Ekdahl Mitchell A, Vandenberg Nicholas W, Melton Danielle H, Hendershot Brad D, Christiansen Cory L, Stoneback Jason W, Gaffney Brecca M M
Department of Mechanical Engineering, University of Colorado Denver, Denver CO, United States; University of Colorado Bone-Anchored Limb Research Group, Aurora, CO, United States.
University of Colorado Bone-Anchored Limb Research Group, Aurora, CO, United States; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
J Biomech. 2025 Apr;183:112620. doi: 10.1016/j.jbiomech.2025.112620. Epub 2025 Mar 8.
People with unilateral transfemoral amputation commonly experience pain at the residual limb-socket interface and heightened risk of musculoskeletal overuse injuries. Compensatory movement patterns acutely alleviate pain but can contribute to chronic aberrant muscle function and joint loading. Bone-anchored limbs have been shown to normalize joint loading during walking compared to socket prostheses, but their effects on muscle forces are not well understood. In this study, we compared dynamic hip muscle forces in all three planes of motion during walking before and after transfemoral bone-anchored limb implantation. Overground walking motion capture data were collected from 19 participants before (in socket prosthesis) and 12 months following bone-anchored limb implantation. Bilateral hip muscle forces were estimated during stance using subject-specific musculoskeletal models, resolved into anteroposterior, mediolateral, and superoinferior components, and compared across timepoints. After bone-anchored limb implantation, amputated-side hip abductor muscle forces were increased throughout stance (p ≤ 0.048), suggesting greater force-generating capacity of hip-spanning muscles during walking. Amputated-side hip flexor posterior muscle forces were decreased following implantation during terminal stance (p < 0.001), which may contribute to reduced anterior hip joint loading in pre-swing observed in bone-anchored limb users. Hip abductor muscle forces were more symmetric during single limb support (p < 0.034) and flexor muscle forces were more asymmetric during terminal stance (p = 0.047) following bone-anchored limb implantation. This study provides new insights of how bone-anchored limbs influence hip muscle function during walking, with implications for hip osteoarthritis development and progression in this population.
单侧经股骨截肢患者通常会在残肢与假肢接受腔的界面处感到疼痛，并且肌肉骨骼过度使用损伤的风险也会增加。代偿性运动模式可在短期内缓解疼痛，但可能会导致慢性异常肌肉功能和关节负荷增加。与接受腔假肢相比，骨锚式假肢已被证明在行走过程中可使关节负荷正常化，但其对肌肉力量的影响尚不清楚。在本研究中，我们比较了经股骨骨锚式假肢植入前后行走过程中三个运动平面上的动态髋部肌肉力量。从19名参与者在植入骨锚式假肢前（使用接受腔假肢时）和植入后12个月收集了地面行走运动捕捉数据。在站立期使用个体化的肌肉骨骼模型估计双侧髋部肌肉力量，将其分解为前后、内外侧和上下分量，并在不同时间点进行比较。植入骨锚式假肢后，截肢侧髋外展肌力量在整个站立期均增加（p≤0.048），这表明在行走过程中跨越髋关节的肌肉产生力量的能力增强。植入后，截肢侧髋后屈肌力量在末期站立期降低（p<0.001），这可能有助于减少骨锚式假肢使用者在摆动前期观察到的髋关节前侧负荷。植入骨锚式假肢后，单腿支撑期髋外展肌力量更对称（p<0.034），末期站立期屈肌力量更不对称（p=0.047）。本研究为骨锚式假肢在行走过程中如何影响髋部肌肉功能提供了新的见解，对该人群髋骨关节炎的发生和发展具有重要意义。
