Transfemoral Amputations: Is There an Effect of Residual Limb Length and Orientation on Energy Expenditure?
Transfemoral Amputations: Is There an Effect of Residual Limb Length and Orientation on Energy Expenditure?
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DOI：
10.1007/s11999-014-3630-x
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发表时间：
2014-10-01
影响因子：
4.2
通讯作者：
Potter, Benjamin K.
中科院分区：
文献类型：
--
作者：
Bell, Johanna C.;Wolf, Erik J.;Potter, Benjamin K.
已经使用多种措施来评估Amplitude的能量成本。由于补偿策略导致的异常运动，经股截肢的人通常表现出更大的质心偏移和增加的能量消耗。然而，很少有研究分析股骨残端长度和方向或截肢的能量消耗的影响，本研究的目的是比较股骨截肢患者的残肢长度和方向与能量效率。我们假设，与那些由于缺乏肌肉组织、杠杆臂较短和/或方向错误以及通过使用代偿运动需要更大的行走努力而导致的较长残肢和/或更异常的残肢股骨对准的患者相比，具有较短残肢和/或更异常的残肢股骨对准的患者具有更高的能量消耗成本和更大的质心运动。对创伤相关的单侧经股截肢进行步态和代谢分析测试。根据残肢长度和残股角将患者分组进行分析，残肢较长的队列比残肢较短的队列行走速度快（自选步行速度1.28 m/s与1.11 m/s，测量的效应量= 1.08; 95%置信区间=短1.10-1.12，长1.26-1.30; p = 0.04）。然而，无论肢体长度或方向如何，在O-2消耗或其他代谢变量（包括质心运动）方面，比较队列之间的可用数字没有差异。然而，在确定经股动脉截肢术后残肢的长度或方向是否影响能量消耗方面，代谢能和质心度量没有显示出差异。因此，这些因素对经股截肢者步态效率和能量需求的影响可能比以前认为的要小。有关证据等级的完整描述，请参见作者指南。
Energy cost of ambulation has been evaluated using a variety of measures. With aberrant motions resulting from compensatory strategies, persons with transfemoral amputations generally exhibit a larger center of mass excursion and an increased energy cost. However, few studies have analyzed the effect of residual femur length and orientation or energy cost of ambulation.The purpose of this study was to compare residual limb length and orientation with energy efficiency in patients with transfemoral amputation. We hypothesized that patients with shorter residual limbs and/or more abnormal residual femur alignment would have higher energy expenditure cost and greater center of mass movement than those with longer residual limbs resulting from lacking musculature, shorter and/or misoriented lever arms, and greater effort required to ambulate through use of compensatory movements.Twenty-six adults with acute, trauma-related unilateral transfemoral amputations underwent gait and metabolic analysis testing. Patients were separated into groups for analysis based on residual limb length and residual femoral angle.Cohorts with longer residual limbs walked faster than those with shorter residual limbs (self-selected walking velocity 1.28 m/s versus 1.11 m/s, measured effect size = 1.08; 95% confidence interval = short 1.10-1.12, long 1.26-1.30; p = 0.04). However, there were no differences found with the numbers available between the compared cohorts regardless of limb length or orientation in regard to O-2 cost or other metabolic variables, including the center of mass motion.Those with longer residual limbs after transfemoral amputation chose a faster self-selected walking velocity, mirroring previous studies; however, metabolic energy and center of mass metrics did not demonstrate a difference in determining whether energy expenditure is affected by length or orientation of the residual limb after transfemoral amputation. These factors may therefore have less effect on transfemoral amputee gait efficiency and energy requirements than previously thought.Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.