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血小板减少伴桡骨缺如综合征患儿上肢假肢的步态分析

Gait Analysis with an Upper Limb Prosthesis in a Child with Thrombocytopenia-Absent Radius Syndrome.

作者信息

Glowinski Sebastian, Pecolt Sebastian, Błażejewski Andrzej, Maciejewski Igor, Królikowski Tomasz

机构信息

Institute of Health Sciences, Slupsk Pomeranian Academy, Westerplatte 64, 76200 Slupsk, Poland.

Institute of Physical Culture and Health, State Higher School of Vocational Education in Koszalin, Lesna 1, 75582 Koszalin, Poland.

出版信息

J Clin Med. 2025 Mar 25;14(7):2245. doi: 10.3390/jcm14072245.

Abstract

: Thrombocytopenia-absent radius (TAR) syndrome is a rare genetic disorder characterized by the bilateral absence of the radius and thrombocytopenia, often leading to functional limitations and gait asymmetries. Prosthetic devices are sometimes employed to improve mobility and posture, but their impact on gait mechanics in pediatric patients remains poorly understood. : The methodology used is based on a study that evaluated the gait parameters of a 10-year-old child with TAR syndrome under static and dynamic conditions, both with and without the use of a custom-designed upper limb prosthesis. The analysis focused on assessing the prosthesis's impact on gait symmetry and biomechanics. A key aspect of the methodology involved studying the distribution of pressure forces on the ground during walking using the FreeMed EXTREME Maxi baropodometric platform. : Gait analysis demonstrated asymmetries between the left and right feet. In the absence of the prosthesis, the patient exhibited excessive forward loading and uneven pressure distributions. The use of a custom prosthesis, particularly with counterbalancing features, improved gait symmetry but led to increased reliance on the left foot. This foot experienced higher pressures (738-852 g/cm) and longer ground contact times (690-865 ms) compared to the right foot (619-748 g/cm and 673-771 ms). The left foot displayed elevated forefoot pressures (61-65%), while the right foot bore weight laterally (66-74%). : The custom prosthesis influenced gait mechanics by redistributing plantar pressures and modifying ground contact times, partially improving gait symmetry. However, compensatory strategies, such as increased loading on the left foot, could contribute to musculoskeletal strain over time. Individualized rehabilitation programs and prosthetic designs are essential for optimizing gait mechanics, improving mobility, and minimizing long-term complications in TAR syndrome patients.

摘要

血小板减少伴桡骨缺如(TAR)综合征是一种罕见的遗传性疾病,其特征为双侧桡骨缺如和血小板减少,常导致功能受限和步态不对称。有时会使用假体装置来改善活动能力和姿势,但它们对儿科患者步态力学的影响仍知之甚少。

所采用的方法基于一项研究,该研究评估了一名患有TAR综合征的10岁儿童在静态和动态条件下、使用和不使用定制设计的上肢假体时的步态参数。分析重点在于评估假体对步态对称性和生物力学的影响。该方法的一个关键方面是使用FreeMed EXTREME Maxi足底压力测量平台研究行走过程中地面压力的分布。

步态分析显示左右脚之间存在不对称。在未使用假体时,患者表现出过度的向前负重和不均匀的压力分布。使用定制假体,特别是具有平衡功能的假体,改善了步态对称性,但导致对左脚的依赖增加。与右脚(619 - 748 g/cm和673 - 771 ms)相比,左脚承受更高的压力(738 - 852 g/cm)和更长的地面接触时间(690 - 865 ms)。左脚前脚掌压力升高(61 - 65%),而右脚则向外侧承重(66 - 74%)。

定制假体通过重新分布足底压力和改变地面接触时间来影响步态力学,部分改善了步态对称性。然而,随着时间的推移,诸如增加左脚负重等代偿策略可能会导致肌肉骨骼劳损。个性化的康复计划和假体设计对于优化TAR综合征患者的步态力学、改善活动能力以及将长期并发症降至最低至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9172/11989493/bd6154fa5600/jcm-14-02245-g001.jpg

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