离步态参数；髋、膝、踝关节以及躯干和骨盆的角运动范围（RoM）；垂直力曲线的两个峰值；垂直力的半高宽（FWHM）和活动中心（CoA）；能量回收（R步）和能量消耗方面的力学行为。主要结果如下：i）与对照组相比，TTA和TFA均表现出一种共同的步态模式，其特征为步长、步宽、双支撑持续时间、骨盆倾斜、躯干侧弯和躯干旋转RoM对称增加。他们还表现出非截肢侧站立持续时间和峰值1不对称增加，以及截肢侧踝关节RoM降低；ii）只有TFA表现出一种特定的步态模式，取决于截肢水平，其特征为R步对称减少，站立持续时间、CoA和FWHM不对称降低，截肢侧峰值1增加，非截肢侧髋和膝关节RoM、CoA和FWHM增加；iii）与使用机械假肢的截肢者相比，使用Genium假肢的截肢者步长更长，髋和膝关节RoM增加，而使用机械假肢的截肢者则相反，骨盆倾斜增加：这些是取决于假肢类型的特定步态模式。总之，我们确定了截肢者中既存在共同的步态模式，也存在特定的步态模式，这些模式要么与截肢水平和假肢组件类型无关，要么与之相关。
