Sharma Sapna, Anderson Kirsten M, Pacha Molly S, Falbo Kierra J, Severe Clare, Hansen Andrew H, Hendershot Brad D, Wilken Jason M
Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
Gait Posture. 2025 Mar;117:228-234. doi: 10.1016/j.gaitpost.2024.12.024. Epub 2024 Dec 27.
Carbon fiber custom dynamic orthoses have been used to improve gait mechanics after lower limb trauma in military service members, with the goal of restoring function and improving outcomes. However, the effects of commercially available carbon fiber orthoses available to civilians on lower extremity joint kinetics and kinematics are poorly understood.
The aim of this study was to examine the effect of two commercially available orthoses on lower extremity kinematics and kinetics in individuals with lower limb trauma.
A total of 23 participants with a lower extremity traumatic injury underwent gait analysis while walking without an orthosis, and while wearing a monolithic carbon fiber orthosis or while wearing a modular carbon fiber orthosis, in a randomized order. Study participants accommodated to each orthosis for three months prior to testing. Joint kinematics and kinetics at the ankle, knee, and hip joints, and ground reaction forces were assessed.
The two study orthoses significantly reduced ankle motion compared to no orthosis, with large effect sizes observed. Peak plantarflexor moment was greater with the modular orthosis compared to the monolithic orthosis. Ankle push-off power did not differ between orthoses but was significantly reduced relative to no orthosis. Push-off power with the study orthoses was over 25% greater as compared to previous studies with military orthoses. Peak loading response power generation at the knee was greater with the monolithic orthosis as compared to the modular orthosis. The kinematics and kinetics at the hip did not differ between orthoses.
Orthoses commonly used in civilian settings to treat limb trauma primarily alter joint kinematics and kinetics at the ankle, in a manner consistent with orthoses used in the military. Additionally, despite the apparent large differences in the designs of the two study orthoses, between-orthosis differences on gait mechanics were limited.
碳纤维定制动态矫形器已被用于改善军事服役人员下肢创伤后的步态力学，目的是恢复功能并改善预后。然而，平民可获得的市售碳纤维矫形器对下肢关节动力学和运动学的影响却鲜为人知。
本研究的目的是检验两种市售矫形器对下肢创伤患者下肢运动学和动力学的影响。
共有23名下肢创伤患者在不穿戴矫形器、穿戴一体式碳纤维矫形器或穿戴模块化碳纤维矫形器的情况下，以随机顺序进行步态分析。研究参与者在测试前三个月适应每种矫形器。评估踝关节、膝关节和髋关节的关节运动学和动力学以及地面反作用力。
与不使用矫形器相比，两种研究用矫形器均显著降低了踝关节运动，观察到较大的效应量。与一体式矫形器相比，模块化矫形器的跖屈肌峰值力矩更大。两种矫形器之间的踝关节蹬离功率没有差异，但相对于不使用矫形器时显著降低。与之前对军事矫形器的研究相比，研究用矫形器的蹬离功率高出25%以上。与模块化矫形器相比，一体式矫形器在膝关节处的峰值负荷反应功率更大。两种矫形器在髋关节处的运动学和动力学没有差异。
民用环境中常用于治疗肢体创伤的矫形器主要以与军事中使用的矫形器一致的方式改变踝关节的关节运动学和动力学。此外，尽管两种研究用矫形器的设计明显存在很大差异，但矫形器之间在步态力学方面的差异有限。
