Davie-Smith Fiona, Carse Bruce
WestMARC, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom.
Prosthet Orthot Int. 2021 Jun 1;45(3):198-204. doi: 10.1097/PXR.0000000000000017.
The Scottish Specialist Prosthetics Service has provided microprocessor knees (MPKs) through the National Health Service since 2014, predominantly to high-activity transfemoral amputations (TFAs). Benefits of MPKs to the lower-activity TFA are less established in the literature.
This study aimed to compare patient-reported and functional measures in low-activity TFAs transitioning from a mechanical knee to a MPK.
This is a retrospective cohort analysis of low-activity individuals with a unilateral TFA provided with an MPK.
Patient-reported measures were recorded in routine clinical care before and 6 months after MPK provision. These included HR-QoL (EQ-5D-5L Health Index), Activities Balance Confidence score, Prosthetic Limb User Survey of Mobility, falls frequency, use of walking aids, and Socket Comfort Score. Functional measures included the two-minute walk test (2MWT), L-test, and Amputee Mobility Predictor score, and three-dimensional gait analysis was used to generate a Gait Profile Score (GPS). The primary outcomes were HR-QoL and GPS.
Forty-five participants fulfilled the inclusion criteria. Thirty-one had pre-MPK and post-MPK measures, of which 15 had three-dimensional gait analysis. The mean age (n = 31) was 60 years (SD 11), and 68% were male. HR-QoL and GPS did not significantly improve with MPK provision (p = 0.014 and p = 0.019); Amputee Mobility Predictor score, L-Test, 2MWT, falls, and Activities Balance Confidence score showed a significant improvement with MPK provision (p < 0.001).
Although no statistically significant change in the primary outcomes was measured, there were sufficient data to support MPK provision in low-activity prosthetic users with participants demonstrating improvements in balance, 2MWT, falls frequency, and confidence.
自2014年以来，苏格兰专科假肢服务机构通过国民医疗服务体系提供微处理器膝关节（MPK），主要针对高活动量的经股骨截肢（TFA）患者。MPK对低活动量TFA患者的益处，在文献中尚无定论。
本研究旨在比较低活动量TFA患者从机械膝关节转换为MPK后，患者报告的指标和功能指标。
这是一项对接受MPK的单侧低活动量TFA患者的回顾性队列分析。
在提供MPK之前和之后6个月的常规临床护理中记录患者报告的指标。这些指标包括健康相关生活质量（EQ-5D-5L健康指数）、活动平衡信心评分、假肢使用者活动能力调查、跌倒频率、助行器使用情况以及接受腔舒适度评分。功能指标包括两分钟步行测试（2MWT）、L测试、截肢者活动能力预测评分，并且使用三维步态分析生成步态轮廓评分（GPS）。主要结局指标为健康相关生活质量和GPS。
45名参与者符合纳入标准。其中31名有MPK植入前后的指标，其中15名进行了三维步态分析。平均年龄（n = 31）为60岁（标准差11），68%为男性。提供MPK后，健康相关生活质量和GPS没有显著改善（p = 0.014和p = 0.019）；截肢者活动能力预测评分、L测试、2MWT、跌倒情况以及活动平衡信心评分在提供MPK后有显著改善（p < 0.001）。
虽然主要结局指标没有统计学上的显著变化，但有足够的数据支持为低活动量假肢使用者提供MPK，参与者在平衡能力、2MWT、跌倒频率和信心方面均有改善。
