University of Colorado Bone-Anchored Limb Research Group, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; VA Eastern Colorado Healthcare System, Aurora, CO, USA.
University of Colorado Bone-Anchored Limb Research Group, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; VA Eastern Colorado Healthcare System, Aurora, CO, USA; Department of Mechanical Engineering, University of Colorado Denver, Denver, CO, USA; Center for Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Gait Posture. 2024 Sep;113:46-52. doi: 10.1016/j.gaitpost.2024.05.019. Epub 2024 May 27.
A bone-anchored limb (BAL) is an alternative to a traditional socket-type prosthesis for people with transfemoral amputation. Early laboratory-based evidence suggests improvement in joint and limb loading mechanics during walking with a BAL compared to socket prosthesis use. However, changes in cumulative joint and limb loading measures, which may be predictive of degenerative joint disease progression, remain unknown.
Do cumulative total limb and hip joint loading during walking change using a BAL for people with unilateral transfemoral amputation, compared to prior socket prosthesis use?
A case-series cohort of eight participants with prior unilateral transfemoral amputation who underwent BAL hardware implantation surgery were retrospectively analyzed (4 M/4 F; BMI: 27.7 ± 3.1 kg/m; age: 50.4 ± 10.2 years). Daily step count and whole-body motion capture data were collected before (using socket prosthesis) and one-year after BAL hardware implantation. Cumulative total limb and hip joint loading and between-limb loading symmetry metrics were calculated during overground walking at both time points and compared using Cohen's d effect sizes.
One year after BAL hardware implantation, participants demonstrated bilateral increases in cumulative total limb loading (amputated: d = -0.65; intact: d = -0.72) and frontal-plane hip moment (amputated: d = -1.29; intact: d = -1.68). Total limb loading and hip joint loading in all planes remained asymmetric over time, with relative overloading of the intact limb in all variables of interest at the one-year point.
Despite increases in cumulative total limb and hip joint loading, between-limb loading asymmetries persist. Habitual loading asymmetry has been implicated in contributing to negative long-term joint health and onset or progression of degenerative joint diseases. Improved understanding of methods to address habitual loading asymmetries is needed to optimize rehabilitation and long-term joint health as people with transfemoral amputation increase physical activity when using a BAL.
对于股骨截肢患者，骨锚定假肢（BAL）是传统套接式假肢的替代方案。早期基于实验室的证据表明，与使用套接式假体相比，BAL 可改善行走时的关节和肢体受力力学。然而，行走时累积的关节和肢体受力测量值的变化（可能预示着退行性关节疾病的进展）尚不清楚。
与之前使用套接式假体相比，使用 BAL 会改变单侧股骨截肢患者行走时的累积总肢体和髋关节负荷吗？
对 8 名接受过 BAL 硬件植入手术的单侧股骨截肢患者的病例系列队列进行回顾性分析（4 名男性/4 名女性；BMI：27.7 ± 3.1kg/m2；年龄：50.4 ± 10.2 岁）。在 BAL 硬件植入前（使用套接式假体）和植入一年后收集日常步数和全身运动捕捉数据。在两个时间点的地面行走过程中计算累积的总肢体和髋关节负荷以及肢体间负荷对称性指标，并使用 Cohen's d 效应大小进行比较。
BAL 硬件植入一年后，参与者双侧累积总肢体负荷（截肢侧：d = -0.65；非截肢侧：d = -0.72）和额状面髋关节力矩（截肢侧：d = -1.29；非截肢侧：d = -1.68）均增加。随着时间的推移，所有平面的总肢体负荷和髋关节负荷仍然不对称，在所有感兴趣的变量中，非截肢侧的相对负荷过重。
尽管累积总肢体和髋关节负荷增加，但肢体间负荷不对称仍然存在。习惯性负荷不对称已被认为是导致关节长期健康状况不佳以及退行性关节疾病的发生或进展的原因之一。需要更好地了解解决习惯性负荷不对称的方法，以优化康复和长期关节健康，因为股骨截肢患者在使用 BAL 时会增加身体活动。
