Acasio Julian C, Butowicz Courtney M, Dearth Christopher L, Bazrgari Babak, Hendershot Brad D
Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA; Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA.
Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA; Research & Surveillance Division, DoD-VA Extremity Trauma and Amputation Center of Excellence, USA.
J Biomech. 2022 Apr;135:111028. doi: 10.1016/j.jbiomech.2022.111028. Epub 2022 Mar 2.
Persons with lower limb amputation (LLA) are at high risk for developing chronic low back pain (LBP), often with biomechanical factors considered as likely contributors. Here, trunk and pelvis kinematics, muscle forces, and resultant spinal loads were characterized in persons with LLA, with and without chronic LBP. Thirty-five persons with unilateral LLA - 19 with chronic LBP ("LLA-cLBP"), 16 without LBP ("LLA-nLBP") - and 15 (uninjured) persons without LBP ("CTR-nLBP") walked overground (1.3 m/s) while thorax and pelvis kinematics were tracked (and ranges of motion [ROM] computed), and used as inputs for a non-linear finite element model of the spine to estimate global and local muscle forces, and resultant spinal loads. In the frontal and transverse planes, thorax ROM were up to 66.6% smaller in LLA-nLBP versus LLA-cLBP (P < 0.001) and CTR-nLBP (P < 0.001). In the sagittal plane, pelvis ROM was 50.4% smaller in LLA-nLBP versus LLA-cLBP (P = 0.014). LLA-cLBP exhibited 45.5% and 34.2% greater peak local and global muscle forces, respectively, versus CTR-nLBP (P < 0.011). Up to 48.1% greater spinal loads were observed in LLA-cLBP versus CTR-nLBP (P < 0.013); peak compression and local muscle forces were respectively 20.2% and 41.0% larger in LLA-nLBP versus CTR-nLBP (P < 0.005). Despite differences in trunk and pelvis kinematics between LLA-cLBP and LLA-nLBP, trunk muscle forces and spinal loads were similar (P > 0.101) between these groups. Similar loading parameters regardless of LBP presence, while highly dependent on trunk muscle activation strategies, may mitigate further accumulation of mechanical fatigue. It remains important to understand the temporality of loading with respect to LBP onset following LLA.
下肢截肢(LLA)患者患慢性腰痛(LBP)的风险很高,生物力学因素通常被认为是可能的促成因素。在此,对有和没有慢性LBP的LLA患者的躯干和骨盆运动学、肌肉力量及脊柱负荷进行了特征分析。35名单侧LLA患者——19名患有慢性LBP(“LLA-cLBP”),16名没有LBP(“LLA-nLBP”)——以及15名(未受伤)无LBP的人(“CTR-nLBP”)在地面上行走(速度为1.3米/秒),同时跟踪胸部和骨盆运动学(并计算运动范围[ROM]),并将其用作脊柱非线性有限元模型的输入,以估计整体和局部肌肉力量以及脊柱负荷。在额面和横断面上,LLA-nLBP患者的胸部ROM比LLA-cLBP患者小66.6%(P<0.001),比CTR-nLBP患者小66.6%(P<0.001)。在矢状面上,LLA-nLBP患者的骨盆ROM比LLA-cLBP患者小50.4%(P=0.014)。与CTR-nLBP相比,LLA-cLBP患者的局部和整体肌肉力量峰值分别高出45.5%和34.2%(P<0.011)。与CTR-nLBP相比,LLA-cLBP患者的脊柱负荷高出48.1%(P<0.013);LLA-nLBP患者的峰值压缩和局部肌肉力量分别比CTR-nLBP患者大20.2%和41.0%(P<0.005)。尽管LLA-cLBP和LLA-nLBP患者的躯干和骨盆运动学存在差异,但这些组之间的躯干肌肉力量和脊柱负荷相似(P>0.101)。无论是否存在LBP,相似的负荷参数虽然高度依赖于躯干肌肉激活策略,但可能会减轻机械疲劳的进一步积累。了解LLA后LBP发作时负荷的时间性仍然很重要。