Casillas J M, Dulieu V, Cohen M, Marcer I, Didier J P
Service de rééducation Fonctionnelle, Centre Hospitalier Universitaire de Dijon, France.
Arch Phys Med Rehabil. 1995 Jan;76(1):39-44. doi: 10.1016/s0003-9993(95)80040-9.
In this study, the metabolic performances of a new energy-storing foot (Proteor) and of the solid-ankle cushion heel (SACH) are compared. Twelve patients with traumatic below-knee amputations (mean age: 50.0 +/- 19.9 years) and 12 patients with vascular below-knee amputations (mean age: 73 +/- 7 years) were studied. Oxygen uptake (VO2) was measured in all the subjects on a walkway at a self-selected velocity; only the subjects with traumatic amputation were tested on a level treadmill (progressive speed: 2.4-4 and 6 km/h), and then in two randomized trials: incline (+5%) and decline walking treadmill test at 4 km/h. Vascular explorations were done in the vascular patients: distal pressure measurements, pulse plethysmography, transcutaneous oxygen tension. Free walking was improved in subjects with traumatic amputation using the energy-storing foot (+6%), with a better bioenergetic efficiency (0.24 +/- 0.4mL/kg.m vs 0.22 +/- 0.04mL/kg.m). However, in subjects with vascular amputation, this foot did not produce an increased free velocity nor an improved energy cost. During the level treadmill test, the traumatic amputee subjects showed a decrease of energy expenditure with the new prosthetic foot, more significant at sufficient speed (4 km/h): 17.00 +/- 3.42 vs 14.67 +/- 2.05 mL/kg/min (p < .05). The same effect is shown during the incline (19.31 +/- 2.80 vs 16.79 +/- 2.32 mL/kg/min-p < .02) and decline walking tests (14.13 +/- 3.64 vs 11.81 +/- 1.54mL/kg/min-p < .02). There is no significant difference in cardiocirculatory effects between the two types of prosthetic foot. Despite a lower velocity, the subjects with vascular amputation exceed 70% of the maximal heart rate, with the cardiocirculatory factor being the main cause of walking restriction. The energy-storing foot should be reserved for active and fast walkers, whereas the SACH foot seems more suitable for elderly patients with amputation with a slow walk.
在本研究中，对一种新型储能假脚（Proteor）和实心踝垫式假脚（SACH）的代谢性能进行了比较。研究了12例膝下创伤性截肢患者（平均年龄：50.0±19.9岁）和12例膝下血管性截肢患者（平均年龄：73±7岁）。在步道上以自选速度测量了所有受试者的摄氧量（VO2）；仅对创伤性截肢患者在水平跑步机上进行了测试（递增速度：2.4 - 4和6 km/h），然后进行了两项随机试验：4 km/h的上坡（+5%）和下坡步行跑步机测试。对血管性截肢患者进行了血管检查：测量远端压力、脉搏容积描记法、经皮氧分压。使用储能假脚的创伤性截肢患者的自由行走能力有所改善（提高了6%），生物能量效率更高（0.24±0.4mL/kg·m对0.22±0.04mL/kg·m）。然而，对于血管性截肢患者，这种假脚并未提高自由行走速度，也未改善能量消耗。在水平跑步机测试中，使用新型假肢的创伤性截肢患者的能量消耗有所降低，在足够速度（4 km/h）时更为显著：17.00±3.42对14.67±2.05 mL/kg/min（p <.05）。在上坡（19.31±2.80对16.79±2.32 mL/kg/min - p <.02）和下坡步行测试（14.13±3.64对11.81±1.54mL/kg/min - p <.02）中也显示出相同的效果。两种类型的假脚在心脏循环效应方面没有显著差异。尽管速度较低，但血管性截肢患者的心率超过了最大心率的70%，心脏循环因素是行走受限的主要原因。储能假脚应留给活跃且行走速度快的人，而SACH假脚似乎更适合行走缓慢的老年截肢患者。
