经股截肢和接受腔假体的患者发生肌肉骨骼过度使用损伤的风险更高,通常是由于关节生物力学改变。骨整合假体,这涉及通过骨锚固假体将假体直接锚固到残肢,是套接字的一种新颖替代品,但它们的生物力学效果在很大程度上是未知的。
四名计划接受单侧经股假体骨整合的患者完成了两个数据收集(接受腔窝假体的基线和假体骨整合后12个月),其中在站立至坐任务期间收集了全身运动学和地面反作用力。行李箱,骨盆,和髋关节运动学,和周围的肌肉力量,使用OpenSim中开发的受试者特定的肌肉骨骼模型进行计算。使用Cohen'sd效应大小在时间点之间比较峰值关节角度和肌肉力。
与接受腔假体的基线相比,骨整合假体患者表现出减少的侧躯干弯曲(d=1.46),骨盆倾斜度(d=1.09),和旋转(d=1.77)向截肢的肢体在站立坐任务。伴有截肢髋屈肌增加,绑架者,和旋转肌肉力量(d>>0.8)。
使用骨整合假体时改善的腰骨盆运动模式和稳定的肌肉力量表明,这种新型假体类型可能会降低过度使用损伤发展和/或进展的风险。如腰痛和骨关节炎。我们将增加的肌肉臀部肌肉力量归因于骨整合假体和残肢之间的负荷传递增加,这允许截肢的更大的偏心能力来控制在站立到坐任务期间的降低。
Patients with transfemoral amputation and socket prostheses are at a heightened risk of developing musculoskeletal overuse injuries, commonly due to altered joint biomechanics. Osseointegrated prostheses, which involve direct anchorage of the prosthesis to the residual limb through a bone anchored prosthesis, are a novel alternative to sockets yet their biomechanical effect is largely unknown.
Four patients scheduled to undergo unilateral transfemoral prosthesis osseointegration completed two data collections (baseline with socket prosthesis and 12-months after prosthesis osseointegration) in which whole-body kinematics and ground reaction forces were collected during stand-to-sit tasks. Trunk, pelvis, and hip kinematics, and the surrounding muscle forces, were calculated using subject-specific musculoskeletal models developed in OpenSim. Peak joint angles and muscle forces were compared between timepoints using Cohen\'s d effect sizes.
Compared to baseline with socket prostheses, patients with osseointegrated prostheses demonstrated reduced lateral trunk bending (d = 1.46), pelvic obliquity (d = 1.09), and rotation (d = 1.77) toward the amputated limb during the stand to sit task. This was accompanied by increased amputated limb hip flexor, abductor, and rotator muscle forces (d> > 0.8).
Improved lumbopelvic movement patterns and stabilizing muscle forces when using an osseointegrated prosthesis indicate that this novel prosthesis type likely reduces the risk of the development and/or progression of overuse injuries, such as low back pain and osteoarthritis. We attribute the increased muscle hip muscle forces to the increased load transmission between the osseointegrated prosthesis and residual limb, which allows a greater eccentric ability of the amputated limb to control lowering during the stand-to-sit task.