Frias-Bocanegra Jose M, Egginton Natalie L, Fong Daniel T, Wheeler Patrick C, Blankenstein Tom, Lewis Mark P, Bennett Alexander, Williams David J, Stapley Sarah A
School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, United Kingdom.
Defence Medical Rehabilitation Centre (Stanford Hall), Loughborough LE12 5QW, United Kingdom.
Mil Med. 2025 Sep 1;190(Supplement_2):437-446. doi: 10.1093/milmed/usaf211.
New recovery pathways to improve and sustain strength and functional outcomes in the veteran amputee population are required to reduce the onset of comorbidities with aging. To date, no comprehensive study has quantified key gait parameters with clinically applied tests and measured lower limb strength in this cohort and their relationship to potential indicators of onset of musculoskeletal (MSK) injuries. This study fills this gap. ADVANCE Study cohorts of unilateral transtibial (UTT; n = 12) and unilateral transfemoral (UTF; n = 10) veteran amputees were matched to military able-bodied controls (n = 10). Participants were tested using 3D motion capture system and force plates permitting analysis of the spatial-temporal intact knee joint kinetic parameters during a 6-minute walking test. An isokinetic dynamometer measured peak knee extension/flexion isometric torque and Hamstring:Quadriceps (H:Q) ratio. UTT amputees displayed a H:Q torque ratio below recommended, an imbalance that may alter their gait functionality within their intact limb. The intact knee extension-flexion torques across the cohorts did not display significant differences, suggesting the extensive military rehabilitation outcomes remained successful 12.5 years post injury. Six-minute walk test (6MWT) analysis demonstrated a similar walking speed and total distance covered between controls and UTT amputees. However, significantly lower values were found for UTF amputees. Ground reaction forces during weight acceptance on the intact side showed no significant differences between cohorts. However, at mid-support and push-off both injured cohorts displayed significantly greater forces in the last 30 s of the 6MWT, indicating kinetic asymmetries. The literature suggests that such differences may indicate unhealthy knee joints. This biomechanical study suggests that the U.K. veteran population conserved exceptional strength levels in their intact limb. However, submaximal exercises representing activities of daily living revealed focus for improvement in amputee gait. This highlights that individualized rehabilitation protocols and tools concentrating on prolonging patient quality of life may delay the early onset of MSK comorbidities.
需要新的康复途径来改善并维持退伍军人截肢群体的力量及功能结果，以减少因衰老而引发的合并症。迄今为止，尚无全面研究通过临床应用测试对该队列中的关键步态参数进行量化，并测量下肢力量，以及这些参数与肌肉骨骼（MSK）损伤发病潜在指标之间的关系。本研究填补了这一空白。将单侧经胫骨（UTT；n = 12）和单侧经股骨（UTF；n = 10）退伍军人截肢者的 ADVANCE 研究队列与身体健全的军事对照者（n = 10）进行匹配。使用 3D 运动捕捉系统和测力板对参与者进行测试，以便在 6 分钟步行测试期间分析时空完整膝关节的动力学参数。等速测力计测量膝关节伸展/屈曲等长峰值扭矩和腘绳肌：股四头肌（H:Q）比率。UTT 截肢者的 H:Q 扭矩比率低于推荐值，这种失衡可能会改变其健全肢体的步态功能。各队列中完整膝关节的伸展 - 屈曲扭矩没有显著差异，这表明在受伤 12.5 年后，广泛的军事康复结果仍然成功。6 分钟步行测试（6MWT）分析表明，对照组和 UTT 截肢者之间的步行速度和总距离相似。然而，UTF 截肢者的数值明显较低。健全侧在负重接受期间的地面反作用力在各队列之间没有显著差异。然而，在支撑中期和蹬离期，两个受伤队列在 6MWT 的最后 30 秒内都表现出明显更大的力，表明存在动力学不对称。文献表明，这种差异可能表明膝关节不健康。这项生物力学研究表明，英国退伍军人在其健全肢体中保留了非凡的力量水平。然而，代表日常生活活动的次最大运动揭示了截肢者步态改善的重点。这突出表明，专注于延长患者生活质量的个性化康复方案和工具可能会延迟 MSK 合并症的早期发作。
