单侧股骨截肢患者残肢臀中肌在生物力学上处于劣势。
The Amputated Limb Gluteus Medius is Biomechanically Disadvantaged in Patients with Unilateral Transfemoral Amputation.
机构信息
Department of Mechanical Engineering, University of Colorado Denver, Denver, CO, USA.
Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
出版信息
Ann Biomed Eng. 2024 Mar;52(3):565-574. doi: 10.1007/s10439-023-03400-0. Epub 2023 Nov 9.
Patients with transfemoral amputation (TFA) are at an increased risk of secondary musculoskeleteal comorbidities, primarily due to asymmetric joint loading. Amputated limb muscle weakness is also prevalent in the TFA population, yet all factors that contribute to muscle strength and thus joint loading are not well understood. Our objective was to bilaterally compare gluteus medius (GMED) muscle factors (volume, fatty infiltration, moment arm) that all contribute to joint loading in patients with TFA. Quantitative magnetic resonance (MR) images of the hip were collected from eight participants with unilateral TFA (2M/6F; age: 47.3 ± 14.7 y/o; BMI: 25.4 ± 5.3 kg/m; time since amputation: 20.6 ± 15.0 years) and used to calculate normalized GMED muscle volume and fatty infiltration. Six participants participated in an instrumented gait analysis session that collected whole-body kinematics during overground walking. Subject-specific musculoskeletal models were used to calculate bilateral GMED (anterior, middle, posterior) moment arms and frontal plane hip joint angles across three gait cycles. Differences in volume, fatty infiltration, hip adduction-abduction angle, and peak moment arms were compared between limbs using paired Cohen's d effect sizes. Volume was smaller by 36.3 ± 18.8% (d = 1.7) and fatty infiltration was greater by 6.4 ± 7.8% (d = 0.8) in the amputated limb GMED compared to the intact limb. The amputated limb GMED abduction moment arms were smaller compared to the intact limb for both overground walking (anterior: d = 0.9; middle: d = 0.1.2) and during normal range of motion (anterior: d = 0.8; middle: d = 0.8) while bilateral hip adduction-abduction angles were similar during overground walking (d = 0.5). These results indicate that in patients with TFA, the amputated limb GMED is biomechanically disadvantaged compared to the intact limb, which may contribute to the etiology of secondary comorbidities. This population might benefit from movement retraining to lengthen the amputated limb GMED abduction moment arm during gait.
接受经股截肢（TFA）的患者存在继发肌肉骨骼合并症的风险增加，主要是由于关节受力不对称。TFA 人群中也普遍存在截肢肢体肌肉无力，但导致肌肉力量从而导致关节受力的所有因素尚未完全清楚。我们的目标是双侧比较臀中肌（GMED）肌肉因素（体积、脂肪浸润、力臂），这些因素都有助于 TFA 患者的关节受力。从 8 名单侧 TFA 患者（2M/6F；年龄：47.3±14.7 岁；BMI：25.4±5.3kg/m；截肢后时间：20.6±15.0 年）收集髋部定量磁共振（MR）图像，并用于计算 GMED 肌肉体积和脂肪浸润的归一化值。6 名参与者参加了一个仪器步态分析会议，该会议在地面行走过程中收集了全身运动学。使用特定于个体的肌肉骨骼模型，计算了双侧 GMED（前、中、后）力臂和额状面髋关节角度，跨越三个步态周期。使用配对 Cohen's d 效应大小比较肢体之间的体积、脂肪浸润、髋关节内收-外展角度和峰值力臂的差异。与健肢相比，患肢 GMED 的体积减少了 36.3±18.8%（d=1.7），脂肪浸润增加了 6.4±7.8%（d=0.8）。与健肢相比，患肢 GMED 的外展力臂在地面行走时（前：d=0.9；中：d=0.1.2）和在正常运动范围内时（前：d=0.8；中：d=0.8）均较小，而双侧髋关节内收-外展角度在地面行走时相似（d=0.5）。这些结果表明，在 TFA 患者中，患肢 GMED 在生物力学上比健肢处于劣势，这可能是继发合并症的病因。该人群可能受益于运动再训练，以在步态中延长患肢 GMED 的外展力臂。
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