Are Women at Increased Risk of Developing Secondary Physical Conditions Associated with Lower-Limb Amputation and Long-Term Prosthesis Use?

女性患上与下肢截肢和长期使用假肢相关的继发性身体状况的风险是否会增加？

• 批准号: 10027253
• 负责人: Rebecca Stine
• 金额: --
• 依托单位: JESSE BROWN VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-10-01 至 2022-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10027253
• 关键词: Amputation; Back Pain; Biomechanics; Consequentialism; Data; Degenerative polyarthritis; Development; Diagnosis; Dual-Energy X-Ray Absorptiometry; Early identification; Equilibrium; Etiology; Female; Fracture; Future; Gait; Gender; Health; Hip Osteoarthritis; Hip Pain; Hip region structure; Immobilization; Incidence; Individual; Investigation; Joints; Kinetics; Knee; Knee Osteoarthritis; Knee Prosthesis; Leg; Limb Prosthesis; Limb structure; Low Back Pain; Lower Extremity; Measures; Mission; Modification; Monitor; Musculoskeletal; Musculoskeletal Development; Osteopenia; Osteoporosis; Participant; Pathology; Patient Care; Patient Self-Report; Persons; Pilot Projects; Population; Prevalence; Prosthesis; Quality of life; Reaction; Rehabilitation therapy; Relative Risks; Resources; Risk; Risk Factors; Roentgen Rays; Scanning; Severities; Surveys; Trauma; Ursidae Family; Vertebral column; Veterans; Walking; Woman; Work; bone; cost effective; experience; falls; gait examination; health administration; improved; kinematics; knee pain; limb amputation; male; men; novel; osteoarthritis pain; prosthesis wearer; prosthetic socket; research and development; residual limb; sound; walking speed

Long-term transfemoral (i.e., above-knee) prosthesis users are at an increased risk of developing secondary musculoskeletal conditions compared to the general able-bodied population. Significant resources have been devoted to the immediate rehabilitation needs of persons undergoing lower-limb amputation, but there needs to be greater consideration for the early identification and modification of potential risk factors responsible for long- term development of secondary health conditions such as knee osteoarthritis (OA), hip OA, osteoporosis/osteopenia, and low back pain. The etiology for the development of these conditions is not entirely known or understood, but in persons with unilateral amputations they are believed to relate to the asymmetries and gait deviations that are typically demonstrated and required to walk with a prosthesis. Surprisingly, there are no studies to date that have investigated or determined the relative risk of transfemoral prosthesis users for developing secondary physical conditions on the basis of gender. We believe that it is important to conduct a preliminary investigation to determine if female transfemoral prosthesis users are at an increased risk of developing secondary musculoskeletal conditions compared to their male counterparts. Therefore, the purpose of this pilot study is to investigate the relative risk of persons with unilateral lower limb amputation for the development of musculoskeletal pathologies due to long-term prosthesis use. Specifically, we will investigate kinematic and kinetic differences between male and female transfemoral prosthesis users and the relationship to increased prevalence of osteopenia, osteoarthritis, and hip, knee or back pain. Additionally, we will develop and administer a nation-wide survey to document indicators of secondary physical conditions. The specific aims of this project are: Aim 1—To analyze biomechanical gait variables that are indicative of musculoskeletal risks in unilateral, transfemoral prosthesis users. We will perform quantitative gait analyses on 10 female subjects and 10 male subjects. It is hypothesized that peak ground reaction forces will be higher on the sound limb for women than for men and that the external knee adduction moment magnitude and rate will also be increased. Aim 2—To determine the presence of musculoskeletal pathologies in unilateral, transfemoral prosthesis users. We will perform a DEXA scan of the hips and spine of the 20 subjects and an X-ray of the sound limb knee to examine any presence of osteopenia or osteoarthritis. It is hypothesized that there will be a greater presence of musculoskeletal pathologies in the female subjects than the male subjects. Aim 3—To obtain information on self-reported musculoskeletal pathologies in unilateral, lower limb prosthesis users. A comprehensive on-line survey will be developed and utilized to determine the prevalence and severity of musculoskeletal pathologies. It is hypothesized that transfemoral prosthesis users will have a higher incidence of musculoskeletal pathologies, falls and fractures than transtibial prosthesis users. Furthermore, it is hypothesized that female prosthesis users will have a higher incidence of secondary physical conditions associated with amputation and long-term prosthesis use when compared with male prosthesis users. These preliminary data could be used in the future as a rationale to conduct larger, more in-depth and focused studies to investigate gender specific differences associated with particular secondary physical conditions that arise from amputation and prosthesis use. To develop cost-effective prosthetic solutions that are gender specific, we first need to collect and analyze data that will support and justify these types of development efforts.

长期经股动脉（即，膝上）假体使用者发生继发性关节炎的风险增加 肌肉骨骼状况与一般健全人群相比。大量资源已被 致力于下肢截肢者的直接康复需求，但需要 更多地考虑早期识别和修改长期存在的潜在风险因素， 继发性健康状况的长期发展，如膝关节骨关节炎（OA），髋关节OA， 骨质疏松症/骨质减少和腰痛。这些疾病发展的病因并不完全是 已知或理解，但在单侧截肢的人，他们被认为是与不对称 以及典型地表现出并且需要用假肢行走的步态偏差。令人惊讶的是， 迄今为止，尚无研究调查或确定经股动脉假体使用者的相对风险， 根据性别发展次要身体状况。 我们认为进行初步调查以确定女性经股动脉 假体使用者发生继发性肌肉骨骼疾病的风险增加， 男性同行因此，本试验性研究的目的是调查以下人群的相对风险： 单侧下肢截肢术治疗长期假肢引起的肌肉骨骼病变 使用.具体来说，我们将研究男性和女性经股动脉之间的运动学和动力学差异 假体使用者与骨质减少、骨关节炎和髋关节、膝关节或背部患病率增加的关系 痛苦此外，我们将制定和管理一项全国范围的调查，以记录中学教育指标。 身体条件。该项目的具体目标是： 目的1-分析生物力学步态变量，表明肌肉骨骼风险， 经股动脉假体使用者。我们将对10名女性受试者进行定量步态分析， 10名男性受试者。据推测，峰值地面反作用力将更高的健全肢体 对于女性，膝关节外收力矩的大小和速率也将 增加 目的2-确定单侧经股动脉假体中是否存在肌肉骨骼病变 用户.我们将对20名受试者的臀部和脊柱进行DEXA扫描，并对声音进行X光检查。 检查四肢膝关节是否存在骨质减少或骨关节炎。据推测， 女性受试者中肌肉骨骼病变的存在多于男性受试者。 目的3-获得自我报告的单侧下肢肌肉骨骼病理信息 假肢使用者将制定和利用一项全面的在线调查， 肌肉骨骼病变的患病率和严重程度。假设经股动脉假体 使用者的肌肉骨骼病变、福尔斯和骨折的发生率高于经胫骨 假肢使用者此外，假设女性假体使用者将具有更高的 与截肢和长期使用假体相关的继发性身体疾病的发生率 与男性假肢使用者相比。 这些初步数据可作为今后开展更大规模、更深入和重点突出的 研究调查与特定次要身体状况相关的性别特异性差异， 由截肢和使用假肢引起。为了开发具有成本效益的针对性别的假肢解决方案， 我们首先需要收集和分析数据，以支持和证明这些类型的发展努力。