Department of Kinesiology, University of Illinois at Chicago, 1919 West Taylor Street, Rm. 646, Chicago, IL, 60612, USA.
Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, 60611, USA.
J Neuroeng Rehabil. 2023 Apr 25;20(1):50. doi: 10.1186/s12984-023-01166-z.
Hip muscles play a prominent role in compensating for the loss of ankle and/or knee muscle function after lower limb amputation. Despite contributions to walking and balance, there is no consensus regarding hip strength deficits in lower limb prosthesis (LLP) users. Identifying patterns of hip muscle weakness in LLP users may increase the specificity of physical therapy interventions (i.e., which muscle group(s) to target), and expedite the search for modifiable factors associated with deficits in hip muscle function among LLP users. The purpose of this study was to test whether hip strength, estimated by maximum voluntary isometric peak torque, differed between the residual and intact limbs of LLP users, and age- and gender-matched controls.
Twenty-eight LLP users (14 transtibial, 14 transfemoral, 7 dysvascular, 13.5 years since amputation), and 28 age- and gender-matched controls participated in a cross-sectional study. Maximum voluntary isometric hip extension, flexion, abduction, and adduction torque were measured with a motorized dynamometer. Participants completed 15 five-second trials with 10-s rest between trials. Peak isometric hip torque was normalized to body mass × thigh length. A 2-way mixed-ANOVA with a between-subject factor of leg (intact, residual, control) and a within-subject factor of muscle group (extensors, flexors, abductors, adductors) tested for differences in strength among combinations of leg and muscle group (α = 0.05). Multiple comparisons were adjusted using Tukey's Honest-Difference.
A significant 2-way interaction between leg and muscle group indicated normalized peak torque differed among combinations of muscle group and leg (p < 0.001). A significant simple main effect of leg (p = 0.001) indicated peak torque differed between two or more legs per muscle group. Post-hoc comparisons revealed hip extensor, flexor, and abductor peak torque was not significantly different between the residual and control legs (p ≥ 0.067) but torques in both legs were significantly greater than in the intact leg (p < 0.001). Peak hip abductor torque was significantly greater in the control and residual legs than the intact leg (p < 0.001), and significantly greater in the residual than control leg (p < 0.001).
Our results suggest that it is the intact, rather than the residual limb, that is weaker. These findings may be due to methodological choices (e.g., normalization), or biomechanical demands placed on residual limb hip muscles. Further research is warranted to both confirm, expand upon, and elucidate possible mechanisms for the present findings; and clarify contributions of intact and residual limb hip muscles to walking and balance in LLP users.
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髋关节肌肉在下肢截肢后补偿踝关节和/或膝关节肌肉功能丧失方面起着重要作用。尽管髋关节肌肉在行走和平衡方面有贡献，但对于下肢假肢（LLP）使用者的髋关节力量缺陷尚无共识。确定 LLP 用户中髋关节肌肉无力的模式可能会增加物理治疗干预的特异性（即针对哪个肌肉群），并加快寻找与 LLP 用户髋关节功能缺陷相关的可改变因素。本研究的目的是测试 LLP 用户的残余肢体和完整肢体的髋关节力量（通过最大自主等长峰值扭矩估计）是否存在差异，以及与年龄和性别匹配的对照组。
28 名 LLP 用户（14 名胫骨截肢，14 名股骨截肢，7 名血管性截肢，截肢后 13.5 年）和 28 名年龄和性别匹配的对照组参加了一项横断面研究。使用电动测力计测量最大自主等长髋关节伸展、屈曲、外展和内收扭矩。参与者完成了 15 次 5 秒的试验，每次试验之间休息 10 秒。等长髋关节峰值扭矩按体重×大腿长度进行归一化。使用 2 因素混合方差分析（腿（完整、残余、对照）的组间因素和肌肉群（伸肌、屈肌、外展肌、内收肌）的组内因素）测试腿和肌肉群组合之间的力量差异（α = 0.05）。使用 Tukey 的诚实差异法进行多重比较调整。
腿和肌肉群之间的显著 2 因素相互作用表明，肌肉群和腿的组合之间的归一化峰值扭矩存在差异（p < 0.001）。腿的显著简单主效应（p = 0.001）表明，每个肌肉群的两条或更多条腿之间的峰值扭矩存在差异。事后比较显示，髋关节伸肌、屈肌和外展肌的峰值扭矩在残余和对照腿之间没有显著差异（p ≥ 0.067），但在两条腿上的峰值扭矩均显著大于完整腿（p < 0.001）。髋关节外展肌的峰值扭矩在对照和残余腿上明显大于完整腿（p < 0.001），在残余腿上明显大于对照腿（p < 0.001）。
我们的结果表明，较弱的是完整的腿，而不是残余的腿。这些发现可能是由于方法学选择（例如，归一化）或残余肢体髋关节肌肉的生物力学需求所致。需要进一步研究来证实、扩展和阐明当前发现的可能机制，并阐明 LLP 用户中残余和完整肢体髋关节肌肉对行走和平衡的贡献。
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