Trunk-Pelvis motions and spinal loads during upslope and downslope walking among persons with transfemoral amputation.
Trunk-Pelvis motions and spinal loads during upslope and downslope walking among persons with transfemoral amputation.
复制标题
股骨截肢者上坡和下坡行走时的躯干-骨盆运动和脊柱负荷。
DOI：
10.1016/j.jbiomech.2019.109316
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发表时间：
2019
影响因子：
2.4
通讯作者：
Hendershot,BradD
中科院分区：
文献类型：
--
作者：
Acasio,JulianC;Shojaei,Iman;Banerjee,Rajit;Dearth,ChristopherL;Bazrgari,Babak;Hendershot,BradD
在日常生活活动（ADL）中，下肢截肢者（与未截肢者相比）的躯干和骨盆运动较大，对下背部的机械需求产生不利影响。基于这样的运动改变导致在平地行走时脊柱负荷增大的证据，我们在此描述了16名单侧经股截肢（TFA）的男性以自选速度行走时躯干-骨盆运动、躯干肌肉力量和由此产生的脊柱负荷，（“上坡”; 1.06 ± 0.14 m/s）和下坡（“下坡”; 0.98 ± 0.20 m/s）10度斜坡。获得三平面躯干和骨盆运动（并计算运动范围[ROM]）作为脊柱的非线性有限元模型的输入，以估计全局和局部肌肉（即，躯干移动器和稳定器）的力，以及由此产生的脊柱载荷。上坡行走与下坡行走相比，躯干运动范围（p = 0.001）、正向（p = 0.004）和横向（p < 0.001）、内侧剪切力峰值（p = 0.011）和局部肌力峰值（p = 0.010）更大（分别为45%、35%、98%、70%和11%）。倾斜之间的峰值前后剪切力（p = 0.33）、压缩力（p = 0.28）和整体肌肉力（p = 0.35）相似。与之前报道的TFA患者在平地上行走相比，此处观察到的5-60%较大的前后和中外侧剪切（尽管步行速度较慢，但<0.25 m/s）表明在斜坡行走时，特别是上坡时，对下背部的机械需求更大。ADL期间躯干运动和脊柱负荷的持续表征支持以下观点：重复暴露于这些大于正常的（即，与TFA和未受伤队列中的平地行走相比）脊柱负荷导致下肢截肢后下背部损伤的风险增加。
Larger trunk and pelvic motions in persons with (vs. without) lower limb amputation during activities of daily living (ADLs) adversely affect the mechanical demands on the lower back. Building on evidence that such altered motions result in larger spinal loads during level-ground walking, here we characterize trunk-pelvic motions, trunk muscle forces, and resultant spinal loads among sixteen males with unilateral, transfemoral amputation (TFA) walking at a self-selected speed both up (“upslope”; 1.06 ± 0.14 m/s) and down (“downslope”; 0.98 ± 0.20 m/s) a 10-degree ramp. Tri-planar trunk and pelvic motions were obtained (and ranges-of-motion [ROM] computed) as inputs for a non-linear finite element model of the spine to estimate global and local muscle (i.e., trunk movers and stabilizers, respectively) forces, and resultant spinal loads. Sagittal- (p = 0.001), frontal- (p = 0.004), and transverse-plane (p < 0.001) trunk ROM, and peak mediolateral shear (p = 0.011) and local muscle forces (p = 0.010) were larger (respectively 45, 35, 98, 70, and 11%) in upslope vs. downslope walking. Peak anteroposterior shear (p = 0.33), compression (p = 0.28), and global muscle (p = 0.35) forces were similar between inclinations. Compared to previous reports of persons with TFA walking on level ground, 5–60% larger anteroposterior and mediolateral shear observed here (despite ∼0.25 m/s slower walking speeds) suggest greater mechanical demands on the low back in sloped walking, particularly upslope. Continued characterization of trunk motions and spinal loads during ADLs support the notion that repeated exposures to these larger-than-normal (i.e., vs. level-ground walking in TFA and uninjured cohorts) spinal loads contribute to an increased risk for low back injury following lower limb amputation.