Perren T, Matter P
Chirurgische Abteilung, Spital Davos/AO-International.
Swiss Surg. 1996;2(6):252-8.
Truly partial weight bearing by usual mode of mobilisation after an operation of the lower limb is not a realistic goal. Frequent and massive overloading could recently be shown in a series of patients with joint replacements. Significant improvements in the loading pattern could be demonstrated with the use of an acoustic feedback system. Our goal was to test the clinical application of this method by using a similar system in the form of an insole-installed device. In the same trial, data on the real weight bearing pattern with prescribed loading after osteosyntheses was to be collected with and without the feedback device. We measured weight bearing continuously in two groups of patients. The first group was mobilised in the usual manner whereas the second group was acoustically alerted to overloading when passing the limit of 15 kg by a sensor device in the insole. Our results showed that 40.8% of steps made by patients mobilised in the usual manner were massively overloaded whereas 12.7% of steps in the second feedback-group produced even minor overloading. Apart from certain technical difficulties, the method was well accepted by the patients. The usual method of progressive weight bearing is unreliable. The value of partial weight bearing after internal fixation of the lower limb remains to be evaluated. In cases in which partial weight bearing is recommended, more attention should be paid to observing the prescribed limits and a reliable system that alerts the patient of excessive weight bearing would be most useful. For routine use in clinics a technically more reliable PMT Feedback System has to be developed.
下肢手术后通过常规活动方式实现真正的部分负重并非现实目标。近期研究表明,一系列关节置换患者存在频繁且大量的负荷过载情况。使用声学反馈系统可显著改善负荷模式。我们的目标是通过使用一种类似鞋垫式装置的系统来测试该方法的临床应用。在同一试验中,要收集有和没有反馈装置时骨合成术后规定负荷下的实际负重模式数据。我们对两组患者进行了连续负重测量。第一组按常规方式活动,而第二组当鞋垫中的传感器装置检测到超过15千克的负荷极限时会收到声学过载警报。我们的结果显示,按常规方式活动的患者所走步数中有40.8%存在大量负荷过载,而在第二组反馈组中,只有12.7%的步数产生了哪怕是轻微的负荷过载。除了某些技术难题外,该方法很受患者欢迎。常规的渐进负重方法不可靠。下肢内固定术后部分负重的价值仍有待评估。在推荐部分负重的情况下,应更加注意遵守规定的负荷极限,而一个能提醒患者负重过量的可靠系统将非常有用。为了在临床常规使用,必须开发一种技术上更可靠的PMT反馈系统。