单侧大腿截肢患者穿不同大腿假肢膝关节在不同坡度行走的运动学分析

Kinematic Analysis of Patients with Unilateral Thigh Amputation Walking at Different Slopes through Different Artificial Limbs

摘要: 研究目的：观察不同类型的大腿假肢膝关节对截肢患者步态的影响。研究方法：采用文献资料法、CAREN系统采集与分析法、数理统计法等研究方法，通过对穿机械假肢膝关节(3R20)和智能假肢膝关节(C-leg4)的8名单侧大腿截肢患者在不同坡度行走的步态进行数据采集和分析，并结合步态对称性公式，探讨大腿截肢患者的步态状况，并与正常人步态参数进行对比分析，旨在研究两种大腿假肢膝关节的步态差异，为改进大腿假肢膝关节提供理论依据。研究结果：在0˚坡度行走时，穿3R20的双支撑期百分比比穿C-leg4的双支撑百分比大2%；穿3R20的髋关节屈伸角度比穿C-leg4的髋关节屈伸角度大3.46˚，穿3R20的膝关节屈伸角度与穿C-leg4的膝关节屈伸角度差值为0.54˚，踝关节屈伸角度差值为0.23˚；穿3R20的时相对称性指数比穿C-leg4的时相对称性指数小0.12，穿3R20的偏差指标和对称度指标分别比穿C-leg4的偏差指标和对称度指标大9%、7%。在+5˚坡度行走时，穿3R20的双支撑期百分比比穿智能膝关节的双支撑百分比大0.94%。穿3R20的髋关节屈伸角度比穿C-leg4的髋关节屈伸角度大3.68˚，穿3R20的膝关节屈伸角度与穿C-leg4的膝关节屈伸角度差值为0.96˚，踝关节屈伸角度差值为0˚；穿3R20的时相对称性指数比穿C-leg4的时相对称性指数小0.05，穿3R20的偏差指标和对称度指标分别比穿C-leg4的偏差指标和对称度指标大6%、9%。在−5˚坡度行走时，穿3R20的双支撑期百分比比穿智能膝关节的双支撑百分比大4.47%。穿3R20的髋关节屈伸角度比穿C-leg4的髋关节屈伸角度大1.45˚，穿3R20的膝关节屈伸角度与穿C-leg4的膝关节屈伸角度差值为0.08˚，踝关节屈伸角度差值为0.16˚；穿3R20的时相对称性指数比穿C-leg4的时相对称性指数小0.12，穿3R20的偏差指标和对称度指标分别比穿C-leg4的偏差指标和对称度指标大14%、8%。研究结论：1) 机械假肢膝关节和智能假肢膝关节的本质区别在于二者的灵活性和稳定性不同。因此，需要从大腿假肢膝关节结构进行改进，达到灵活性和稳定性的合理代偿。2) 机械假肢膝关节与智能假肢膝关节在不同坡度的步态差异较大。而步态状况主要是通过人体的平衡性、协调性对称性来反映。因此，需要从大腿假肢膝关节的结构进行改进。3) 智能假肢膝关节的步态更接近正常人步态，但截肢侧、健侧的对称性与正常人左右腿的对称性相比还有一定差距。因此，智能假肢膝关节还需要从灵活性、对称性等方面再进行改进。

Abstract: Research Objective: To observe the effect of different types of thigh prosthesis and knee joint on gait of amputees. Research Method: By using the methods of documentation, CAREN system acquisition and analysis, mathematical statistics and other research methods, the gait data of 8 patients with lateral thigh amputation who wear mechanical prosthetic knee joint (3R20) and intelligent prosthetic knee joint (C-leg4) on different slopes were collected and analyzed, and the gait symmetry formula was used to explore the thigh. The gait status of amputated patients and gait parameters of normal people were compared and analyzed in order to study the gait difference between the two kinds of thigh prosthetic knee joints and provide theoretical basis for improving the thigh prosthetic knee joints. The results showed that: When walking at 0 degree gradient, the percentage of double support period of wearing 3R20 is 2% larger than that of wearing C-leg4; the hip flexion and extension angle of wearing 3R20 is 3.46 degrees larger than that of wearing C-leg4; the difference between knee flexion and extension angle of wearing 3R20 and that of wearing C-leg4 is 0.54 degrees; and the difference between ankle flexion and extension angle of wearing 3R20 and wearing C-leg4 is 0.23 degrees. The relative symmetry index of wearing 3R20 is 0.12 less than that of wearing C-leg4. The deviation index and symmetry index of wearing 3R20 are 9% and 7% higher than those of wearing C-leg4, respectively. When walking on a slope of +5 degrees, the percentage of double support period in wearing 3R20 is 0.94% higher than that in wearing smart knee joint. The hip flexion and extension angle of 3R20 is 3.68 degrees larger than that of C-leg4, the difference between knee flexion and extension angle of 3R20 and that of C-leg4 is 0.96 degrees, and the difference between ankle flexion and extension angle of 3R20 is 0 degrees; the relative symmetry index of 3R20 is 0.05 less than that of C-leg4, and the deviation index of 3R20 is 0.05 less than that of C-leg4. The deviation index and symmetry index are 6% and 9% higher than those of C-leg4. The percentage of double support period of wearing 3R20 is 4.47% higher than that of wearing smart knee joint when walking at −5 degree slope. The hip flexion and extension angle of 3R20 is 1.45 degrees larger than that of C-leg4, the difference between knee flexion and extension angle of 3R20 and C-leg4 is 0.08 degrees, and the difference between ankle flexion and extension angle of 3R20 is 0.16 degrees; the relative symmetry index of 3R20 is 0.12 less than that of C-leg4, and the deviation index of 3R20 is 0. The deviation index and symmetry index of C-leg4 are 14% and 8% higher than those of C-leg4. Research Conclusion: 1) The essential difference between mechanical prosthetic knee joint and intelligent prosthetic knee joint lies in their different flexibility and stability. Therefore, it is necessary to improve the structure of the knee joint of the thigh prosthesis to achieve reasonable compensation for flexibility and stability. 2) The gait of mechanical prosthetic knee joint and intelligent prosthetic knee joint differs greatly in different gradients. The gait status is mainly reflected by the balance and coordination symmetry of the human body. Therefore, it is necessary to improve the structure of the knee joint of the thigh prosthesis. 3) The gait of the knee joint of the intelligent prosthesis is closer to that of the normal person, but the symmetry of the amputated side and the healthy side still lags behind that of the left and right legs of the normal person. Therefore, the knee joint of intelligent prosthesis needs to be improved from the aspects of flexibility and symmetry.