Armitage Lucy, Buller Angela, Rajan Ginu, Prusty Gangadhara, Simmons Anne, Kark Lauren
Graduate School of Biomedical Engineering, UNSW Sydney, Sydney, NSW, Australia.
OAPL, Redfern, NSW, Australia.
Prosthet Orthot Int. 2020 Feb;44(1):18-26. doi: 10.1177/0309364619868364. Epub 2019 Nov 26.
The clinical utility of measuring pressure at the prosthetic socket-residual limb interface is currently unknown.
This study aimed to identify whether measuring interface pressure during prosthetic design and fabrication results in closer agreement in pressure measurements between sockets made by different clinicians, and a reduction in pressure over areas of concern. It also investigated whether clinicians value knowing the interface pressure during the fabrication process.
Mixed methods.
Three prosthetists designed a complete prosthetic system for a transtibial residual limb surrogate. Standardised mechanical testing was performed on each prosthetic system to gain pressure measurements at four key anatomical locations. These measurements were provided to the clinicians, who subsequently modified their sockets as each saw fit. The pressure at each location was re-measured. Each prosthetist completed a survey that evaluated the usefulness of knowing interface pressures during the fabrication process.
Feedback and subsequent socket modifications saw a reduction in the pressure measurements at three of the four anatomical locations. Furthermore, the pressure measurements between prosthetists converged. All three prosthetists found value in the pressure measurement system and felt they would use it clinically.
Results suggest that sensors measuring pressure at the socket-limb interface has clinical utility in the context of informing prosthetic socket design and fabrication. If the technology is used at the check socket stage, iterative designs with repeated measurements can result in increased consistency between clinicians for the same residual limb, and reductions in the magnitudes of pressures over specific anatomical landmarks.
This study provides new information on the value of pressure feedback to the prosthetic socket design process. It shows that with feedback, socket modifications can result in reduced limb pressures, and more consistent pressure distributions between prosthetists. It also justifies the use of pressure feedback in informing clinical decisions.
目前尚不清楚测量假肢接受腔与残肢界面处压力的临床效用。
本研究旨在确定在假肢设计和制造过程中测量界面压力是否能使不同临床医生制作的接受腔之间的压力测量结果更一致，以及关注区域的压力是否降低。本研究还调查了临床医生是否重视在制造过程中了解界面压力。
混合方法。
三名假肢矫形师为一名经胫残肢模型设计了一套完整的假肢系统。对每个假肢系统进行标准化机械测试，以获取四个关键解剖位置的压力测量值。这些测量值提供给临床医生，临床医生随后根据各自的判断对接受腔进行修改。重新测量每个位置的压力。每位假肢矫形师都完成了一项调查，评估在制造过程中了解界面压力的有用性。
通过反馈及随后对接受腔的修改，四个解剖位置中的三个位置的压力测量值有所降低。此外，假肢矫形师之间的压力测量结果趋于一致。所有三名假肢矫形师都发现压力测量系统具有价值，并认为他们会在临床中使用该系统。
结果表明，在假肢接受腔设计和制造过程中，测量接受腔与肢体界面压力的传感器具有临床效用。如果在检查接受腔阶段使用该技术，通过重复测量进行迭代设计可使同一残肢的临床医生之间的一致性提高，并降低特定解剖标志处的压力大小。
本研究提供了有关压力反馈对假肢接受腔设计过程价值的新信息。研究表明，通过反馈，接受腔的修改可降低肢体压力，并使假肢矫形师之间的压力分布更一致。这也证明了在临床决策中使用压力反馈的合理性。
