北京生物医学工程

基于便携式步态测试仪的不同接受腔单侧大腿截肢者行走特点研究

Research on walking characteristics of unilateral transfemoral amputees wearing prostheses with different socket based on the portable gait analyzer

作者：李松靳飞张宽闫松华

单位：首都医科大学生物医学工程学院（北京 100069）<br />中国康复研究中心（北京 100068）<br />中国康复科学所(北京 100068)<br />临床生物力学应用基础研究北京市重点实验室(北京 100069)<br />通信作者：闫松华，副教授。E-mail: yansh74@ ccmu.edu.cn

关键词：单侧大腿截肢；四边形接受腔；坐骨包容接受腔；假肢；步态分析

分类号：R318

出版年·卷·期（页码）：2023·42·2（178-183）

摘要：

目的探讨穿戴坐骨包容接受腔与四边形接受腔大腿假肢的单侧大腿截肢者在日常生活中行走时的步态差异，为临床制定大腿假肢使用处方提供指导。方法选取7位大腿截肢患者作为实验组，为患者分别适配四边形和坐骨包容接受腔大腿假肢。同时选取7位年龄、性别、身高和体重相匹配的健康受试者作为对照组。所有受试者以舒适的步速在室外平路上行走240 m，应用便携式步态测试仪（intelligent device for energy expenditure and activity, IDEEA）采集步态数据，包括7个时空参数和4个加速度参数，通过IBM SPSS Statistics 23对数据进行处理。对比患者穿戴两种假肢与健康受试者之间、患者分别穿戴同种假肢时患侧与健侧之间、患者穿戴两种假肢时患侧之间，健侧之间的参数差异。结果与健康受试者相比，患者分别穿戴两种假肢行走时，两种假肢健侧和患侧的站立时间和步态周期显著增大（P<0.05），步速、步频、跨步长显著减小（P<0.05）；两种假肢患侧的摆动时间显著延长（P<0.05），地面冲击和足落地控制显著减小（P<0.05）；四边形接受腔假肢双侧和坐骨包容接受腔假肢健侧的单步时间显著延长（P<0.05）。四边形接受腔假肢患侧摆动时间显著长于健侧（P=0.03）；坐骨包容接受腔假肢患侧摆动时间显著长于健侧（P=0.02），地面冲击显著小于健侧（P=0.04）。四边形接受腔假肢患侧的步态周期显著长于坐骨包容接受腔假肢（P=0.01）；四边形接受腔假肢健侧的步态周期显著长于坐骨包容接受腔假肢（P=0.03）。结论患者穿戴两种假肢在室外行走时，步行速度均明显慢于健康受试者；患者步行过程中健侧均有代偿；患者穿戴坐骨包容接受腔假肢行走时的速度显著快于穿戴四边形接受腔假肢时的速度；患者穿戴坐骨包容接受腔假肢行走时假肢侧在支撑期的稳定性比穿四边形接受腔假肢更好。

To investigate the gait differences between unilateral transfemoral amputees with ischial containment prostheses and quadrilateral prostheses in daily life, in order to provide guidance for the formulation of prosthesis prescription for unilateral transfemoral amputees in clinic. Methods Seven participants with transfemoral amputees were selected as the test group. quadrilateral prostheses and ischial containment prostheses were made and well fitted with patients. At the same time, 7 healthy participants matched for age, sex, height, and weight were selected as the control group. All subjects walked 240 m on the flat road at a comfortable, self-selected velocity, at the same time the Intelligent device for energy expenditure and activity (IDEEA) was used to collect the gait parameters, including 7 spatiotemporal parameters and 4 acceleration parameters. Data were processed and analyzed by IBM SPSS Statistics 23, gait differences were compared between patients wearing two kinds of prosthetics and healthy people, between the affected sides or the healthy sides of patients wearing different prosthetics, and between the affected side and the healthy side of patients wearing same prosthetics. Results Compared with healthy subjects, when they walked on the flat road, for the patients, the standing duration and gait cycle were significantly increased (P<0.05); stride speed, stride frequency and stride length significantly decreased (P<0.05); the swinging duration of affected side of prostheses was significantly longer(P<0.05), ground impact and foot landing control decreased significantly(P<0.05); The single step time of quadrilateral prostheses and the healthy side of ischial containment prostheses was significantly longer (P<0.05). The swinging duration of affected side of quadrilateral prostheses was significantly longer than healthy side (P=0.03); The swinging duration of affected side of ischial containment prostheses was significantly longer than healthy side(P=0.02), ground impact was significantly lower than healthy side(P=0.04). The gait cycle of affected side of quadrilateral prostheses was significantly longer than ischial containment prostheses (P=0.01)；The gait cycle of healthy side of quadrilateral prostheses was significantly longer than ischial containment prostheses (P=0.03). Conclusions The walking speed of patients wearing prosthetics was significantly slower than healthy subjects. There were compensations on the healthy side during walking. Walking speed of participants with ischial containment prostheses was significantly faster than participants with quadrilateral prostheses. Ischial containment prostheses was more stable than quadrilateral prostheses during support period of affected side when walking.

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