步长改变对单侧下肢截肢患者完整肢内侧胫股关节接触力的影响

IF 2.2 3区医学 Q3 NEUROSCIENCES

Gait & posture Pub Date : 2025-04-07 DOI:10.1016/j.gaitpost.2025.04.004

E. Daniel Syrett , Carrie L. Peterson , Benjamin J. Darter

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引用次数: 0

摘要

下肢截肢（LLA）患者经常表现为完整肢体膝关节骨关节炎，可能是由于关节负荷的改变。先前的研究表明步长（SL）的变化可能会影响膝关节负荷，但这在该人群中尚未得到评估。因此，本研究的目的是研究SL变化对LLA患者完整肢体内侧室胫股关节接触力（mTJCF）的影响。方法14例经胫骨截肢患者在自行选择（SLSS）、15 %增加（SLI）和15 %减少（SLD） 3种步长条件下以自行选择的速度行走。使用标准OpenSim程序分析每种情况下的10个步态周期。采用线性混合效应模型比较不同条件下完整肢体mTJCF的第一峰、第二峰和脉冲。结果SLI组第1峰较SLSS组增高（2.65 BW比2.39 BW, p = 0.02）。与SLSS （2.61 BW vs. 2.94 BW, p <； 0.01）和SLI （2.61 BW vs. 3.05 BW, p <； 0.01）相比，SLD期间第2峰降低。各工况间冲量差异较大（SLSS: 1.35 ± 0.29 BW-s, SLI: 1.61 ± 0.33 BW-s, SLD: 1.14 ± 0.35 BW-s， p均为 <； 0.01）。所有其他比较均无显著性。结论SL的改变改变了LLA患者的完整肢体mTJCF，尽管这些改变是否具有临床意义尚不清楚。临床医生在实施可能改变SL的干预措施时应考虑这些影响。

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The effect of step length alterations on intact limb medial tibiofemoral joint contact force in individuals with unilateral lower limb amputation

Introduction

Individuals with lower limb amputation (LLA) frequently demonstrate intact limb knee osteoarthritis, likely from alterations in joint loading. Prior work suggests changes in step length (SL) may affect knee joint loading, however this has not been evaluated in this population. Therefore, the purpose of this study was to examine the effect of SL changes on intact limb medial compartment tibiofemoral joint contact force (mTJCF) in individuals with LLA.

Methods

Fourteen individuals with transtibial amputation walked at their self-selected velocity for three step length conditions: self-selected (SL_SS), 15 % increased (SL_I), and 15 % decreased (SL_D). Ten gait cycles from each condition were analyzed using standard OpenSim procedures. Intact limb mTJCF 1st Peaks, 2nd Peaks, and Impulses were compared between conditions using linear mixed effects models.

Results

1st Peak was increased during SL_I compared to SL_SS (2.65 BW vs. 2.39 BW, p = 0.02). 2nd Peak was reduced during SL_D compared to SL_SS (2.61 BW vs. 2.94 BW, p < 0.01) and SL_I (2.61 BW vs. 3.05 BW, p < 0.01). Impulse was different between all conditions (SL_SS: 1.35 ± 0.29 BW-s, SL_I: 1.61 ± 0.33 BW-s, SL_D: 1.14 ± 0.35 BW-s, all p < 0.01). All other comparisons were non-significant.

Conclusion

Changes in SL altered intact limb mTJCF of individuals with LLA, though whether these changes are clinically meaningful is unknown. Clinicians should consider such effects when performing interventions that may alter SL.

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来源期刊

Gait & posture 医学-神经科学

CiteScore

4.70

自引率

12.50%

发文量

616

审稿时长

6 months

期刊介绍： Gait & Posture is a vehicle for the publication of up-to-date basic and clinical research on all aspects of locomotion and balance. The topics covered include: Techniques for the measurement of gait and posture, and the standardization of results presentation; Studies of normal and pathological gait; Treatment of gait and postural abnormalities; Biomechanical and theoretical approaches to gait and posture; Mathematical models of joint and muscle mechanics; Neurological and musculoskeletal function in gait and posture; The evolution of upright posture and bipedal locomotion; Adaptations of carrying loads, walking on uneven surfaces, climbing stairs etc; spinal biomechanics only if they are directly related to gait and/or posture and are of general interest to our readers; The effect of aging and development on gait and posture; Psychological and cultural aspects of gait; Patient education.