單側膝下截肢患者之步態和步行能量消耗分析

Gait Analysis and Energy Expenditure of Walking Among Patients with Unilateral Transtibial Amputation

黃國峰(Gwo-Feng Huang) ； 周有禮(You-Li Chou) ； 蘇芳慶(Fong-Chin Su) ； 周伯禧(Pei-Hsi Chou)

《中華民國復健醫學會雜誌》 29卷3期 (2001/09) Pp. 123-132

摘要

截肢對截肢者而言不僅是失去肢節，也失去許多行動能力，最新的義肢設計不僅在彌補原有肢節，更重要在改進其生活上活動與獨立生活的能力。然而義肢步態與一般步態的差異性仍不明確，特別是穿上不同的義足時義肢側與健側的運動學與動力學是不同的。
本研究分為兩階段，第一階段對膝下截肢病患作步態分析，選取10名膝下截肢的病患，穿戴三種不同的義足，如：傳統義足(SACH foot)、單軸義足(single axis foot)和多軸義足(multiple axis foot)，分別以舒適的速度行走，利用動態分析設備來偵測步態週期的特徵。第二階段研究為針對第一階段之三種不同的義肢作能量消耗分析，並以第一階段的10名膝下截肢病人，利用能量測量儀及跑步機分別以每小時1、1.5和2英哩(mile)的速度及跑步機標別之0、4和8三個坡度(grade)的斜坡，進行能量消耗分析測試，並在測試結果後進行能量消耗分析對義肢舒適性滿意度之相關性的問卷調查。結果在傳統義足提供站立期的穩定度(stance stability)，可用在低活動度(lower-activity level)，且足部需較少背曲(dorsiflexion)的截肢患者。單軸義足允許做少量的足背曲(dorsiflexion)和足蹠曲(plantar-flexion)，可使用在早期到晚期站立期(early-to-late stance)足部的背曲，可走斜坡及稍微不平的路面。多軸義足除了可增加踝關節的活動和經由可塑性內骨架來促進義足推進(push-off)的功能，在站立期可產生少量的轉動，因此推薦使用在中度活動度截肢患者使用。依本實驗分析膝下截肢患者在能量消耗方面，比正常人多消耗52%至58%，在耗氧量方面，亦比正常人多消耗51%至53%。在舒適度方面，以多軸義足最為舒適，其次是單軸義足，而以傳統義足在快走時最不舒適。這研究結果將能夠提供主觀及客觀的數據，給臨床醫師作為處方義肢的參考。

關鍵字

膝下截肢患者 ； 運動學 ； 步態分析 ； 能量消耗

並列摘要

Amputations not only cause the loss of limb but also accompany with inconvenience of physical mobility for the patients. The newly developed prosthetic designs make possible to the replacement of amputated parts, thus greatly improve the body mobility and life independence of the patients. However, the real manifestation of the prosthetic gait and the discrepancy between the prosthetic and normal gaits is still lacking, especially there are significant difference in kinematics and kinetics between the sound side and prosthetic side with different type of prosthetic feet.
There are two steps in these studies: The first step is analyzing the gait of ten unilateral transtibial amputees, walking normal speed and wearing three different prosthesis : SACH foot, single axis foot, multiple axis foot. Motion data was collected by 3D motion analyzing system. The second step is researching the energy expenditure of the same ten patients in the first step. These patients walk at speed of 1 mile per hour, 1.5 miles per hour and 2 miles per hour on slope of 0 grade, 4 grade and 8 grade respectively. Energy expenditure is detected while amputees walking on metabolic measurement cart and heavy-duty treadmill. Subjective results are additionally determined via questionnaire after testing. A survey is conducted to determine the comfort level of prosthesis foot with patients after the experiment. The results showed that the SACH foot provides good late-stance stability through limited dorsiflexion, which is suitable for lower activity level amputees. The single axis foot allow small range of dorsiflexion and plantarflexion which is suitable for the amputees walking on slopes or rough road surface. The multiple axis foot, provides less late-stance stability and more late-stance dorsiflexion ankle motion, which is desirable for higher activity levels or for activities requiring more ankle dorsiflexion. This study finds that the energy expenditure of amputee is from 52% to 58% and the oxygen uptake is from 51% to 53% of the normal subjects. According to the result of questionnaire, multiple axis feet is the most comfortable type and single axis feet is the next. SACH type is the worst one in comparison with the two types mentioned above. Research results will provide quantitative and qualitative insight to facilitate proper prosthetic foot selection.

並列關鍵字

below-knee amputee ； kinematics ； gait analysis ； energy expenditure