设为首页 |  加入收藏
首页首页 期刊简介 消息通知 编委会 电子期刊 投稿须知 广告合作 联系我们
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.

参考文献:

[1] 赵燕潮. 中国残联发布我国最新残疾人口数据[J]. 残疾人研究, 2012(A01): 11.
[2] 泽村诚志. 截肢与假肢[M]. 孙国凤,译. 北京:中国社会出版社,2010: 81-82.
[3] 肖晓鸿. 假肢与矫形器技术(第2版)[M]. 上海:复旦大学出版社,2016: 102-105.
[4] 赵正全. 假肢矫形器技术与临床应用[M]. 北京: 电子工业出版社, 2020: 275.?
[5] Hong JH, Mun MS. Relationship between socket pressure and EMG of two muscles in trans-femoral stumps during gait [J]. Prosthetics and Orthotics International, 2005, 29(1): 59-72.?
[6] LaPrè AK, Price MA, Wedge RD, et al. Approach for gait analysis in persons with limb loss including residuum and prosthesis socket dynamics[J]. International Journal for Numerical Methods in Biomedical Engineering, 2018, 34(4): e2936. ?
[7] Rietman JS, Postema K, Geertzen JHB. Gait analysis in prosthetics: opinions, ideas and conclusions [J]. Prosthetics and Orthotics International, 2002, 26(1): 50-57.
[8] 周大伟. 大腿假肢坐骨包容接受腔的发展与设计特点[C]//第五届北京国际康复论坛论文集. 北京: 中国康复研究中心, 2010: 977-983.
[9] 王盛, 伍琦, 朱奕, 等. 便携式步态分析与实验室步态分析时空参数的一致性研究[J]. 中华物理医学与康复杂志, 2014, 36(8): 621-624.
Wang S, Wu Q, Zhu Y, et al.Agreement between portable and laboratory analyses of temporal and spatial gait parameters[J]. Chinese Journal of Physical Medicine and Rehabilitation, 2014, 36(8): 621-624.
[10] 张腾宇, 李立峰, 季润, 等. 三维步态分析在截肢患者康复中的应用[J]. 中国康复理论与实践, 2010, 16(3): 293-295.
Zhang TY, Li LF, Ji R, et al.Application of 3D gait analysis in rehabilitation of amputees[J]. Chinese Journal of Rehabilitation Theory and Practice, 2010, 16(3): 293-295.
[11] 吴志彬, 蒋宛凌, 舒彬. 步态分析在下肢假肢装配中的应用[J]. 中国康复医学杂志, 2013, 28(12): 1171-1174.?
[12] 张文通,钮金圆,许光旭,等.一种便携式步态分析仪评估脑卒中步态时空参数的信度与效度研究[J]. 康复学报, 2016, 26(5): 25-28.
Zhang WT, Niu JY, Xu GX, et al.Reliability and validity of the portable analyses of temporal and spatial gait parameters in patients with stroke[J]. Rehabilitation Medicine, 2016, 26(5): 25-28.
[13] 刁子龙, 曹学军, 杨平, 等. 单侧大腿截肢者步行能力研究[J]. 中国康复理论与实践,2015, 21(4): 470-474.
Diao ZL, Cao XJ, Yang P, et al. Walking ability of amputees with unilateral transfemoral prosthesis[J]. Chinese Journal of Rehabilitation Theory and Practice, 2015, 21(4): 470-474.
[14] 闫松华,周兴龙,党德华,等.小学阶段超重/肥胖儿童平地行走的运动学研究[J].医用生物力学, 2014, 29 (6): 548-553.
Yan SH, Zhou XL, Dang DH, et al.Kinematic analysis on gait of overweight and obese primary school children during level walking[J]. ?Journal of Medical Biomechanics, 2014, 29 (6): 548-553.
[15] 励建安,孟殿怀. 步态分析的临床应用[J]. 中华物理医学与康复杂志, 2006, 28(7) : 500-503.
[16] 郑陈帆,闫松华,张宽,等.坐骨神经痛患者的步态特征[J].医用生物力学, 2016, 31(1) : 73-77.
Zheng CF, Yan SH, Zhang K, et al.Gait characteristics of patients with sciatica[J]. ?Journal of Medical Biomechanics, 2016, 31(1) : 73-77.
[17] 张昊华,闫松华,方沉,等.用便携式步态分析仪评估全髋关节置换术手术效果[J].医用生物力学,2015, 30 (4): 361-366.
Zhang HH, Yan SH, Fang C, et al.To evaluate the operation effect of total hip arthroplasty with portable gait analyzer[J]. ?Journal of Medical Biomechanics, 2015, 30 (4) : 361-366.

服务与反馈:
文章下载】【加入收藏
提示:您还未登录,请登录!点此登录
 
友情链接  
地址:北京安定门外安贞医院内北京生物医学工程编辑部
电话:010-64456508  传真:010-64456661
电子邮箱:llbl910219@126.com