# 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

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.

1. 引言

2. 研究目的

3. 研究对象与方法

3.1. 研究对象

Table 1. Basic information of subjects

3.2. 研究方法

3.2.1. 文献资料法

3.2.2. CAREN系统采集与分析法

Figure 1. CAREN rehabilitation system chart

Figure 2. CAREN rehabilitation system assessment test

3.2.3. 数理统计法

4. 结果与讨论

4.1. 3R20相关参数分析

4.2. C-leg4相关参数分析

Table 2. Relevant parameters of amputated side and healthy side from patients wearing 3R20 knee joint

Table 3. Relevant parameters of amputated side and healthy side from patients wearing C-leg4 knee joint

1) 穿3R20和C-leg4在−5˚坡度的双支撑时间最大，其次是0˚坡度。分析主要原因，可能是大腿假肢膝关节本身结构决定。3R20需要通过双腿支撑时间加长来代偿稳定性，而C-leg4可通过传感器、智能微处理器、伺服电机、可控智能液压缸控制调节系统来调节不确定情况下的安全稳定性。3R20只具有一个回转轴，通过内置弹簧控制在摆动期关节灵活性较好。C-leg4是采用人工智能学科的科学原理，采集信息、电子、控制、生物医疗、材料、能源以及机械技术为一体的大腿假肢，在摆动期时相通过CPU来控制。

2) 穿3R20和C-leg4在0˚和+5˚坡度行走时下肢关节角度差异较大。穿3R20与C-leg4下肢关节屈伸角度中，差异性最大的是髋关节屈伸角度。主要原因可能是大腿假肢膝关节接触髋关节部位，导致髋关节灵活性变差。

3) 在3种不同坡度行走时，穿3R20的时相对称性指数、偏差指标和对称度指标比穿C-leg4大。说明穿3R20的平衡性和协调性没有穿C-leg4好。主要原因可能是健侧膝关节和截肢侧膝关节的失调影响步行状况。

5. 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。

NOTES

*第一作者。

#通讯作者。

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