Groeneveld Alyssa M G, Jonkergouw Niels, Bruijn Sjoerd M, Houdijk Han, Kooiman Vera G M, Leijendekkers Ruud A, Prins Maarten R
Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam and Amsterdam Movement Sciences, Amsterdam, the Netherlands; Department of Human movement sciences, Sportgeneeskunde Rotterdam, Rotterdam, the Netherlands.
Department of Research and Development, Military Rehabilitation Centre Aardenburg, Doorn, the Netherlands; Department of Human Movement Sciences, University Groningen, University Medical Center, Groningen, the Netherlands.
Gait Posture. 2025 Mar;117:274-282. doi: 10.1016/j.gaitpost.2025.01.010. Epub 2025 Jan 14.
The alignment of a bone-anchored prosthesis has consequences for the external moments around the residual joints and implant, and these external moments can lead to serious negative long-term effects. A clear understanding of the relationship between transtibial prosthetic alignment and external joint and implant moment for bone-anchored prosthetic users is still lacking.
What is the effect of systematic frontal plane prosthetic alignment changes on lower limb external joint moments in people with a transtibial bone-anchored prosthesis?
Participants underwent gait analysis on an instrumented dual belt treadmill. Between analyses, frontal-plane alignment adjustments were made, shifting the prosthetic foot 2, 4, and 6 mm medial and lateral in relation to the residual limb. The effect of alignment changes on frontal- and sagittal plane external joint moments during the stance phase of gait were assessed at the hip, knee, and implant level, using statistical parametric mapping regression analyses.
Twenty-seven unilateral transtibial bone-anchored prosthesis users were included. Alignment changes had a significant effect on external frontal plane knee and implant moments on the prosthetic side, with the largest effect at the level of the implant. Incremental medial and lateral displacements resulted in a progressive increase or decrease of the external adduction moments, respectively. Alignment changes did not significantly affect external moments around the prosthetic hip, non-prosthetic joints in the frontal plane or in any of the evaluated joints or implant in the sagittal plane.
Mediolateral foot alignment changes have a considerable effect on the frontal plane external knee and implant moments at the prosthetic side of a transtibial bone-anchored prosthesis. The findings of this study can help prosthetists to anticipate and adjust alignment changes for transtibial BAP users to minimize joint moments before issues arise.
骨锚式假肢的对线情况会对残端关节和植入物周围的外力矩产生影响，而这些外力矩可能会导致严重的长期负面影响。目前仍缺乏对骨锚式假肢使用者胫骨假肢对线与外部关节及植入物力矩之间关系的清晰认识。
系统性的额状面假肢对线变化对胫骨骨锚式假肢使用者下肢的外部关节力矩有何影响？
参与者在装有仪器的双带跑步机上进行步态分析。在两次分析之间，进行额状面对线调整，使假肢脚相对于残肢向内或向外移动2、4和6毫米。使用统计参数映射回归分析，评估对线变化对步态站立期髋关节、膝关节和植入物水平的额状面和矢状面外部关节力矩的影响。
纳入了27名单侧胫骨骨锚式假肢使用者。对线变化对假肢侧的额状面膝关节和植入物力矩有显著影响，在植入物水平影响最大。向内和向外的增量位移分别导致内收外力矩逐渐增加或减少。对线变化对假肢髋关节周围的外力矩、额状面非假肢关节或矢状面任何评估关节或植入物的外力矩均无显著影响。
胫侧内外侧足部对线变化对胫骨骨锚式假肢假肢侧的额状面外部膝关节和植入物力矩有相当大的影响。本研究结果可帮助假肢师预测和调整胫骨骨锚式假肢使用者的对线变化，以便在问题出现前将关节力矩降至最低。
