Medical Engineering & Physics最新文献

Numerous studies have suggested that the primary cause of failure in transtibial anterior cruciate ligament reconstruction (ACLR) is often attributed to non-anatomical placement of the bone tunnels, typically resulting from improper tibial guidance. We aimed to establish the optimal tibial tunnel angle for anatomical ACLR by adapting the transtibial (TT) technique. Additionally, we aimed to assess graft bending angle (GBA) and length changes during in vivo dynamic flexion of the knee.

Twenty knee joints underwent a CT scan and dual fluoroscopic imaging system (DFIS) to reproduce relative knee position during dynamic flexion. For the single-legged lunge, subjects began in a natural standing position and flexed the right knee beyond 90° When performing the lunge task, the subject supported the body weight on the right leg, while the left leg was used to keep the balance. The tibial and femoral tunnels were established on each knee using a modified TT technique for single-bundle ACLR. The tibial tunnel angulation to the tibial axis and the sagittal plane were measured. Considering that ACL injuries tend to occur at low knee flexion angles, GBA and graft length were measured between 0° and 90° of flexion in this study.

The tibial tunnel angulated the sagittal plane at 42.8° ± 3.4°, and angulated the tibial axis at 45.3° ± 5.1° The GBA was 0° at 90° flexion of the knee and increased substantially to 76.4 ± 5.5° at 0° flexion. The GBA significantly increased with the knee extending from 90° to 0° (p < 0.001). The ACL length was 30.2mm±3.0 mm at 0° flexion and decreased to 27.5mm ± 2.8 mm at 90° flexion (p = 0.072). To achieve anatomic single-bundle ACLR, the optimal tibial tunnel should be angulated at approximately 43° to the sagittal plane and approximately 45° to the tibial axis using the modified TT technique. What's more, anatomical TT ACLR resulted in comparable GBA and a relatively constant ACL length from 0° to 90° of flexion. These findings provide theoretical support for the clinical application and the promotion of the current modified TT technique with the assistance of a robot to achieve anatomical ACLR.

Commercial straight metal plates have been generally used to fix fractured bones, but recently, the need for customized and helical metal plates has emerged. Customized metal plates are designed to fit the shape of the fracture area that is a 3D curved surface, making it more difficult than designing on a 2D plane. Helical plates are researched due to their advantage in avoiding blood vessel damage compared to commercially available straight metal plates. In this paper, we propose a novel algorithm to design a customized helical metal plate for the femur using cylindrical depth images and Boolean operations. We also present the results of 3D printing a metal plate designed using the proposed algorithm, and the shape matching is verified by calculating the minimum distance between the surface of the printed plate and the surface of the femur.

Understanding the role of mechanical force on tissue nutrient transport is essential, as sustained force may affect nutrient levels within the disc and initiate disc degeneration. This study aims to evaluate the time-dependent effects of different compressive force amplitudes as well as tensile force on glucose concentration and cell viability within the disc. Based on the mechano-electrochemical mixture theory, a multiphasic finite element model of the lumbar intervertebral disc was developed. The minimum glucose concentration and minimum cell density in both normal and degenerated discs were predicted for different compressive force amplitudes, tensile force, and corresponding creep time. Under high compressive force, the minimum glucose concentration exhibited an increasing and then decreasing trend with creep time in the normal disc, whereas that of the degenerated disc increased, then decreased, and finally increased again. At steady state, a higher compressive force was accompanied by a lower glucose concentration distribution. In the degenerated disc, the minimum cell density was negatively correlated with creep time, with a greater range of affected tissue under a higher compressive force. For tensile force, the minimum glucose concentration of the degenerated disc raised over time. This study highlighted the importance of creep time, force magnitude, and force type in affecting nutrient concentration and cell viability. Sustained weight-bearing activities could deteriorate the nutrient environment of the degenerated disc, while tensile force might have a nonnegligible role in effectively improving nutrient levels within the degenerated disc.

The mechanical interaction of a tilting anchor and cancellous bones of various densities was simulated using finite element modeling. The model enjoyed a sophisticated representation of the bone, as an elasto-plastic material with large deformation capability. The anchor's tilting action during implantation phase, as well as its fixation stiffness during pull-out test, were predicted by the model and a parametric study was performed to investigate the effects of the anchor's distal width and corner fillet radius, on these measures. The model predictions were validated against the results of an experimental test on ovine humerus specimens. The model could reasonably reproduce the tilting action of the anchor during the implantation phase. Comparison of the model predictions with the experimental results revealed similar trends during both the implantation and the pull-out phases, but smaller displacement magnitudes (end points: 1.4 vs. 2.1 mm and 4.6 vs. 5.2 mm, respectively). The results of the parametric study indicated substantial increase in the fixation stiffness with increasing bone density. Reducing the distal width and increasing the fillet radius improved the anchor's implantation configuration and fixation stiffness in low-density bones. For high-density bone applications, however, a larger distal width was favored for improving the fixation stiffness.

