Abstract：
Coronally uneven surfaces are prevalent in natural and man-made terrain, such as holes or bumps in the ground, curbs, sidewalks, and driveways. These surfaces can be challenging to navigate, especially for individuals with lower limb amputations. This study examined the biomechanical response of individuals with unilateral transtibial amputation (TTA) taking a step on a coronally uneven surface while wearing their clinically prescribed prosthesis, compared to individuals without mobility impairments (controls). An instrumented walkway was used with the middle force plate positioned either flush or rotated ± 15˚ in the coronal plane and concealed (blinded). TTAs used greater hip abduction compared to controls across all conditions, but especially during blinded inversion. The recovery step width of TTAs was wider after blinded eversion and narrower after blinded inversion, but unchanged for controls. These results suggest TTAs may have decreased balance control on unexpected, uneven surfaces. Additionally, TTAs generated less positive prosthetic ankle joint work during blinded inversion and eversion, and less negative coronal hip joint work during blinded inversion compared to controls. These biomechanical responses could lead to increased energy expenditure on uneven terrain. Surface condition had no effect on the vertical center of mass for either group of participants. Finally, the TTAs and the control group generated similar vertical GRF impulses, suggesting the TTAs had sufficient body support despite differences in surface conditions. These results are important to consider for future prosthetic foot designs and rehabilitation strategies.
摘要：
在自然和人造地形中，冠状凹凸不平的表面普遍存在，如地面上的洞或隆起，路缘,人行道,和车道。这些表面导航可能具有挑战性，尤其是下肢截肢者.这项研究检查了单侧胫骨截肢（TTA）患者在佩戴临床处方假体时在冠状凹凸不平的表面上迈出一步的生物力学反应，与没有行动障碍的个体(对照)相比。使用带仪表的走道，中间测力板在冠状平面内齐平或旋转±15º并隐藏（百叶窗）。在所有情况下，与对照组相比，TTAs使用了更大的髋关节外展，但尤其是在盲倒置期间。盲化外翻后，TTAs的恢复步长较宽，盲化后较窄，但控件不变。这些结果表明，TTA可能在意外情况下降低了平衡控制，不平坦的表面。此外,在盲内翻和外翻期间，TTAs产生较少的积极假体踝关节工作，与对照组相比，盲内翻期间的负冠状髋关节工作较少。这些生物力学反应可能导致不平坦地形上的能量消耗增加。表面状况对两组参与者的垂直质心均无影响。最后,TTA和对照组产生类似的垂直GRF脉冲，这表明尽管表面条件不同，TTA仍有足够的身体支持。这些结果对于未来的假足设计和康复策略很重要。
