Subjective Objective Measurements Isehial-Evaluations

The UOEH Association of Health Sciences

NII-Electronic Library Service

The UOEHAssociation ofHealth Sciences

J UOEH21 (2):107-118 {1999) 107

(Origina])

Subjectivethe Isehial-Evaluations

and Objective Measurements of

Ramal Containment Prosthesis

Kenii HAcHIsuKAL, Yuichi UMEzuL, Hajime OGATAi,

Saburo OHMINE', Koichi SHiNKoDA2 and Hideaki ARIzoNosiDepartment

ofRehabigitation Medicine, School ofMedicine,2Rehahilitation

Unit, University HbspitaZ, U}ziversity of Occupational and

Japan. Ykehatanishi-ku, Kitakyushu 807-8555, Jcrpan'IArizono's

Smplies. }khatahigas'hi-ku, Kitakyu,sht{ 805-O061, Japan

Environmentai Health,

Abstract: We examined 12 transfemoral amputees, 6 using the IRC socket and 6 the QL socket, to confirm whether the ischial-ramal containment (IRC) socket is truly su-

perior to the quadrilateral (QL) socket. In subjective evaluation, the IRC group was significantly better in the totai score and in items of comfort, that is, to sit on a

chair and lumbar lordosis at heel off (Mann-Whitney test, P <O.05) , better but not

significant in the items of comfbrtable to wear, comfortable to go up and down

stairs, and truncal sway during stance phase. By computed tomography, the femur of the IRC group was kept in a position significantly more medial than that of

the QL group (Mann-Whitney test, P<O.05), but no signjfjcant difference in

gluteal medial muscle atrophy ratios between the two groups was found (Mann- Whitney test, P >O.05). By X-ray, the stump of the IRC group was maintained

significantly more adducted during one foot standing on the prosthesis (Mann- Whitney test, P<O.05), but the lateral fbrce ratio during mid-stance of the IRC

group was smaller, but not significantly, than that of the QL group. Physiological

cost index (PCI) , an indirect simple method fOr evaluating oxygen consumption of

gait, had no significant difference between the two groups (Mann-Whitney test, P

>O.05), and a multiple regression analysis revealed that the stump length ratio

and lateral fbrce ratio during mid-stance were significant explanatory variables for

predicting PCI (adjustedR square : O.87, F-value : 11.85, P <O.05) , The results

of this study have revealed that the advantage of the IRC socket is a tender feeling

of the stump, but that the rnetabolic efficiency is not superior to the QL socket at

the most comfortable speed.

KL7 worcZs:ischial-ramal containment socket, transfemoral amputation, prosthesis, evaluation.

<Received 22 January 1999, accepted 15 April 1999 )




leg K HAcHisuKA et al

Introduction

The quadrilateral (QL) socket design provides excellent support and stability for trans-

femoraL amputees during walking, and has replaced the p]ug fit socket [1,2]. The QLsocket has a contour with narrow anterior-posterior and wide medial-lateral dimensions, and

an ischial seat is attached to the top of the posterior wal] to bear the arnputee's body weight

(Fig. 1 ). Although the QL prosthesis is standard all over the world, we have occasionally

seen a transfemoral amputee using the QL socket who has his or her stump slightly abducted

[3] , complains of a feeling of being pushed up by the edge of the posterior wal1 at hip ex-

tension [4], and experiences pain on the ischial tuberosity, especially, at the beginning ot:

gait training. In recent years, new socket designs fora transfemoral amputee have been in-

troduced : a narrow medial-lateral socket known as Normal Shape-Noirnai Alignment [5] ,Contoured Adducted TTochanteric-Controlled Alignment Method (CAT-CAM) [6], and

Narrow Medial-Lateral socket (Narrow M-L) [7] . These new socket designs are generally

called the ischial-ramal containment socket (IRC) [8-10], because they have the common

feature that the' socket contains the ischial tuberosity and ramus inside the socket. The es-

sential structure of the RC socket is l. ) narrow medial-lateral and wide anterier-posterior di-

mensions, 2 ) no definite ischial seat at the top of the posterior wall, and containment of the

ischial tuberosity and ramus inside the socket.