Background

The high mortality rate associated with coronary heart disease has led to state-of-the-art non-invasive methods for cardiac diagnosis including computed tomography and magnetic resonance imaging. However, stenosis computation and clinical assessment of non-calcified plaques has been very challenging due to their ambiguous intensity response in CT i.e. a significant overlap with surrounding muscle tissues and blood. Accordingly, this research presents an approach for computation of coronary stenosis by investigating cross-sectional lumen behaviour along the length of 3D coronary segments.

Methods

Non-calcified plaques are characterized by comparatively lower-intensity values with respect to the surrounding. Accordingly, segment-wise orthogonal volume was reconstructed in 3D space using the segmented coronary tree. Subsequently, the cross sectional volumetric data was investigated using proposed CNN-based plaque quantification model and subsequent stenosis grading in clinical context was performed. In the last step, plaque-affected orthogonal volume was further investigated by comparing vessel-wall thickness and lumen area obstruction w.r.t. expert-based annotations to validate the stenosis grading performance of model.

Results

The experimental data consists of clinical CT images obtained from the Rotterdam CT repository leading to 600 coronary segments and subsequent 15786 cross-sectional images. According to the results, the proposed method quantified coronary vessel stenosis i.e. severity of the non-calcified plaque with an overall accuracy of 83%. Moreover, for individual grading, the proposed model show promising results with accuracy equal to 86%, 90% and 79% respectively for severe, moderate and mild stenosis. The stenosis grading performance of the proposed model was further validated by performing lumen-area versus wall-thickness analysis as per annotations of manual experts. The statistical results for lumen area analysis precisely correlates with the quantification performance of the model with a mean deviation of 5% only.

Conclusion

The overall results demonstrates capability of the proposed model to grade the vessel stenosis with reasonable accuracy and precision equivalent to human experts.

The aim of this work is to investigate in-silico the biomechanical effects of a proximal fibular osteotomy (PFO) on a knee joint with different varus/valgus deformities on the progression of knee osteoarthritis (KOA). A finite element analysis (FEA) of a human lower extremity consisting of the femoral, tibial and fibular bones and the cartilage connecting them was designed. The FEA was performed in a static standing primitive position to determine the contact pressure (CP) distribution and the location of the center of pressure (CoP). The analysis examined the relationship between these factors and the degree of deformation of the hip-knee angle in the baseline condition. The results suggested that PFO could be a simple and effective surgical treatment for patients with associated genu varum. This work also reported that a possible CP homogenization and a CoP correction can be achieved for medial varus deformities after PFO. However, it reduced its effectiveness for tibial origin valgus misalignment and worsened in cases of femoral valgus misalignment.

Biomechanical modeling of the knee during motion is a pivotal component in disease treatment, implant designs, and rehabilitation strategies. Historically, dynamic simulations of the knee have been scant. This study uniquely integrates a dual fluoroscopic imaging system (DFIS) to investigate the in vivo dynamic behavior of the meniscus during functional activities using a finite element (FE) model. The model was subsequently validated through experiments. Motion capture of a single-leg lunge was executed by DFIS. The motion model was reconstructed using 2D-to-3D registration in conjunction with computed tomography (CT) scans. Both CT and magnetic resonance imaging (MRI) data facilitated the development of the knee FE model. In vivo knee displacements and rotations were utilized as driving conditions for the FE model. Moreover, a 3D-printed model, accompanied with digital imaging correlation (DIC), was used to evaluate the accuracy of the FE model. To a better inner view of knees during the DIC analysis, tibia and femur were crafted by transparent resin. The availability of the FE model was guaranteed by the similar strain distribution of the DIC and FE simulation. Subsequent modeling revealed that the compressive stress distribution between the medial and lateral menisci was balanced in the standing posture. As the flexion angle increased, the medial meniscus bore the primary compressive load, with peak stresses occurring between 60 and 80° of flexion. The simulation of a healthy knee provides a critical theoretical foundation for addressing knee pathologies and advancing prosthetic designs.

Anchorage, evaluated by the maximum insertion torque (IT), refers to mechanical engagement between dental implant and host bone at the time of insertion without external loads. Sufficient anchorage has been highly recommended in the clinic. In several studies, the effects of implant diameter and taper body design under external loading have been evaluated after insertion; however, there are few studies, in which their effects on stress distribution during insertion have been investigated to understand establishment of anchorage. Therefore, the objective of this study was to investigate the effects of dental implant diameter and tapered body design on anchorage combining experiments, analytical modeling, and finite element analysis (FEA). Two implant designs (parallel-walled and tapered) with two implant diameters were inserted into rigid polyurethane (PU) foam with corresponding straight drill protocols. The IT was fit to the analytical model (R² = 0.88–1.0). The insertion process was modeled using explicit FEA. For parallel-walled implants, normalized IT and final FEA contact ratio were not related to the implant diameter while the implant diameter affected normalized IT (R² = 0.90, p < 0.05, β₁ = 0.20 and β₂ = 0.93, standardized regression coefficients for implant diameter and taper body design) and final FEA contact ratio of tapered implants. The taper design distributed the PU foam stress further away from the thread compared to parallel-walled implants, which demonstrated compression in PU foam established by the tapered body during insertion.