Research Centre for Musculoskeletal Science and Sports Medicine, Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK; School of Health Sciences, University of Salford, Salford, UK.
Research Centre for Musculoskeletal Science and Sports Medicine, Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK.
Ann Phys Rehabil Med. 2021 Jan;64(1):101395. doi: 10.1016/j.rehab.2020.04.007. Epub 2020 Aug 26.
Previous work has highlighted the highly functional post-rehabilitation level of military individuals who sustained traumatic amputation. Understanding how these individuals walk with their prosthesis could be key to setting a precedent for what is realistically possible in the rehabilitation of individuals with amputations.
The aim of this paper is to answer how "normal" should the gait of an individual with an amputation(s) be and can we aspire to mimic able-bodied gait with the most advanced prosthetics in highly functioning individuals?
This was a cross-sectional study comparing the gait of severely injured and highly functional UK trans-tibial (n=10), trans-femoral (n=10) and bilateral trans-femoral (n=10) military amputees after completion of their rehabilitation programme to that of able-bodied controls (n=10). Joint kinematics and kinetics of the pelvis, hip, knee and ankle were measured with 3-D gait analysis during 5min of walking on level ground at a self-selected speed. Peak angle, moment or range of motion of intact and prosthetic limbs were compared to control values.
Joint kinematics of unilateral trans-tibial amputees was similar to that of controls. Individuals with a trans-femoral amputation walked with a more anterior tilted pelvis (P=0.006), with reduced range of pelvic obliquity (P=0.0023) and ankle plantarflexion (P<0.001) than controls. Across all amputee groups, hip joint moments and power were greater and knee and ankle joint moments were less than for controls.
This is the first study to provide a comprehensive description of gait patterns of unilateral trans-tibial, trans-femoral and bilateral trans-femoral amputees as compared with healthy able-bodied individuals. The groups differed in joint kinematics and kinetics, but these can be expected in part because of limitations in prosthesis and socket designs. The results from this study could be considered benchmark data for healthcare professionals to compare gait patterns of other individuals with amputation who experienced similar injuries and rehabilitation services.
先前的研究强调了经历创伤性截肢的军人在康复后的高度功能性。了解这些个体如何使用假肢行走，可能是为截肢患者的康复设定现实目标的关键。
本文旨在回答截肢患者的步态应该“正常”到什么程度，并且我们是否可以期望在高度功能性个体中使用最先进的假肢来模拟健全人的步态。
这是一项横断面研究，比较了完成康复计划后的 10 名严重受伤和高度功能性的英国胫骨（n=10）、股骨（n=10）和双侧股骨（n=10）截肢军人与 10 名健全对照者的步态。在水平地面上以自我选择的速度行走 5 分钟期间，使用三维步态分析测量骨盆、髋关节、膝关节和踝关节的运动学和动力学。将完整和假肢肢体的峰值角度、力矩或运动范围与对照值进行比较。
单侧胫骨截肢者的关节运动学与对照组相似。股骨截肢者骨盆前倾（P=0.006），骨盆倾斜度（P=0.0023）和踝关节跖屈（P<0.001）范围减小。在所有截肢者组中，髋关节力矩和功率大于对照组，膝关节和踝关节力矩小于对照组。
这是第一项比较单侧胫骨、股骨和双侧股骨截肢者与健康健全个体步态模式的全面描述的研究。这些组在关节运动学和动力学方面存在差异，但部分原因是假肢和插座设计的限制。本研究的结果可以被认为是医疗保健专业人员比较经历类似损伤和康复服务的其他截肢患者步态模式的基准数据。
