在经胫骨截肢患者中，负重影响与骨关节炎相关的完整肢体膝关节负荷估算

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics Pub Date : 2025-02-27 DOI:10.1016/j.clinbiomech.2025.106486

Satria Ardianuari , David C. Morgenroth , Richard R. Neptune , Glenn K. Klute

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引用次数: 0

摘要

背景：负重负重可加重经胫骨截肢患者完整肢体膝关节负荷升高，可能导致骨关节炎。假肢脚的机械性能，如推离力，有可能减少膝关节的负荷。本研究探讨了负重载体位置和假足类型对这些个体完整肢体膝关节负重测量的影响。方法选取12例单侧胫骨截肢患者。分析完整肢体外膝关节内收和屈曲力矩，量化假体推离力和功对膝关节内收第一峰力矩的影响。线性混合效应回归评估了负载位置和假脚对这些指标的影响。结果：完整侧负荷条件下，受试者的第一个膝关节内收力矩和脉冲峰值最小，其次是后负荷和前负荷条件，其中假体侧负荷条件下的幅度最大（增加20 - 35%）。然而，我们发现假肢足在这些指标上没有显着差异。此外，负载位置和假脚对膝关节弯曲力矩峰值没有显著影响。后负荷条件下，膝关节第一次内收力矩峰值与假体推离功呈负相关（P = 0.089）。解释：完整侧负重负重在临床上可能更有利于减轻完整肢膝关节负重增加的风险。此外，载荷承载策略对完整肢体膝关节载荷的影响大于特定假肢脚类型。这些生物力学研究结果可以帮助指导康复负重策略，以尽量减少经胫骨截肢患者膝骨关节炎的高风险。

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Load carriage influences intact limb knee loading estimate associated with osteoarthritis in individuals with transtibial amputation

Background

Load carriage can exacerbate the elevated intact limb knee loading in individuals with transtibial amputation, potentially contributing to osteoarthritis. Prosthetic foot mechanical properties like push-off power have the potential to reduce this elevated knee loading. This study investigated how load carriage position and prosthetic foot type affect intact limb knee loading measures for these individuals.

Methods

Twelve participants with unilateral transtibial amputation were recruited. Intact limb external knee adduction and flexion moments were analyzed, with prosthetic push-off power and work quantified for effects on first peak knee adduction moment. A linear mixed-effects regression evaluated the effects of load position and prosthetic foot on these metrics.

Findings

Participants exhibited the smallest first peak knee adduction moment and impulse with the intact-side load condition, followed by the back load and front load conditions, with the prosthetic-side load condition having the highest magnitude (20–35 % increase). However, we found no significant differences in these metrics by prosthetic foot. Additionally, load position and prosthetic foot did not significantly affect peak knee flexion moment. Only a negative trend toward correlation (P = 0.089) was observed between first peak knee adduction moment and prosthetic push-off work in the back load condition.

Interpretation

Intact-side load carriage may be more clinically beneficial for mitigating the risk of increased intact limb knee loading. Further, load carriage strategy affects intact limb knee loading more than specific prosthetic foot type. These biomechanical findings can help guide rehabilitative load carriage strategies to minimize the elevated risk of knee osteoarthritis in individuals with transtibial amputation.

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来源期刊

Clinical Biomechanics 医学-工程：生物医学

CiteScore

3.30

自引率

5.60%

发文量

189

审稿时长

12.3 weeks

期刊介绍： Clinical Biomechanics is an international multidisciplinary journal of biomechanics with a focus on medical and clinical applications of new knowledge in the field. The science of biomechanics helps explain the causes of cell, tissue, organ and body system disorders, and supports clinicians in the diagnosis, prognosis and evaluation of treatment methods and technologies. Clinical Biomechanics aims to strengthen the links between laboratory and clinic by publishing cutting-edge biomechanics research which helps to explain the causes of injury and disease, and which provides evidence contributing to improved clinical management. A rigorous peer review system is employed and every attempt is made to process and publish top-quality papers promptly. Clinical Biomechanics explores all facets of body system, organ, tissue and cell biomechanics, with an emphasis on medical and clinical applications of the basic science aspects. The role of basic science is therefore recognized in a medical or clinical context. The readership of the journal closely reflects its multi-disciplinary contents, being a balance of scientists, engineers and clinicians. The contents are in the form of research papers, brief reports, review papers and correspondence, whilst special interest issues and supplements are published from time to time. Disciplines covered include biomechanics and mechanobiology at all scales, bioengineering and use of tissue engineering and biomaterials for clinical applications, biophysics, as well as biomechanical aspects of medical robotics, ergonomics, physical and occupational therapeutics and rehabilitation.