Fig. 1 . Top and antcrior vicws ofthe quadrilateral socket for a left transfemoral amputee,

A : anterior, L : lateral, M : medial, * : ischial seat.




IRC Prosthcsis for Transfcmoral Amputation i09

The initjal idea of the IRC socket was derived frem Long's line [3 , 5] , Long noticed

that a transfemoral amputee wearing the QL socket had his or her stump abducted during

walking, and advocatedanew alignment of the socket so that the tip of the femur on the am-

putated side was set en a line perpendicular from the hip joint to the ground to maintain the

stump in a normal position. Sabolich developed this concept and adopted a bony lock to

prevent the stump from abducting by adding pressures to the lower femur and pelvis toward

the inside and to the ischial tuberosity and ramus toward the outside [6]. A transfemora]

amputee wearing a CAT-CAM prosthesis reported increased comfort, ease of donning and

doffing, and increased gait efficiency [11]. Flandry described the diminished compensa-

tory lateral trunk lean during walking, increased customary gait velocities, and reduction in

the quantity ofconsumed oxygen per meter by up to 50 % [12]. Gailey indjcated a signifi-

cantly lower energy expenditure during walking with the CAT-CAM socket at a faster pacethan that with the QL socket [13]. In our previous survey of the IRC prosthesis, amputees

wearing the IRC socket noticed that there was a more comfortable feelillg at the ischial tuber-

osity during walking after they had their socket converted from the QL socket to the IRC

socket, and that lateral trunk lean during the stance phase was reduced [14], However,

some amputees wearing the IRC socket still showed lateral trunk lean, and could not actually

realize any reduction of oxygen consumption during walking, fbr example, less fatigue from

walkjng on the prosthesis. This study, therefbre, was perTformed to confirm whether the IRC

socket is better than the QL socket in subjective assessment and objective measurement, and

whether metabolic efficiency of the IRC socket evaluated with the physiological cost index

(PCI) [15] is really superior to the QL socket

Materials and method

Twelve transfemoral amputees ( 6 for the IRC group and 6 fbr the QL group) were se-

lected as 36 subjects according to the inclusion and exclusion criteria from amputees who had

been rehabilitated in the UniveTsity Hospital of Occupational and Environmental Health and

aff11iated hospitals. The inclusion criteria for selecting the IRC group were as follows : 1 )unilateral transfemoral amputees, 2 ) being prescribed andf'or checked at their brace clinics

by one of the authors, 3 ) being able to walk usefully with the IRC prosthesis, 4 ) having

once used the QL socket, and S ) agreeing to join this clinical study. The exclusion criteria

were as fbllows: 1) amputees wearing aplug-fit type socket, 2) amputees suffering from

is¢ hemic heart diseases, diabetes mellitus, renal insufficiency, and or degenerative joint dis-

ease, and 3 ) taking any medicine affecting cardio-respiratory functions, that is, 5-blocker,and Ca-antagonist, For selecting the QL group,

`CIRC"

in the third item of the inclusion cri-

teria was replaced by "QL"

and the fourth item was omitted.

Befbre evaluating the IRC and QL sockets, all the prostheses were carefuIly checked by

the authors, and were remade or modified to obtain optimal fit, if necessary. Six transfemo-




110 K TIAcHtsuKA et at

ral amputees ( 5 males and 1 female) were using the IRC socket which was made by an ex-

perienced certified clinical prosthetist according to the manual [7] . The IRC sockets were

the Scandinavian flexible type with a Surlyn plastic inner socket and acrylic resin hard frame

(Fig. 2 ) , afld were attached to the endoskeletal prostheses. Their parts were a safety knee

for 5 prostheses and a manual ]ock kncc fbr onc, and a sing]c axis foot for 6. Six trans-

femoral amputees ( 6 males) were using the QL sockets which were also made by expcricnced

cenified clinical prosthetists, Five QL sockets were attached to the endoskeletal and one to

the shell prostheses, and their parts were a safety knee for 5 prostheses and a manual lock

knee for one, anda single axis foot fbr3 and an energy storing foot fbr3. Stump length ra-

tios were obtained by dividing the length from the ischial tuberosity to the tip ol' the stump by

the Iength from the ischial tuberosity to the lateral femoral condyle on the non-amputated side.

