脊髓损伤患者辅助器械行走的影响

,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2014/2/26,#,The influence of walking with an orthosis on bone mineral densityby determination of the absolute values of the loads appliedon the limb,通,过测定下肢的绝对值载荷来探讨配戴矫形器步行对骨密度的影响。,Abstract,Spinal cord injury is damage to the spinal cord that results in loss of mobility and sensation below the level of injury.Most patients use various types of orthoses to stand and walk.It has been claimed that walking and standing with orthosis reduces bone osteoporosis,improves joint range of motion and decreases muscle spasm.Unfortunately,there are discrepancies regarding the clinical effects of walking and standing on bone mineral density.,脊髓损伤是指损伤脊髓而导致损伤平面以下活动能力和感觉的丧失。大多数患者借用各类矫形,器站,立和行,走,。,Y,有人认为,，配,戴矫形,器直立和走路可,减少骨质疏松，改善关节活动度，并减少肌肉痉挛。然而，关于行走和站立对骨密度的临床效果存在差异。,The aim of this research was to find the absolute values of the loads transmitted by body and orthosis in walking with use of an orthosis.5 normal subjects were recruited to stand and walk with a new design of reciprocal gait orthosis.The loads transmitted through the orthosis and anatomy was measured by use of strain gauge and motion analysis systems.,目的,：,得,出配戴矫形器步行时通过身体和矫形器传导,的,载荷,绝,对值,。,实验对象：,5,例,健康,受,试者配戴一种新型的复式步行矫形器（,RGO,）站立和行走,。,方法：,通,过张力计量器和运动分析系统来得,到,通过,身,体解剖结构和矫形器传输的负荷,。,结果,：,通过解剖结构得到的数据比矫形器得到的数据更有意义。此外，该矫形器和身体的力和力矩模式彼此完全不同。在配戴矫形器行走的过程中，携带矫形器,行走,能够影响骨密度是由于大部分的,载荷,通过解剖结构进行综合的传递。,It has been shown that the loads applied on the anatomy were significantly more than that transmitted through the orthosis.Moreover,the patterns of the forces and moments of the orthosis and body completely differed from each other.As the most part of the loads applied on the complex transmitted by anatomy in walking with an orthosis,walking with orthosis can influence bone mineral density.,Introduction,Spinal cord injury(SCI)is characterized according to the amount of functional loss,sensational loss and of the inability to stand and walk 1,2.The incidence of SCI varies amongst countries.For example there are 12.7 and 59 new cases per million in France and the United States of America,respectively 3,4.,脊髓损伤（,SCI,）,的,特,点包括功能、感觉的丧失及不能行走和直立。在各个国家，脊髓损伤的发病率各不相同。比如，在法国每年一百万人中有,12.7,例发病，而美国有,59,例。,It may be a result of trauma(especially motor vehicle accident),penetrating injuries,or disease.As a result of this type of disability most SCI individuals rely on a wheelchair for their mobility.They can transport themselves from one place to another using a manual wheelchair with the speed and energy expenditure which is similar to normal subjects 5,6.,它可以由创伤（特别是交通事故），穿通伤，或疾病导致。由于这种类型的残疾大多数脊髓损伤的患者靠轮椅移动。他们可以如正常人一样，借助手动轮椅从一个地方到另一个地方。,Although,wheelchair use provides mobility to those patients,it is not without problems.The main problems are the restriction to mobility from architectural features in the landscape,and a number of health issues due to prolonged sitting.Decubitus ulcers,osteoporosis,joint deformities,especially hip joint adduction contracture can result from prolonged wheelchair use 7.SCI individuals often undergo various rehabilitation programmes for walking and exercises.It is claimed that walking is a good exercise for paraplegics in order to maintain good health;decrease urinary tract infections;improve cardiovascular and digestive systems functions and improve psychological health and decreasing bone osteoporosis 7.,虽然，患者可以通过轮椅移动，但也存在些问题。主要问题是活动场所受到建筑特征的限制，及长期,坐,位,所,带来的健康问题。如褥疮溃疡，骨质疏松，关节畸形，尤其是长期使用轮椅引起的髋关节内收挛缩。脊髓损伤患,者,通,常,进行过各种步行方面的康复训练。据称，步行可以很好的维持截瘫患者的身体健康：降低泌尿道感染，改善心血管系统和消化系统功能，促进心理健康，减少骨质疏松。,Shortly after SCI,the metabolism changes resulting in the body sending a large amount of calcium and other minerals in the urine.This happens independently of the weight,age and sex of the person.The rate of calcium and mineral loss is high during the first 616 months after the injury.Osteoporosis also happens due to the reduction of body weight applied to the bones.Due to SCI these patients cannot stand and apply load to the lower limb bones,the bones become weaker and thus more brittle.,SCI,早期，新陈代谢的改变导致大量的钙和其他的矿物质进入尿中。这种现象与个人的体重，年龄和性别无关。钙和矿物质流失的速率在损伤后的,6-16,个月最快。骨质疏松症也因施加到骨头上的体重的减少而发,生。,由于脊髓损伤患者不,能,通过,站立使,得,下,肢骨负重，下肢骨变得越来越脆弱。,In contrast to the lower limbs,more force may be applied on the upper limbs and spine;as a result the percentage of osteoporosis in the upper limb and spine is significantly less than that in the lower limb bones 8.In the research undertook by Biering et al.9,the bone mineral density(BMD)of lumbar spine and the proximal part of tibia was measured 41 months after injury in a group of paraplegic subjects with complete lesion at C7T1.It was shown that BMD remain unchanged in lumbar spine,however,it decreased to 50 and 70%of normal value at proximal tibia and femoral neck respectively.,与,下,肢相,比，更多的力施加于上肢和脊柱，从而使得上肢和脊柱骨质疏松的百分比比下肢,骨,低,。,Biering,等人研究了一组,C7-T1,完全性损伤的患者，测量了腰椎和胫骨近端部分的骨矿物质密度（,BMD,）,。,其,结果表明，,BMD,在腰椎没有变化，然而，在胫骨近端和股骨颈分别降至,50,，即,70,的正,常值,。,Although it was claimed that standing and walking with an orthoisis or a frame