Does Transfemoral Prosthetic Socket Design and Alignment Influence Low Back Pain? A Comparison Between Ischial-Containment and Sub-Ischial Sockets

经股假肢接受腔的设计和对准是否会影响腰痛？

• 批准号: 10586859
• 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: 2022
• 资助国家: 美国
• 起止时间: 2022-11-01 至 2024-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10586859
• 关键词: Adopted; Amputation; Amputees; Anterior; Back; Compensation; Comprehension; Containment; Control Groups; Data; Development; Early identification; Equilibrium; Etiology; Exhibits; Femur; Future; Gait; Health; Immobilization; Investigation; Joints; Knee; Knee Prosthesis; Knowledge; Lead; Leg; Limb Prosthesis; Lordosis; Low Back Pain; Lower Extremity; Measures; Methods; Mission; Modeling; Modification; Motion; Musculoskeletal; Patient Care; Pattern; Pelvis; Persons; Phase; Play; Population; Positioning Attribute; Posture; Procedures; Process; Prosthesis; Prosthesis Design; Quality of life; Rehabilitation therapy; Research; Research Subjects; Resources; Risk; Risk Factors; Role; Rotation; Shock; Spinal; Therapeutic Intervention; Vertebral column; Veterans; Veterans Health Administration; Walking; Work; absorption; bone; improved; kinematics; limb amputation; neglect; prevent; prosthesis fitting; prosthesis wearer; prosthetic alignment; prosthetic socket; research and development; residual limb; socket design; sound; therapy design; therapy development; 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 low back pain (LBP). The etiology for the development of LBP is not entirely known or understood, but in persons with unilateral amputations it is believed to relate to the asymmetries and gait deviations that are typically demonstrated and required to walk with a prosthesis. Previous studies have primarily focused on the lumbar spine and pelvis, while neglecting trunk posture and spinal segmental motions. There have been limited studies to date that have investigated or determined if transfemoral prosthesis users adopt standing and gait postures and pelvic rotation patterns that put them at increased risk of developing or worsening LBP. We propose to conduct a preliminary investigation of the trunk and pelvic positioning and motions during standing and walking to determine if long-term unilateral, transfemoral prosthesis users are at an increased risk of developing LBP due to socket design and prosthetic alignment. Therefore, the purpose of this study is to investigate and compare the effects of the standard ischial containment (IC) socket to a sub-ischial (SI) socket design on the trunk posture and pelvic motions of transfemoral prosthesis users. We propose the following specific aims for this project: • Aim 1: To measure kinematics of the pelvis and spinal segments in unilateral, transfemoral prosthesis users during gait. We will perform quantitative motion analyses on two groups of 6 research subjects with lower limb amputation using 2 different socket designs (IC and SI) walking over level ground at three self-selected walking speeds (slow, normal, fast). Data will be compared between socket type and to an able-bodied control group. Hypothesis 1a—IC socket wearers will have greater anterior pelvic tilt compared to SI socket wearers and able-bodied controls, and they will exhibit considerably greater sagittal-plane rotations of the pelvis and spinal segments during walking. Hypothesis 1b—IC socket wearers will exhibit greater lumbar erector spinae activity while walking compared to SI socket wearers and able-bodied controls. • Aim 2: To measure trunk posture and pelvic orientation in unilateral, transfemoral prosthesis users during standing. We will use a multi-segment model of the spine and pelvis of the research and control subjects to determine neutral spinal, pelvis and prosthetic alignment during standing. Hypothesis 2a—IC socket wearers will demonstrate greater trunk flexion and anterior pelvic tilt during standing compared to SI socket wearers and control subjects. Hypothesis 2b—IC socket wearers will exhibit greater erector spinae activity during standing compared to SI socket wearers and able-bodied controls. These preliminary data could be used in the future as a rationale to conduct larger, more in-depth and focused studies to investigate LBP associated with amputation and prosthesis use. Additionally, our results may suggest that conventional prosthetic socket designs should be reassessed to allow greater rotation between the pelvis and femur of the residual limb. Understanding spinal motion and compensations would improve our comprehension of the factors contributing to LBP and possibly lead to the development of new prosthetic and therapeutic interventions designed to prevent or alleviate LBP.

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， 长期发展的继发性健康状况，如腰痛（LBP）。发展的病因 LBP的发生并不完全已知或理解，但在单侧截肢的人中，据信与以下因素有关： 不对称和步态偏差，这是典型的表现和需要步行的假肢。 以前的研究主要集中在腰椎和骨盆，而忽略了躯干姿势和脊柱 节段运动迄今为止，只有有限的研究调查或确定经股动脉 假肢使用者采用站立和步态姿势以及骨盆旋转模式，使他们面临更大的风险， LBP发展或恶化。 我们建议进行初步调查的躯干和骨盆的定位和运动在站立 和步行，以确定长期单侧经股动脉假体使用者的风险是否增加， 由于接受腔设计和假体对线，导致LBP。因此，本研究的目的是 研究并比较标准坐骨包容（IC）接受腔与坐骨下（SI）接受腔的效果 经股动脉假体使用者躯干姿势和骨盆运动的设计。我们提议下列 该项目的具体目标： ·目的1：测量单侧经股动脉骨盆和脊柱节段的运动学。 在步态期间使用假肢。我们将对两组6项研究进行定量运动分析 下肢截肢受试者使用2种不同的插座设计（IC和SI）在平地上行走 以三种自选的步行速度（慢、正常、快）。数据将在套接字类型之间进行比较 和一个健全的对照组。假设1a-IC插座佩戴者的骨盆前部 与SI插座佩戴者和健全对照者相比， 行走时骨盆和脊柱节段的矢状面旋转。假设1b-IC插座 与SI插座佩戴者相比，佩戴者在行走时将表现出更大的腰椎竖脊肌活动 和健全的对照组 ·目的2：测量单侧经股动脉假体的躯干姿势和骨盆方向 使用者站立时。我们将使用多段模型的脊柱和骨盆的研究和 对照受试者在站立期间确定中性脊柱、骨盆和假体对准。假设 2a-IC接受腔佩戴者在站立时躯干屈曲和骨盆前倾角更大 与SI插座佩戴者和对照受试者相比。假设2b-IC插座佩戴者将表现出 与SI插座佩戴者和健全对照组相比，站立时竖脊肌活动更大。 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LBP与截肢和假体使用相关。此外，我们的研究结果可能表明， 传统的假肢接受腔设计应该重新评估， 和大腿骨上了解脊柱运动和补偿将改善我们的 了解导致LBP的因素，并可能导致新假体的开发， 旨在预防或缓解LBP的治疗干预。