Subje¢ tive evaluation of the sockets consisted of 6 items of self-assessment and 3 items

of specialist-assessment, which wcrc based on the results of our previous study [14],A selflassessment questionnaire, including

"comfortable

to wear," "easc

to swing the prosthe-sis,""comfortablc to go up and down stairs,""comfortable to sit on a chair,']"appearance of

the socket," and "donning

and doffing thc sockct," was handed to the subjects at the brace

clinic, and these items were rated as 4 for good, 3 fbr slightly good, 2 fbr slightly poor, and 1

for poor by the subjects. Specialist-assessment items, "hip

abduction during swing phase,"C`truncal

sway during stancc phasc," and "lumbar

lordosis at heel off," were rated as 4 for no

abduction (sway or lordosis),3 fbr slight, 2 for somewhat, and 1 fbr severe by three of the

Fig.2. Top and antcrior

amputce,

A : an terior, M :

view of the ischial-rainal containment socket for a right Lransfemorul

medial, 'i:

: indentation of the posLcrior svul] bearing ischial tuberosity.




IRC Prosthesis for Transi'emeral Amputation 111

authors (KH, SO, and HA) , while the subjects walked on a walkway in the training room two

or three times. VVhen there was a difference in judgment among the evaluators, they ac-

cepted a majority decision.

Cemputed tomograms of every 2 cm of transverse s]ice between the hip afld upper

thighs were taken to reconfirm whether the socket fitted well and to examine the femur posi-tion which was one of the features of the IRC socket. During a scan, the amputees wearing

their prosthesis lay on their back with their feet pressing against a footrest to maintain total

contact between the stump and socket. Femur posjtion at the anterior-posterior direction

was determined by the ratio of distance between the anterior edge of the thigh and femur di-

vided by the anterior-posterior dimension of the thigh 4 cm below the great trochanter andmultiplied by 1OO. The femur position at the medial-lateral direction was defined as a ratio

of distance between the medial edge of the thigh and femur divided by the medial-lateral di-

mension of the thigh 4 cm below the great trochanter and multiplied by leO.

To ascertain atrophy of the gluteal medial muscle, we measured the areas of the bilateral

gluteal medial muscles at the slice containing the inferior anterior iliac spine by an image ana-

lyzer (Avionics, Japan) . Gluteal medial muscle atrophy ratio was defined as the area on the

amputated side divided by that on the non-amputated side.

Anterior-posterior X-ray photographs of the pelvis and femurs weTe taken while the sub-

.iects were standing on one foot to examine the hip adduction angle simulating mid-stance of

gait. The angle between the longitudinal axis of the femur and the perpendicular line to a

line connecting the upper borders of the acetabulum of the bilateral hip joint was rneasured.

Residual femur abduction during standing was defined as the adduction angle of the non-

amputated hip joint during standing on a non-arnputated foot subtracted from that of the arn-

putated hip during standing on the prosthesis.

To measure lateral stability of the socket, the amputees were asked to walk on a walk-

way containing a force plate (Kistler, Switzerland) at their most comfortable speed until five

appropriate ground-reaction fbrce patterns were obtained. The signals from the force plate

were transmitted to an A/D converter and personal computer to calculate the forces of the

vertical, right-left and front-back directions. Data were normalized by the individual's body

weight and tirne of the stance phase and were then averaged for each amputee [16]. Lat-

eral force ratio was defined as the lateral fOrce during mid-stance on the amputated side di-

vided by that on the non-amputated,

To examine the metabolic efficiency of gait with the presthesis, the physiological cost

index (PCI) was obtained [15] : [heart rate at the endofa three minute gait (beats/min) -

heart rate at rest (beats/min)] / velocity (m/min). Heart rates at rest and at the end ofa

three minute walk were monitored by a telemetric electrocardiograph (NEC-Sanei, Japan) ,

axid velocity was obtained by the distance of a three minute gait at the subject's most comfort-

able speed.

