Department of Mechanical Engineering, University of Colorado Denver, Denver, CO, United States of America; Center for Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America.
Department of Mechanical Engineering, University of Colorado Denver, Denver, CO, United States of America.
Clin Biomech (Bristol). 2022 Aug;98:105715. doi: 10.1016/j.clinbiomech.2022.105715. Epub 2022 Jul 9.
Patients with transfemoral amputation and socket prostheses are at a heightened risk of developing musculoskeletal overuse injuries, commonly due to altered joint biomechanics. Osseointegrated prostheses, which involve direct anchorage of the prosthesis to the residual limb through a bone anchored prosthesis, are a novel alternative to sockets yet their biomechanical effect is largely unknown.
Four patients scheduled to undergo unilateral transfemoral prosthesis osseointegration completed two data collections (baseline with socket prosthesis and 12-months after prosthesis osseointegration) in which whole-body kinematics and ground reaction forces were collected during stand-to-sit tasks. Trunk, pelvis, and hip kinematics, and the surrounding muscle forces, were calculated using subject-specific musculoskeletal models developed in OpenSim. Peak joint angles and muscle forces were compared between timepoints using Cohen's d effect sizes.
Compared to baseline with socket prostheses, patients with osseointegrated prostheses demonstrated reduced lateral trunk bending (d = 1.46), pelvic obliquity (d = 1.09), and rotation (d = 1.77) toward the amputated limb during the stand to sit task. This was accompanied by increased amputated limb hip flexor, abductor, and rotator muscle forces (d> > 0.8).
Improved lumbopelvic movement patterns and stabilizing muscle forces when using an osseointegrated prosthesis indicate that this novel prosthesis type likely reduces the risk of the development and/or progression of overuse injuries, such as low back pain and osteoarthritis. We attribute the increased muscle hip muscle forces to the increased load transmission between the osseointegrated prosthesis and residual limb, which allows a greater eccentric ability of the amputated limb to control lowering during the stand-to-sit task.
接受股骨截肢和接受接受腔假肢的患者存在发生肌肉骨骼过度使用损伤的风险增加，通常是由于关节生物力学改变所致。骨整合假肢是一种新型的替代接受腔的方法，它通过骨锚定假体将假体直接固定在残肢上，但它们的生物力学效果在很大程度上尚不清楚。
4 名计划接受单侧股骨假体骨整合的患者完成了两次数据采集（使用接受腔假肢的基线和假体骨整合后 12 个月），在此期间，在站立到坐下任务中收集了全身运动学和地面反作用力。使用在 OpenSim 中开发的基于个体的肌肉骨骼模型计算了躯干、骨盆和臀部运动学以及周围肌肉力。使用 Cohen's d 效应量比较了两个时间点的峰值关节角度和肌肉力。
与使用接受腔假肢的基线相比，使用骨整合假肢的患者在站立到坐下任务中向截肢侧的侧向躯干弯曲（d=1.46）、骨盆倾斜（d=1.09）和旋转（d=1.77）减少。这伴随着截肢侧髋关节屈肌、外展肌和旋转肌的力量增加（d>0.8）。
使用骨整合假肢时，腰骨盆运动模式的改善和稳定肌肉力量表明，这种新型假体类型可能降低过度使用损伤（如腰痛和骨关节炎）的发展和/或进展的风险。我们将髋关节肌肉力量的增加归因于骨整合假体和残肢之间增加的负荷传递，这允许截肢侧在站立到坐下任务中更有效地控制降低。
