Improving Socket Fit in Female and Male Veterans with Transtibial and TransfemoralAmputation

改善经小腿和经股截肢术的女性和男性退伍军人的接受腔贴合度

• 批准号: 10609490
• 负责人: Alena Grabowski
• 金额: --
• 依托单位: VA EASTERN COLORADO HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10609490
• 关键词: 3D Print; Address; Affect; Amputation; Back; Back Pain; Biomechanics; Boa; Compensation; Coupling; Custom; Degenerative polyarthritis; Diabetes Mellitus; Enrollment; Equilibrium; Evaluation; Female; Femur; Future; High Prevalence; Impairment; Individual; Injury; Joints; Kinetics; Knee; Knowledge; Leg; Limb structure; Low Back Pain; Lower Extremity; Manufacturer; Measures; Mechanics; Motion; Movement; Muscular Atrophy; Nylons; Obesity; Outcome; Pain; Participant; Patients; Persons; Physical activity; Printing; Prosthesis; Quality of life; Questionnaires; Reaction; Refit; Rehabilitation therapy; Research; Rest; Risk; Risk Reduction; Running; Scanning; Services; Skin; Suspensions; Technology; Tendon structure; Thick; Time; United States Department of Veterans Affairs; Veterans; Walking; carbon fiber; comorbidity; fall risk; functional improvement; functional loss; improved; kinematics; light weight; limb amputation; limb movement; male; manufacture; novel; prosthesis fitting; prosthesis wearer; prosthetic socket; rehabilitation research; residual limb; satisfaction; skin irritation; socket design; treadmill

A prosthetic socket is perhaps the most important part of a prosthesis because it allows force and energy to be transferred between the residual limb and prosthetic components, and influences successful rehabilitation following lower-limb amputation. People with lower-limb amputation are typically fit with a rigid prosthetic socket. However, the use of a prosthesis incorporating this type socket has led to negative secondary conditions such as osteoarthritis, back pain, residual limb skin breakdown and discomfort; 57% of prosthetic users are dissatisfied with the comfort of their prosthesis. People with unilateral transtibial or transfemoral amputation typically walk with asymmetric biomechanics, such as ground reaction forces, joint motion, and joint kinetics. People with unilateral amputation typically compensate for the functional loss of the muscles and tendons of the affected leg with greater forces borne by their unaffected leg. Asymmetric forces likely contribute to the higher prevalence of osteoarthritis and low back pain in people with a leg amputation. Pain and improper fit of the socket can result in loss of material, time, and money for patients, prosthetists, and manufacturers. An adjustable socket that accommodates residual limb volume fluctuations could allow prosthetists to optimize socket fit for each patient, which could reduce the risk of comorbidities such as osteoarthritis, pain, and the need to re-fit prosthetic sockets in the long term. Moreover, use of an adjustable socket design has the potential to improve function and comfort of Veterans with lower limb amputation. Quorum Prosthetics (Windsor, CO) has developed a new modular adjustable socket, the Quatro socket, that could decrease biomechanical asymmetry, decrease movement of the residual limb relative to the socket (socket pistoning), and improve comfort and satisfaction during walking due to its ability to accommodate residual limb volume changes of up to 12%. The Quatro socket is produced by 3D printing high-strength Nylon 12, which is stronger and lighter than typically used carbon fiber; 3D printing also decreases build time and allows customized changes down to 80 μm in thickness. Each socket can be custom printed from a scan of a patient's limb, cast, or existing socket, so it is form-fit to the individual user. The Quatro socket utilizes 3 Boa dials (Boa Technology, Steamboat Springs, CO) that ratchet to tighten or loosen cables that run through 4 padded panels to quickly and systematically adjust the volume and compression of the socket around the user's limb. This technology allows a user to don or doff the socket in ~20 sec and adjust for volume changes up to 12%. We will determine the effects of using a conventional rigid and an adjustable Quatro prosthetic socket with the same suspension and prosthetic components on the biomechanics, socket pistoning, and comfort/satisfaction of 10 female and 10 male Veterans with a unilateral transtibial amputation (Aim 1) and of 10 female and 10 male Veterans with a unilateral transfemoral amputation (Aim 2) during walking. Subjects will walk on a force-measuring treadmill at 0.75-1.5 m/s on level ground and at 1.0 m/s on uphill/downhill slopes of 3° and 6° using each socket. After each set of trials with a socket, subjects will complete a modified questionnaire (PEQ) that assesses their comfort/satisfaction. Prior to and each year for 4 years after enrollment, subjects will be asked to complete a PEQ. An adjustable prosthetic socket could improve the mechanical coupling between the person and prosthesis and reduce their biomechanical asymmetry, which could enhance function and lower the risk of secondary injury. Decreasing socket pistoning could reduce skin irritation and breakdown, which may lower abandonment of prostheses. A better fitting socket could improve comfort, satisfaction, rehabilitation, and function for Veterans with amputations, which could ultimately improve their quality of life. Our results can also be used to inform future prosthetic socket designs. In these ways, our research will advance knowledge in rehabilitation research, directly benefit Veterans, and contribute to the quality of services provided by the Department of Veterans Affairs.

