Department of Bioengineering, Imperial College London, London, UK.
Dorset Orthopaedic GB, Manchester, UK.
J Neuroeng Rehabil. 2023 Dec 19;20(1):169. doi: 10.1186/s12984-023-01296-4.
Currently, there is little available in-depth analysis of the biomechanical effect of different prostheses on the musculoskeletal system function and residual limb internal loading for persons with bilateral transfemoral/through-knee amputations (BTF). Commercially available prostheses for BTF include full-length articulated prostheses (microprocessor-controlled prosthetic knees with dynamic response prosthetic feet) and foreshortened non-articulated stubby prostheses. This study aims to assess and compare the BTF musculoskeletal function and loading during gait with these two types of prostheses.
Gait data were collected from four male traumatic military BTF and four able-bodied (AB) matched controls using a 10-camera motion capture system with two force plates. BTF completed level-ground walking trials with full-length articulated and foreshortened non-articulated stubby prostheses. Inverse kinematics, inverse dynamics and musculoskeletal modelling simulations were conducted.
Full-length articulated prostheses introduced larger stride length (by 0.5 m) and walking speed (by 0.3 m/s) than stubbies. BTF with articulated prostheses showed larger peak hip extension angles (by 10.1°), flexion moment (by 1.0 Nm/kg) and second peak hip contact force (by 3.8 bodyweight) than stubbies. There was no difference in the hip joint loading profile between BTF with stubbies and AB for one gait cycle. Full-length articulated prostheses introduced higher hip flexor muscle force impulse than stubbies.
Compared to stubbies, BTF with full-length articulated prostheses can achieve similar activity levels to persons without limb loss, but this may introduce detrimental muscle and hip joint loading, which may lead to reduced muscular endurance and joint degeneration. This study provides beneficial guidance in making informed decisions for prosthesis choice.
目前，对于双侧股骨/膝下截肢（BTF）患者，不同假肢对肌肉骨骼系统功能和残肢内部负荷的生物力学影响，缺乏深入的分析。市面上适用于 BTF 的假肢包括全长关节假肢（带有动态响应假肢脚的微处理器控制假肢膝盖）和缩短的非关节短残肢假肢。本研究旨在评估和比较这两种类型的假肢在步态中对 BTF 的肌肉骨骼功能和负荷。
使用带有两个测力板的 10 摄像机运动捕捉系统，从四名男性创伤性军事 BTF 和四名匹配的健全（AB）对照者中收集步态数据。BTF 使用全长关节和缩短的非关节短残肢假肢完成平地行走试验。进行了运动学逆解、动力学逆解和肌肉骨骼建模模拟。
全长关节假肢比短残肢假肢具有更大的步长（0.5 米）和行走速度（0.3 米/秒）。使用关节假肢的 BTF 具有更大的髋关节伸展角度峰值（10.1°）、弯曲力矩（1.0 Nm/kg）和第二峰值髋关节接触力（3.8 体重）。在一个步态周期中，使用短残肢假肢的 BTF 和 AB 的髋关节负荷曲线没有差异。全长关节假肢比短残肢假肢引入更高的髋关节屈肌肌力脉冲。
与短残肢假肢相比，使用全长关节假肢的 BTF 可以达到与无肢体丧失者相似的活动水平，但这可能会引入有害的肌肉和髋关节负荷，从而导致肌肉耐力降低和关节退化。本研究为假肢选择提供了有益的指导。
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