National Research Center for Rehabilitation Technical Aids, No. 1, Ronghuazhonglu, BDA, Beijing, China; Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, No. 37, Xueyuan Road, Haidian District, Beijing, China; Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, No.1, Ronghuazhonglu, BDA, Beijing, China.
National Research Center for Rehabilitation Technical Aids, No. 1, Ronghuazhonglu, BDA, Beijing, China; Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, No.1, Ronghuazhonglu, BDA, Beijing, China.
Gait Posture. 2020 Feb;76:85-91. doi: 10.1016/j.gaitpost.2019.11.006. Epub 2019 Nov 7.
Prosthetic alignment directly affects the biomechanical loading in individuals with lower-limb amputation, and improper alignment may be contribute to the high incidence of hip and knee osteoarthritis (OA). The biomechanical changes caused by different alignments should be considered in prosthetic fitting. However, the quantitative effect of alignment on the kinetic features of individuals with transfemoral amputation remains unclear.
As important kinetics indexes, how are the hip and knee joint moments affected by prosthetic alignment in individuals with transfemoral amputation?
Gait tests of ten individuals with transfemoral amputation and fifteen individuals without amputation (control group) were performed. Several prosthetic alignment conditions were used, including the so-called "initial" alignment and eight malalignments. The hip and knee joint moments of the individuals with amputation under various alignments were analysed and compared with those of the control group. Statistical analyses were performed by one-way ANOVA, repeated measure multivariate ANOVA, and paired t tests.
The peaks and impulses of the hip abductor and external rotator moments on the residual side were significantly smaller than those of the control group (P < 0.0056). The peaks of the hip extensor, adductor and external rotator moments on the intact side were significantly larger than those on the residual side (P < 0.05). Alignment significantly affected the intact hip and knee joint moments for each individual with amputation (P < 0.00625), but there was no consistent effect among individuals.
The significantly larger hip joint moment on the intact side of individuals with transfemoral amputation may be associated with the higher incidence of hip OA on the intact side. Alignment significantly affects the hip and knee joint moments of each individual with transfemoral amputation, but the individual responses to alignment changes are different. This situation may imply that the method for optimizing alignment should be personalized.
下肢截肢者的假肢对线直接影响其生物力学负荷，对线不当可能导致髋膝骨关节炎（OA）的高发。在假肢适配中应考虑不同对线引起的生物力学变化。然而，不同对线对股骨截肢者的动力学特征的定量影响尚不清楚。
作为重要的动力学指标，股骨截肢者的假肢对线如何影响髋关节和膝关节的力矩？
对 10 名股骨截肢者和 15 名无截肢者（对照组）进行步态测试。使用了几种假肢对线条件，包括所谓的“初始”对线和 8 种对线不良。分析了截肢者在各种对线条件下的髋关节和膝关节力矩，并与对照组进行了比较。统计分析采用单因素方差分析、重复测量多变量方差分析和配对 t 检验。
残肢侧髋关节外展肌和外旋肌力矩的峰值和冲量明显小于对照组（P<0.0056）。健肢侧髋关节伸肌、内收肌和外旋肌力矩的峰值明显大于残肢侧（P<0.05）。对线显著影响每位截肢者的健肢髋关节和膝关节力矩（P<0.00625），但个体之间没有一致的影响。
股骨截肢者健肢髋关节力矩明显增大，可能与健肢 OA 发生率较高有关。对线显著影响每位股骨截肢者的髋关节和膝关节力矩，但个体对线变化的反应不同。这种情况可能意味着优化对线的方法应该因人而异。