Data were presented as mean ± standard deviation, and statistical analyses were proc-




112 K HAcmsuKA et aJ

essed with SPSS 8.0 J for Windows. A t -test was apptied to compare the differences in age,

duration after amputation, and stump length ratio between the IRC and QL groups, and Mann-

Whitney test was used to compare the differences in the subjective evaluation and objective

measurement between the two groups. A multiple regression analysis was perfbrmed to de-

termine what factors were related to PCI. Its predicting variable was PCI, and explanatory

variables were stump length ratio, lateral force ratio during mid-stance, socket type, femur

position at the medial-lateral direction, residual femur abduction during standing, gluteal me-

dial muscle atrophy ratio, and age. As the socket type was c'ategorical, the data were con-

verted to 1 fbr the IRC socket and 2 fbr the QL socket befbre analysis, Differences with P-

value of less than O.05 were regarded as significant.

Results

1 . Subjects'characteristics

There were no significant differences in age and stump length ratio between the IRC and

QL groups (Table 1 I t-test,P >O.05) . No difference in causes ofamputation was fbund :

trauma fbr 5 subjects and atherosclerosis obliterans for1 subject in each group. Although

duration after amputation of the IRC group was longer than that of the QL group <t -test, P<O.05) ,

subjects of the two groups were eligible for this comparative study,

2 . Subjective evaluation of the IRC and QL sockets

Selfassessments revealed that the IRC socket was significantly more comfortable to sit

on a chair but had a significantly poorer appearance than the QL socket (Table 2 ; Mann-

Whitney test, P<O.05). The IRC socket was also comfbrtable to wear and to go up and

Table L Subjects'characteristics

RC greup

Numbcr dn]afc:fomaJe)Age (years)Causesofarnputatien

Trauma

ASO

Duration after amputation (years) t11Stump length ratio

6 (6:O)46.2 ± 13.2

5

1

7.7 ± 5.5 *

O.70 ± O.14

QL group

6 (5:1)38,8 ± 14.2

5

1

3.9 ± 5.6

O.67 ± O.11

Age, duTation, and ratio are presented as mean ± standard deviation, 1 ) : ratio of the length from the ischia] tu-

berosity to the tip of the stump divided by the length fron] the ischial tuberosity to the lateral femoral condyle on

the non-arnputated side, IRC group : amputees wearing the ischial-ramal containment socket, QI. group : ampu-

tees wearing the quadrilateral socket. " : t-test ; P < O.OS, the IRC group vs. the QL greup.

ASO : atherosclerosis obliterans.




IRC Prosthesis for Transfenioral Amputation 113

Table2. Sub;]¢ ctiye evaluation of the IRC and QL sockets

IRC group QL group

Self-assessment

Comfortable to wear

Ease to swing the prosthesis

Comtbrtable to go up and down staiTs

Comfortable to sit on chair

Appearance of thc socket

Donning and doffing the socket

Specialist-assessrnent

Hip abduction during swing phase

Truncal sway during stance phase Lumbar lordsis at heel off

3,8 ± O,44.o ± e.o

4.0 ± O.O4.0 ± O.O *

3.0 ± O.6 *

4,O ± O.O

3.8 ± O,4

3.7 ± O.5

4.e ± o.o *

3,3 ± O,53,7 ± O,8

3.2 ± 12

3.2 ± O,4

4.0 ± O.O

4.0 ± O.O

3.7 ± O,5

3,2 ± O,4

3.2 ± 0,4

Total score 34.2 ± 12 * 31.3 ± 2.5

Data are presented as mean ± standard deviatjon.

Mann-Whitney test, the IRC group vs, the QL group ;*:p<e.os.

down stairs, but not significantly.

Specialist-assessments indicated the IRC socket induced less tmncal sway durifig stance

phase and less lumbar ]ordosis at heel off than the QL socket (Mann-Whitney test, P <O.05) .

