Military Rehabilitation Center Aardenburg, Doorn, the Netherlands; Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Military Rehabilitation Center Aardenburg, Doorn, the Netherlands; Vrije Universiteit Amsterdam, Faculty of Behavioural and Movement Sciences, Amsterdam, the Netherlands.
Gait Posture. 2024 Jul;112:128-133. doi: 10.1016/j.gaitpost.2024.05.012. Epub 2024 May 15.
In the process of transtibial prosthetic fitting, alignment is the process of positioning the prosthetic foot relative to the residual limb. Changes in frontal plane alignment can impact knee moments during walking, which can either cause or, when aligned properly, prevent injuries. However, clinical evaluation of dynamic knee moments is challenging, limiting prosthetists' insights into dynamic joint loading. Typically, knee joint loading is assessed in static stance using the knee moment arm as a proxy for subsequent dynamic alignment. It remains uncertain if static alignment accurately represents actual dynamics during walking.
Is the frontal knee moment arm in stance predictive for the knee moment arm and external knee adduction moment during gait in transtibial bone-anchored prosthesis users?
In this cross-sectional study, twenty-seven unilateral transtibial bone-anchored prosthesis users underwent data acquisition on the M-Gait instrumented treadmill. Static and dynamic measurements were conducted, and knee moment arm and external knee adduction moment were calculated. Pearson's correlation and linear regression analyses were performed to examine relationships between static and dynamic knee moment arms and external knee adduction moments.
The static knee moment arm showed significant associations with dynamic knee moment arm at the ground reaction force peaks (First: r=0.60, r=35%, p<0.001; Second: r=0.62, r=38%, p=0.001) and knee adduction moment (First: r=0.42, r=17%, p=0.030; Second: r=0.59, r=35%, p=0.001). A 1 mm between-subject difference in static knee moment arm corresponded, on average, with a 0.9% difference in knee adduction moment at the first peak and a 1.5% difference at the second peak of the ground reaction force.
While static alignment is important to optimize adduction moments during stance it may only partly mitigate excessive moments during gait. The fair correlation and limited percentage of explained variance underscores the importance of dynamic alignment in optimizing the body's dynamic load during walking.
在胫骨假肢适配过程中，对线是将假肢脚相对于残肢定位的过程。额状面对线的变化会影响步行时的膝关节力矩，这可能导致受伤，或者在对线正确的情况下防止受伤。然而，动态膝关节力矩的临床评估具有挑战性，限制了假肢矫形师对动态关节负荷的了解。通常，使用膝关节力矩臂作为后续动态对线的代理，在静态站立位评估膝关节关节负荷。目前尚不确定静态对线是否能准确反映步行时的实际动态情况。
在胫骨骨锚定假肢使用者中，站立时的额状面膝关节力矩臂是否可以预测步态中的膝关节力矩臂和膝关节外展力矩？
在这项横断面研究中，27 名单侧胫骨骨锚定假肢使用者在 M-Gait 仪器化跑步机上进行了数据采集。进行了静态和动态测量，并计算了膝关节力矩臂和膝关节外展力矩。进行了 Pearson 相关和线性回归分析，以检验静态和动态膝关节力矩臂与膝关节外展力矩之间的关系。
静态膝关节力矩臂与地面反力峰值时的动态膝关节力矩臂（第一次：r=0.60，r=35%，p<0.001；第二次：r=0.62，r=38%，p=0.001）和膝关节外展力矩（第一次：r=0.42，r=17%，p=0.030；第二次：r=0.59，r=35%，p=0.001）具有显著相关性。在静态膝关节力矩臂之间有 1 毫米的个体差异，平均对应于地面反力峰值时膝关节外展力矩有 0.9%的差异，在地面反力第二次峰值时膝关节外展力矩有 1.5%的差异。
虽然静态对线对于优化站立时的内收力矩很重要，但它可能只能部分减轻步行时的过度力矩。良好的相关性和有限的可解释方差百分比强调了动态对线在优化行走时身体动态负荷方面的重要性。
