Hirsch G, McBride M E, Murray D D, Sanderson D J, Dukes I, Menard M R
Division of Physical Medicine and Rehabilitation, Vancouver Hospital and Health Sciences Centre, University of British Columbia, Canada.
Am J Phys Med Rehabil. 1996 Jul-Aug;75(4):283-91. doi: 10.1097/00002060-199607000-00009.
Gait was analyzed in seven otherwise healthy males at least 11 mo after they had recovered from a traumatic unilateral transmetatarsal amputation incurred during the course of their usual occupation. All seven were fitted with a semirigid foot orthosis. Four were also fitted with a Chopart prosthesis. Gait was evaluated with forceplate measurements of ground reaction force during free walking, by clinical observation of such ambulation on videotape, and by the subjective impression of the men as obtained by a questionnaire. In all men, with unmodified footwear, with the orthosis, and with the prosthesis, the forceplate data showed an abnormal pattern characterized by reduced stance duration and deficient forward propulsion on the amputated side. The abnormality and asymmetry of ground-reaction forces were less with greater preserved stump length and for a given stump length were with the above-ankle concept (Chopart) prosthesis than with the below-ankle concept. These features were recognized during the clinical analysis of all footwear, but there was an extra irregularity of weight progression noted with the fixed ankle of the Chopart prosthesis. The questionnaire reported stump problems to be the principal difficulty, and the follow-up revealed persistent attempts at surgical management including consideration of amputation at a higher level. It was concluded that the patient and the surgeons are likely to choose preservation of limb length over considerations of function during acute care and that the prosthetic concept best suited to deal with the resulting stump should emphasize unloading the distal part of the stump and smoothing out the impulsive force peak on the stump in late stance to minimize pain and to enhance ambulation capacity.
对7名在日常工作中遭受创伤性单侧跖骨截肢且已康复至少11个月的健康男性进行了步态分析。这7名男性均佩戴了半刚性足部矫形器。其中4人还佩戴了Chopart假肢。通过测力台测量自由行走时的地面反作用力、通过录像临床观察此类行走情况以及通过问卷调查获得男性的主观感受来评估步态。在所有男性中，无论穿着未改良的鞋、佩戴矫形器还是假肢，测力台数据均显示出一种异常模式，其特征为站立时间缩短以及截肢侧向前推进不足。残端保留长度越长，地面反作用力的异常和不对称性越小；对于给定的残端长度，与踝下概念假肢相比，踝上概念（Chopart）假肢的地面反作用力异常和不对称性更小。这些特征在对所有鞋类的临床分析中均被识别出来，但Chopart假肢固定踝关节处的体重转移存在额外的不规则性。问卷调查显示残端问题是主要困难，随访发现患者持续尝试手术治疗，包括考虑更高水平的截肢。研究得出结论，在急性护理期间，患者和外科医生可能会选择保留肢体长度而非考虑功能，并且最适合处理由此产生的残端的假肢概念应强调减轻残端远端的负荷，并在站立后期平滑残端上的冲击力峰值，以尽量减少疼痛并提高行走能力。