3 . 0bjective measurement of amputees wearing the IRC and QL sockets

By computed tomography, femurs in the IRC and QL sockets were kept in almost the

same position at the anterior-posterior direction (Table 3 ; Mann-Whitney test, P >O.05) , but

the QL socket sifted the femur significantly more laterally at the medial-lateral direction

(Mann-wnitney test, P<O.05), As the femur position in the IRC socket and no space be-

tween the stump and socket were confirmed by computed tomography, the IRC sockets were

regarded as fitting well,

There was no significant difference in gluteal medial muscle atrophy between the groups

(Mann-Whitney test, P >O.e5) ,

During one foot standing on the prosthesis, subjects wearing the IRC socket had their re-

sidual femur significantly less abducted than those wearing the QL socket (Mann-Whitneytest, P <O.05) ,

and when walking on the force plate, subjects wearing the IRC socket had a

tendency of being less pushed toward the amputated sjde during mid-stance. However, no

significant difference in PCI was fbund between the IRC and QL groups (Mann-Whitney test,

P >O.05) ,

4 . Factors affecting PCI

Multiple regression analysis disclosed that stump length ratio and lateral fOrce ratio dur-




114 K HACHTSUKA et at

ing mid-stance were significant explanatory variables fbr PCI (adjusted R square : O.87,

F-value:11,85,P <O.05), that is, the longer the stump length and the less the lateral fbrce

toward the amputated side during mid-stance, the less oxygen consumption of gait (Table 4 ) .Socket type was not an important factor at the most comfortable speed.

Table 3. Measurements of amputees wearing the IRC and QI･ sockets

IRC group (2L group

Femurposition in thethigh (%) 1) Anterior-postcriordircction

Mcdial-lateral direction 2)

3)Gluteal mcdial musc]e atrophy ratio

Residual t'emurabduction during standing Cdegree)4)Lateral force ratio during mid-stance 5)

Physiological eost index 6}

42.9 ±- 3.4

57.4 ± 4,5 *

O.75 ± O.10

3.0 ± 2.5 *

128 ± O.11

O,48 ± O.23

46,7 ± 2.2

67.4 ± O,9O.74 ± O,08

11.0 ± 6.0

1.44 ± O.16

055 ± O.18

1) : Distance betwcen the anterior edge of the thigh and femur divided by the anterior-posterior dimension of the

thigh 4 cm below the great trochanter on thc amputated side and multiplied by 100, 2) : distance betwccn the me-

dial edge of the thigh and femur divided by the medial-lateral dimension of the high 4 cm below the great tro-

chanter on the amputated side and multiplied by 1OO, 3) : ratio of the gluteal medial muscle area on the amputated

side at thc slicc containing the inferior anterior iliac spine to that on the non-amputated side, 4) : adduction angle

of the non-amputatcd hip joint during standing subtractcd from that of the amputated hip joint, 5) : ratio of the

lateral force on the force plate during mid-stance on the amuputatcd side to that on thc non-amputated side, 6) :

(heart rate during walking-heart rate at rest)/walking speed (m,lmin). Mann-Whitncy test, the IRC group vs.

theQL group;* : P<O.05.

rl"able 4. Factors aiTecting the physiological eost index

Explanatory variables B SEB Beta P-value

Stump length ratio

Lateral force ratio during mid-stance

Socket type *

Femur position in the inedial-lateraldircction

Hip abduction during standing

Gluteal medial muscle atrophy ratio

Age (year)

-O.953

O.788

-O,328

1.721

O,O16

-O.268

<-0.UOI

O.275O.262O,148O.835O.O08O,327O,O02-O.575

O.621-O,869

o,s2e

O,500-O.120-O.079

O.026O.040O.091O.108O.104O.459O.580

Multiple regression analysis for predieting PCIlmultipie R : O.977, R square : O,954, adjusted R square : O.873 ;

F-value:11,849, and P-value:O,Ol5, ':socket

types were converted into 1 fOr the IRC socket and 2 for the

QL socket,




IRC Prosthesis for Transfcmoral Amputation 115

Discussion

Subjects in this study were carefu11y selected without prejudice according to the inclu-

sion and exclusion criteria, and no physical or mental disturbances except transfemoral ampu-

tation affected the subjective eyaluation and objective measurement of the sockets. All the

IRC and QL prostheses fitted very well, because some sockets were remade or modified be-

fbre the beginning of this study. The evaluation and measurement used in this study are es-

tablished methods or based on preceding studies.

