单侧大腿截肢患者穿戴不同假肢膝关节行走的步态分析

Gait Analysis of Patients with Unilateral Thigh Amputation Wearing Different Prosthetic Knee Joints

摘要: 研究目的：通过大腿截肢患者穿戴不同假肢膝关节行走的步态分析对不同假肢膝关节进行科学评估。研究方法：本文拟使用卡伦系统对单侧大腿截肢患者穿戴4种不同假肢膝关节(机械四连杆假肢膝关节、液压四连杆假肢膝关节、双气压多轴假肢膝关节、智能假肢膝关节)在3种步行条件下(0˚、±5˚行走)的步态能力进行研究，评价4种假肢膝关节在不同路况条件下的适配效果，为临床假肢膝关节的选择提供理论参考和数据支持。研究结果：1) 在0˚行走条件下，受试者步行速度最大；5˚、−5˚时步行速度均减小以增强步行稳定性；2) 在5˚时，受试者穿戴4种假肢膝关节行走步频均最小，其中3R20步频小于其他三组且在同样步行条件下与其他三组间有显著性差异(p < 0.05)；3) 3种行走条件下3R20、3R60、3R106、C-LEG 4种假肢膝关节单步长均表现为患侧小于健侧，出现步长不对称的情况，其中3R20健患侧步长差异最大，表现最差，C-LEG在5˚行走条件下差异较大，说明C-LEG应在上坡路况行走状态进行改进提高；4) 从摆动期数值来看，3R20健患侧摆动期差异最大，表现最差；在0˚和−5˚条件下，C-LEG摆动期健患侧差异最小，表现最好，而在5˚时，3R60表现最好。结论：4种假肢膝关节中3R20在3种行走条件下步态表现最差；C-LEG表现最好，但应加强在上坡条件下受试者的适应性以提高在上坡路况的表现。

Abstract: Research Purpose: The gait analysis of patients with leg amputation wearing different prosthetic knee joints was used to evaluate the different prosthetic knee joints scientifically. Research Methods: This paper intends to use the Karen system to study the gait ability of patients with uni-lateral thigh amputation wearing four different kinds of artificial knee joints (mechanical four-link artificial knee joint, hydraulic four-link artificial knee joint, double-pneumatic multi-axis artificial knee joint, and intelligent artificial knee joint) under three walking conditions(0˚, ±5˚ walking), and evaluate the fitting effect of four kinds of artificial knee joints under different road conditions, so as to provide theoretical reference and data support for the selection of clinical artificial knee joints. Research Results: 1) Under the walking condition of 0˚, the walking speed of the subject is the maximum; Walking speed decreased at 5˚ and −5˚ to enhance walking stability. 2) At 5˚, the walking frequency of subjects wearing the four kinds of artificial knee joints is the minimum, among which 3R20 step is smaller than the other three groups and has significant difference with the other three groups under the same walking condition. 3) Under three walking conditions, the single-step length of 3R20, 3R60, 3R106 and C-LEG of the four kinds of artificial legs and knees all show that the affected side is smaller than the healthy side, and the step length is asymmetric. Among them, 3R20 has the largest difference in step length on the healthy side and the worst performance. C-LEG has a large difference in 5˚ walking condition, indicating that C-LEG should be improved in uphill walking condition. 4) From the value of swinging period, 3R20 showed the largest difference and the worst performance in swinging period. Under the conditions of 0˚ and −5˚, the difference between the healthy side and the affected side in the C-LEG swinging stage was the smallest and the performance was the best, while at 5˚, the performance of 3R60 was the best. Conclusion: Among the four kinds of artificial knee joints, 3R20 has the worst gait performance under three walking conditions. C-LEG performs best, but the fitness of the subject in uphill conditions should be enhanced to improve performance in uphill conditions.