下肢关节力矩在接受股骨截肢术后骨整合一年后的变化：一个病例系列。
Changes in lower extremity joint moments one-year following osseointegration in individuals with Transfemoral lower-limb amputation: A case series.
机构信息
Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Geriatrics, Geriatric Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Aurura, CO, USA.
Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Geriatrics, Geriatric Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Aurura, CO, USA.
出版信息
Clin Biomech (Bristol). 2023 Apr;104:105948. doi: 10.1016/j.clinbiomech.2023.105948. Epub 2023 Mar 27.
BACKGROUND
Dissatisfaction with socket prostheses has led to the development of bone-anchored prostheses through osseointegration for people with transfemoral amputation, eliminating the need for a prosthetic socket. Gait deviations of transfemoral prosthesis users may be linked to increased risk of osteoarthritis, and it remains unknown if gait biomechanics change following osseointegration. The purpose of this case series was to evaluate the longitudinal changes in joint kinetics one year post-osseointegration in patients with transfemoral amputation during walking.
METHODS
Knee, hip, and trunk internal moments were evaluated in the prosthetic and intact limbs during walking at a self-selected speed in four participants pre- and one-year post-osseointegration. Longitudinal changes were quantified using the percent change (%∆) in peak joint moments between the two time points and Cohen's d (d) effect size was used to determine the magnitude of effect on joint moments during walking one year following osseointegration.
FINDINGS
Participants demonstrated increased peak knee extension moment (224 ± 308%∆, d = -1.31) in the prosthetic limb, while demonstrating reduced peak knee extension moment (-43 ± 34%∆, d = 1.82) in the intact limb post-osseointegration. Participants demonstrated bilateral reduction of peak hip extension moment (prosthetic: -22 ± 37%∆, d = 0.86; intact: -29 ± 10%∆, d = 1.27) and bilateral increase of peak hip abduction moment (prosthetic: 45 ± 40%∆, d = 1.20; intact: 23 ± 44%∆, d = 0.74) post-osseointegration. Participants demonstrated reduced peak trunk moments on both the prosthetic (extension: -31 ± 16%∆, d = 1.51; lateral flexion: -21 ± 20%∆, d = 0.63) and intact side (extension: -7 ± 22%∆, d = 0.38; lateral flexion: -22 ± 18%∆, d = 1.12) post-osseointegration.
INTERPRETATION
This case series suggests improved gait symmetry in individuals with transfemoral amputation one year following osseointegration, justifying future investigation.
背景
由于对义肢接受腔的不满，骨整合式的骨锚式义肢已被开发出来，用于股骨截肢患者，从而消除了对义肢接受腔的需求。股骨截肢患者的步态偏差可能与骨关节炎风险增加有关，但目前尚不清楚骨整合后生物力学步态是否会发生变化。本病例系列研究的目的是评估股骨截肢患者在骨整合后一年内行走时的关节动力学纵向变化。
方法
在 4 名参与者骨整合术前和术后一年，以自身选择的速度行走时，评估了假肢和未受损肢体的膝关节、髋关节和躯干内力矩。使用两个时间点之间的峰值关节力矩的百分比变化（%∆）来量化纵向变化，并用 Cohen's d（d）效应量来确定骨整合后一年行走时关节力矩的变化程度。
结果
参与者在假肢侧表现出更大的峰值膝关节伸展力矩（224±308%∆，d=-1.31），而在未受损侧表现出较小的峰值膝关节伸展力矩（-43±34%∆，d=1.82）。参与者在双侧都表现出峰值髋关节伸展力矩的减小（假肢：-22±37%∆，d=0.86；未受损：-29±10%∆，d=1.27）和峰值髋关节外展力矩的增加（假肢：45±40%∆，d=1.20；未受损：23±44%∆，d=0.74）。参与者在假肢侧和未受损侧的躯干都表现出较小的峰值力矩（伸展：-31±16%∆，d=1.51；侧屈：-21±20%∆，d=0.63）。
解释
本病例系列研究表明，股骨截肢患者在骨整合后一年的步态对称性得到了改善，这为进一步的研究提供了依据。
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