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

长期使用经股动脉(即膝盖以上)假体的人患继发性心脏病的风险增加 肌肉骨骼状况与一般健全人群相比。重要的资源已经被 致力于下肢截肢者的直接康复需求，但需要 应更多地考虑及早识别和修改导致长期失业的潜在风险因素 二次健康状况的长期发展，如下腰痛(LBP)。发展的病因学 LBP的发病率尚不完全清楚或了解，但在单侧截肢者中，据信与 不对称和步态偏差，通常是假肢行走时所表现出来的和需要的。 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 节段性运动。到目前为止，已经有有限的研究调查或确定是否经股动脉 假体使用者采用站立和步态姿势以及骨盆旋转模式，使他们面临更高的风险 发展或恶化的LBP。 我们建议对站立时躯干和骨盆的位置和运动进行初步调查。 步行以确定长期单侧、经股动脉假体使用者是否有更高的风险 由于插座设计和假体对准而开发LBP。因此，这项研究的目的是 调查并比较标准坐骨包容(IC)插座和坐骨下(SI)插座的效果 股骨头假体使用者躯干姿势和骨盆运动的设计。我们提出以下建议 该项目的具体目标： ·目标1：测量单侧经股骨骨盆和脊柱节段的运动学 假肢使用者在步态过程中。我们将对两组6项研究进行定量的运动分析 使用两种不同插座设计(IC和SI)的受试者在平地上行走 以三种自己选择的步行速度(慢、正常、快)。数据将在套接字类型之间进行比较 和一个身体健全的对照组。假设1a-IC插座佩戴者会有更大的骨盆前部 与SI插座佩戴者和身体健全的控制者相比，它们的倾斜度要大得多 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，佩戴者在行走时会表现出更强的腰椎竖脊活动 和健全的控制力。 ·目标2：测量单侧股骨头假体的躯干姿势和骨盆方位 站立时的使用者。我们将使用研究的脊柱和骨盆的多节段模型和 对照受试者确定站立时脊柱、骨盆和假体的中性对齐情况。假设 2a-IC插座佩戴者站立时躯干屈曲和骨盆前倾较大 与SI插座佩戴者和对照受试者比较。假设2b-IC插座佩戴者将展示 与SI插座佩戴者和身体健全的对照组相比，站立时竖脊肌有更大的活动。 这些初步数据可以在未来作为进行更大范围、更深入和有重点的研究的基础 研究与截肢和假体使用相关的LBP。此外，我们的结果可能表明 传统的假体接受腔设计应该重新评估，以允许骨盆之间有更大的旋转 和残肢的股骨。了解脊柱运动和补偿将改善我们的 了解导致腰痛的因素，并可能导致新假体和 旨在预防或减轻LBP的治疗性干预。

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.