假体插座可能是假体中最重要的部分，因为它允许力量和能量 在残留的肢体和假肢组成部分之间转移，并影响成功 下限截肢后的康复。下limb截肢的人通常适合刚性 假肢插座。但是，使用该类型插座的假体的使用导致负面 诸如骨关节炎，背痛，残留的肢体皮肤崩溃和不适之类的次要疾病； 57％ 假肢对假体的舒适性不满意。具有单方面跨位或的人 经济截肢通常与不对称的生物力学行走，例如接地力，关节 运动和关节动力学。单侧截肢的人通常会补偿 受影响的腿的肌肉和肌腱以其未受影响的腿承担的更大的力量。不对称力 可能会导致截肢者的骨关节炎和腰痛的较高患病率。 插座的疼痛和不当拟合可能会导致患者，假肢和 制造商。可调节的插座，可容纳剩余肢体体积波动，可以允许 假肢主义者优化适合每个患者的插座，这可能会降低合并症的风险 从长远来看，骨关节炎，疼痛以及需要重新拟合假肢的需求。此外，使用可调节的 套筒设计有可能改善具有下肢截肢的退伍军人的功能和舒适性。 法定人物假肢（Windsor，CO）已开发了一个新的模块化可调插座，Quatro插座， 这可能会降低生物力学不对称性，减少残留肢体相对于插座的运动 （插座装备），并提高步行期间的舒适度和满意度，因为它的能力 残留肢体体积的变化高达12％。 Quatro插座是通过3D打印高强度尼龙产生的 12，比通常使用的碳纤维更强大，更轻； 3D打印也减少了建立时间和 允许自定义更改厚度为80μm。每个插座都可以从扫描中自定义 患者的肢体，铸造或现有插座，因此它对单个用户形成了合适的形式。 Quatro插座利用3 BOA 拨号（BOA技术，Steamboat Springs，co），棘轮拧紧或松散的电缆，贯穿4 填充面板以快速有系统地调整插座周围的插座的音量和压缩 用户的肢体。这项技术使用户可以在约20秒内对插座进行插入或调整插座，并调整数量更改 最多12％。我们将确定使用常规刚性和可调节的Quatro假肢的影响 插座在生物力学，插座和插座上具有相同的悬架和假肢成分 单侧截肢和10位男性退伍军人的舒适/满意（AIM 1）和 步行过程中有10名女性和10名男性退伍军人，具有单方面的跨性截肢（AIM 2）。 受试者将以0.75-1.5 m/s的水平地面和1.0 m/s的速度行走，以0.75-1.5 m/s的速度行走 使用每个插座上坡/下坡插槽3°和6°。每组带有插座的试验后，受试者将 完成评估其舒适性/满意度的修改调查表（PEQ）。每年和每年4 入学后几年，将要求受试者完成PEQ。可调节的假肢可以 改善人与假体之间的机械耦合并减少其生物力学 不对称，这可以增强功能并降低继发性损伤的风险。减少插座活塞 可以减少皮肤刺激和分解，这可能会降低假体的遗弃。更好的合适 插座可以改善具有截肢的退伍军人的舒适性，满意度，康复和功能， 最终可以改善他们的生活质量。我们的结果也可用于告知未来的假肢插座 设计。通过这些方式，我们的研究将提高有关康复研究的知识，直接受益 退伍军人，并为退伍军人事务部提供的服务质量做出贡献。