McAnelly R D, Refaeian M, O'Connell D G, Powell G D, Walsh N E
Department of Rehabilitation Medicine, University of Texas Health Science Center, and Warm Springs and Baptist Rehabilitation Hosptial, San Antonio 78284-7798, USA.
Arch Phys Med Rehabil. 1998 May;79(5):585-8. doi: 10.1016/s0003-9993(98)90078-8.
Patients with hip disarticulation (HD) require high energy expenditure for successful prosthetic ambulation. Thus, older patients are rarely fitted with an HD prosthesis. To our knowledge there are no reports of gait analysis following successful prosthetic fitting of an elderly HD amputee patient with systemic cardiopulmonary disease. We report the case of successful prosthetic ambulation in a 73-year-old man with HD secondary to histiosarcoma and a medical history significant for stable angina, chronic obstructive pulmonary disease, and diabetes mellitus. The patient underwent gait training with an endoskeletal prosthesis and achieved ambulation to 400 feet with bilateral forearm crutches. Vicon kinematic gait analysis revealed a cadence of 44 steps/min (112 steps/min normal), and double support time of 47% (26% normal). Oxygen rate during ambulation (VO2) was 11.0 mL/kg/min at velocity of .35 m/sec, compared with published figures for ambulation in those with HD of 10.73 mL/kg/min at velocity of .93 m/sec. At 1-year follow-up, the patient continued to walk into church with the prosthesis. We conclude that a trial fitting of an HD prosthesis should be considered on an individual basis in elderly amputee patients.
髋关节离断（HD）患者成功使用假肢行走需要消耗大量能量。因此，老年患者很少安装HD假肢。据我们所知，尚无关于患有全身性心肺疾病的老年HD截肢患者成功安装假肢后步态分析的报道。我们报告了一例73岁男性患者的病例，该患者因组织细胞肉瘤导致HD，有稳定型心绞痛、慢性阻塞性肺疾病和糖尿病病史。患者使用内骨骼假肢进行步态训练，借助双侧前臂拐杖能够行走400英尺。Vicon运动学步态分析显示，步频为44步/分钟（正常为112步/分钟），双支撑时间为47%（正常为26%）。在速度为0.35米/秒时，行走过程中的耗氧率（VO2）为11.0毫升/千克/分钟，而已发表的HD患者在速度为0.93米/秒时的行走耗氧率数据为10.73毫升/千克/分钟。在1年的随访中，该患者继续佩戴假肢走进教堂。我们得出结论，对于老年截肢患者，应根据个体情况考虑进行HD假肢的试穿。