However, there are still two issues : small number of subjects and comparison of self-

assessments. With regard to the number of subjects, we are unlikely to add new amputees to

the subjects of this study within a few years, because recent patients who are Qbliged to un-

dergo a transfemoral amputation are old, have one or two complications hindering their walk-

ing, and do not fu1fi11 our inclusion criteria. However, although the sample size is small, the

results obtained from this study properly explain features of these two types of sockets, and

because of this, the limited number of the subjects may be permitted. In the self-assessment,

the IRC group had already used the QL socket before a trial of the IRC socket, and were able

to compare the features of the two sockets, whereas the QL group only had experience using

the QL socket. As judgement criteria of the IRC and QL groups may not be identical in

comparison with seliassessments, it may not be rational to examine the difference in self-

assessments between the two groups. HQwever, this bias does not cause a false positive er-

ror and allows us to compare self-assessments between the groups. The reasons are as fol-

lows : the QL group possibly had a tendency toward rating self-assessment items higher and

the IRC group lower, because the amputee generally prefers a familiar prosthesis, even if it

does not fit well, and the QL group was accustomed to the QL socket;this tendency may re-

duce differences between the two groups.

The IRC socket is comfortable to wear, to go up and down stairs, and to sit on a chair,

and decreases lumbar lordosis at heel off, These results may derive from features of the

socket design (Fig. 2):wide anterior-posterior dimension and no typical ischial seat [4].The wide anterior-posterior dimension of the IRC socket reduces pressure against the Scarpa' s

triangle and maintains a sufficient space for quadriceps, hamstrings, and gluteal muscles.

An indentation of the posterior wall instead of the ischial seat gently supports the ischial tu-

berosity. This is one of the most important advantages of the IRC socket.

While lying on one's back and during one foot standing on the prosthesis, the stump is

maintained significantly more rnedially in the IRC socket, but while actually walking, the ]at-

eral fOrce toward the amputated side during mid-stance is not significantly less in the IRC

group. This means that the IRC socket design is usefuI for preventing the stump from ab-

ducting during the stance phase but is unable to prevent abduction completely. The stump

abduction may be affected by an amputee's habitual walking pattem, gluteal medial muscle




116 K HAcmsuKA et at

atrophy, and method of transfemoral amputation. If an amputee has already acquired trunk

lateral lean, which is one of the abnormal gait patterns frequently observed in transfemoral

amputees, the IRC socket can not improve the gait pattern. All the subjects in this study had

already had gluteal medial muscle atrophy by computed tomography, and a transfemoral am-

putee with gluteal medial muscle atrophy may not gain complete lateral stability during the

stance phase, even if the IRC socket is applied, As the adductor masnus muscle has a major

mechanical advantage in holding the thigh in its normal anatomical position, loss of function

of the adductor magnus muscle after a transfemoral amputation leads to abduction of the re-

sidual femur [17]. A preserved muscie at the time of transfemoral amputation, which

maintains the function of the ,residual femur adduction, prevents excessive abduction of the

stump, and the IRC socket in addition to the preserved muscle will brjng sufficient lateral sta-

bility during the stance phase.

PCI, an indirect simple method to evaJuate the approximate oxygen consumption of gait,

showed no difTerence between the IRC and QL groups. Although PCI may not be sensitive

enough to detect a subtle difference of oxygen consumption, we think that there is no great

difference in the metabolic efficiency of gait at the most comfortable speed, because truncal

sway during the stance phase and lateral force ratio during mid-stance are not significantly

improved by the IRC socket. By multiple regression analysis, it was seen that the most im-

portant factor re]ated to PCI is stump length ratio and lateral force ratio during mid-stance,

and the socket type is not so impertant as these factors. On the other hand, improved meta-

bolic efficiency of gait by the IRC prosthesis has been reported [12 , 13]. If the QL pros-thesis is remade or modified befOre entry of measurements and its optimal fit is confirmed

clinicatiy and by computed tomography, this process will possibly diminish any difference in

metabolic efiiciency between the IRC and QL groups. However, a significant difference be-

tween the IRC and QL sockets may be obta{ned if oxygen consumption of gait with the IRC

socket is measured at a faster speed.

