Department of Mechanical Engineering, University of Colorado Denver, Denver CO, United States.
Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, United States.
J Biomech. 2024 May;168:112098. doi: 10.1016/j.jbiomech.2024.112098. Epub 2024 Apr 15.
Individuals with unilateral transtibial amputation (TTA) using socket prostheses demonstrate asymmetric joint biomechanics during walking, which increases the risk of secondary comorbidities (e.g., low back pain (LBP), osteoarthritis (OA)). Bone-anchored limbs are an alternative to socket prostheses, yet it remains unknown how they influence multi-joint loading. Our objective was to determine the influence of bone-anchored limb use on multi-joint biomechanics during walking. Motion capture data (kinematics, ground reaction forces) were collected during overground walking from ten participants with unilateral TTA prior to (using socket prostheses) and 12-months after bone-anchored limb implantation. Within this year, each participant completed a rehabilitation protocol that guided progression of loading based on patient pain response and optimized biomechanics. Musculoskeletal models were developed at each testing timepoint (baseline or 12-months after implantation) and used to calculate joint kinematics, internal joint moments, and joint reaction forces (JRFs). Analyses were performed during three stance periods on each limb. The between-limb normalized symmetry index (NSI) was calculated for joint moments and JRF impulses. Discrete (range of motion (ROM), impulse NSI) dependent variables were compared before and after implantation using paired t-tests with Bonferroni-Holm corrections while continuous (ensemble averages of kinematics, moments, JRFs) were compared using statistical parametric mapping (p < 0.05). When using a bone-anchored limb, frontal plane pelvic (residual: pre = 9.6 ± 3.3°, post = 6.3 ± 2.5°, p = 0.004; intact: pre = 10.2 ± 3.9°, post = 7.9 ± 2.6°, p = 0.006) and lumbar (residual: pre = 15.9 ± 7.0°, post = 10.6 ± 2.5°, p = 0.024, intact: pre = 17.1 ± 7.0°, post = 11.4 ± 2.8°, p = 0.014) ROM was reduced compared to socket prosthesis use. The intact limb hip extension moment impulse increased (pre = -11.0 ± 3.6 Nms/kg, post = -16.5 ± 4.4 Nms/kg, p = 0.005) and sagittal plane hip moment impulse symmetry improved (flexion: pre = 23.1 ± 16.0 %, post = -3.9 ± 19.5 %, p = 0.004, extension: pre = 29.2 ± 20.3 %, post = 8.7 ± 22.9 %, p = 0.049). Residual limb knee extension moment impulse decreased compared to baseline (pre = 15.7 ± 10.8 Nms/kg, post = 7.8 ± 3.9 Nms/kg, p = 0.030). These results indicate that bone-anchored limb implantation alters multi-joint biomechanics, which may impact LBP or OA risk factors in the TTA population longitudinally.
个体使用接受腔假肢进行单侧胫骨截肢（TTA）时，在行走过程中表现出关节生物力学的不对称性，这增加了继发合并症（例如腰痛（LBP）、骨关节炎（OA））的风险。骨锚定肢体是接受腔假肢的替代物，但尚不清楚它们如何影响多关节负荷。我们的目的是确定使用骨锚定肢体对行走过程中多关节生物力学的影响。在 10 名单侧 TTA 患者使用接受腔假肢（使用接受腔假肢）和骨锚定肢体植入后 12 个月（使用骨锚定肢体）期间，在地面上行走时收集运动捕捉数据（运动学、地面反作用力）。在这一年中，每位参与者都完成了一个康复方案，该方案根据患者的疼痛反应和优化的生物力学指导基于患者的疼痛反应和优化的生物力学来指导负荷的进展。在每个测试时间点（基线或植入后 12 个月）都开发了肌肉骨骼模型，并用于计算关节运动学、内部关节力矩和关节反作用力（JRF）。在每个肢体的三个站立阶段进行分析。使用关节力矩和 JRF 脉冲的双侧归一化对称指数（NSI）进行计算。使用配对 t 检验（带有 Bonferroni-Holm 校正）比较植入前后的离散（运动范围（ROM）、脉冲 NSI）因变量，而使用统计参数映射（p <0.05）比较连续（运动学、力矩、JRF 的集合平均值）。当使用骨锚定肢体时，额状面骨盆（残留：预= 9.6 ± 3.3°，后= 6.3 ± 2.5°，p = 0.004；完整：预= 10.2 ± 3.9°，后= 7.9 ± 2.6°，p = 0.006）和腰椎（残留：预= 15.9 ± 7.0°，后= 10.6 ± 2.5°，p = 0.024，完整：预= 17.1 ± 7.0°，后= 11.4 ± 2.8°，p = 0.014）ROM 与使用接受腔假肢相比有所降低。完整肢体髋关节伸展力矩脉冲增加（预= -11.0 ± 3.6 Nms/kg，后= -16.5 ± 4.4 Nms/kg，p = 0.005），矢状面髋关节力矩脉冲对称性得到改善（屈曲：预= 23.1 ± 16.0%，后= -3.9 ± 19.5%，p = 0.004，伸展：预= 29.2 ± 20.3%，后= 8.7 ± 22.9%，p = 0.049）。与基线相比，残肢膝关节伸展力矩脉冲减少（预= 15.7 ± 10.8 Nms/kg，后= 7.8 ± 3.9 Nms/kg，p = 0.030）。这些结果表明，骨锚定肢体植入改变了多关节生物力学，这可能会影响 TTA 人群的腰痛或 OA 风险因素。
