Schmid-Zalaudek Karin, Fischer Theresa, Száva Zoltán, Lackner Helmut Karl, Kropiunig Ursula, Bittner Christian, Höcker Karl, Winkler Günther, Peternell Gerfried
Physiology Division, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, 8010 Graz, Austria.
Information and Communication Technology Division, Austrian Workers' Compensation Board (AUVA), 1100 Vienna, Austria.
J Clin Med. 2022 May 10;11(10):2683. doi: 10.3390/jcm11102683.
Unilateral lower limb amputations usually present with asymmetric interlimb gait patterns, in the long term leading to secondary physical conditions and carrying the risk of low physical activity and impairment of general health. To assess prosthetic fittings and rehabilitation measures, reference values for asymmetries as well as the most significant gait parameters are required. Kinetic gait data of 865 patients with unilateral lower limb amputations (hip and knee disarticulations, transfemoral, transtibial and foot amputations) and 216 able-bodied participants were quantitatively assessed by instrumented gait analyses. Characteristic spatiotemporal (stance time, walking speed, step length and width) and ground reaction force parameters (weight-acceptance and push-off peak) were contrasted to normal gait. All spatiotemporal and ground reaction force parameters differed significantly from normal gait with the largest differences in transfemoral amputations. These also differed between amputation levels and showed age-dependencies. The stance time and push-off peak difference were identified as the most discriminative parameters with the highest diagnostic specificity and sensitivity. The present results mark the first step to establishing universal reference values for gait parameters by means of which the quality and suitability of a prosthetic fitting and the rehabilitation progress can be assessed, and are generalizable for all adults with unilateral lower limb amputations in terms of level walking.
单侧下肢截肢通常会出现不对称的肢体间步态模式，长期来看会导致继发性身体状况，并存在身体活动量低和整体健康受损的风险。为了评估假肢适配和康复措施，需要不对称性以及最重要的步态参数的参考值。通过仪器化步态分析对865名单侧下肢截肢患者（髋关节和膝关节离断、大腿截肢、小腿截肢和足部截肢）和216名健全参与者的动态步态数据进行了定量评估。将特征性时空参数（站立时间、步行速度、步长和步宽）和地面反作用力参数（承重和蹬离峰值）与正常步态进行对比。所有时空参数和地面反作用力参数与正常步态均有显著差异，其中大腿截肢的差异最大。这些差异在截肢水平之间也有所不同，并且呈现出年龄依赖性。站立时间和蹬离峰值差异被确定为最具鉴别力的参数，具有最高的诊断特异性和敏感性。目前的结果标志着通过建立步态参数通用参考值来评估假肢适配质量和适用性以及康复进展的第一步，并且对于所有单侧下肢截肢的成年人在平地行走方面具有普遍适用性。