Some subj'ects complained of the poor appearance of the IRC socket. The standard

IRC socket has a lateral wall high above the great trochanter, which puts pressure on the pel-vis. A bulge is noticed at this portion, especially when a transfemoral amputee puts onjeans.

As the ponion is not rnandatory to keep the stump in a normal position from our clinical ex-

perience, we propose that the height of the lateral wall to be within 5 cm above the great tro-

chanter, and that its hard frame at the great trochanter be trimmed away,

The results of this study reveal that the advantages of the IRC socket are a comfbrtable

feeling, that is, comfortable to wear, to go up and down stairs, and to sit on a chair, and a low

pressure against the ischia] tuberosity, but that metabolic eflliciency of the IRC socket evalu-

ated with the PCI at the most comfortable speed is not superior to the QL socket. These re-

sults adequately explain clinical impressions of the IRC prosthesis. In a future study, the

IRC prosthesis including an Intelligent Knee Joint, which enables a transfemoral amputee to

walk at various speeds with ease, will clarify the metabolic efficiency of gait.




IRC Prosthesis for Transl'emoral Amputation 117

Acknowledgements

The authors thank T.Shukuwa, CPO for participation in the clinical study, and

O. Yoshimura, Dr. I. Shigenaga and H. Ohkawa, RPT for cooperation in data collection.Dr,

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The 　 UOEH 　 Assooiation 　 of 　 Health 　 Soienoes

118 KHA 〔：HISUKA 　 et　 ai

　　 London 　pp　29L39

16 ．Ehara　Y （1989）： Analysis　of　biomcchanical　factors．　In ： Clinical　a皿alysis　o 「gait（Tsuchiya　K ，

　　ed ），　Ishiyaku−Shuppan，　Tokyo 　pp　61 − 94　（jn　Japanese）

17．Gottschalk　FA ＆ Stills　M （1994）： The　biemechanics　of　transfemoral　amputation ．　 Prosthet　Orthot

　　 lnt　　l8 ：　 12 − 17

坐骨収納型大腿義足の主観的および客観的評価

蜂須賀研二1，梅津　祐

一

，緒方　　甫L

，大峯

有薗　秀昭3

⊥

産業医科大学医学部　リハビリテーション医学教室

2産業医科大学病院　リハビリテ

ーション部

3有薗製作所

三郎2

，新小田幸一

要　　旨：坐骨収納型（IRC ）大腿義足が四辺形（QL）大腿義足よりも優れているか否かを明

らかにする目的で，IRC義足使用者 6 名，　 QL 義足使用者 6 名を対象にして，義足の

主観的評価，CT を用いた大腿骨の位置，　 X 線写貞による大腿骨内転角，立脚中期の

床反力側方成分， physiological　cest 　index （PCI ）を用いたエネルギー

効率の測定を行

った．H之c 義足は有意に主観的装着感に優れ，背臥位と立位では断端は内転位に保た

れていた（Mann −Whitney　tcst，　P 〈 0．1）5），実際の歩行では，立脚 1「1期の側方成分は減

少する傾向にあったが有意差はなく，また，PCI は両群問で有意差はなかった（Mann −

Whinlcy　 tcst，　P ＞ 0．05）．重回帰分析によれ．ば

，　 PCI を予測する宥意な因了

．はソケット

のタイプではなく，断端長と立脚中期成分の 2 因子であった．従って，IRC 義足は装

着感に優れ，断端を内転位に保つが，最適歩行速度のもとではエネルギー効率が優

れているわけではなかった．

　　　　　　　　　　　　　　　 JUOEH （産業医大誌）21 （2）；107− 118 （1999）

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