Clinical Biomechanics最新文献

Load distribution between the radius and ulna through the forearm interosseous membrane: Effects of elbow flexion and Varus–Valgus alignment 通过前臂骨间膜在桡骨和尺骨之间的负荷分布：肘关节屈曲和内翻对准的影响

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2025-12-19 DOI: 10.1016/j.clinbiomech.2025.106742

Takahiro Yamazaki, Yusuke Matsuura, Takashi Nomoto, Seiji Ohtori, Takane Suzuki

Background

The forearm interosseous membrane helps distribute load between the radius and ulna, yet the combined influence of elbow flexion and varus–valgus alignment on load transfer remains unclear. This study aimed to quantify interosseous membrane-mediated load transfer across elbow flexion angles under varus and valgus loading.

Methods

Seven fresh-frozen cadaveric forearms were tested using a custom setup with tension/compression force sensors mounted to record loads transmitted through the radius and ulna. Specimens were positioned at multiple elbow flexion angles within 0–90° under controlled varus and valgus loading. The interosseous membrane load-transfer rate was calculated from synchronized force data, and conditions were compared statistically (Wilcoxon signed-rank test).

Findings

The interosseous membrane load-transfer rate was significantly greater under varus than valgus loading (mean ± SD: 24.4 ± 14.8 % vs 10.1 ± 7.9 %, p < 0.001). Across the tested elbow flexion angles, flexion had no significant effect on the load-transfer rate in either alignment condition.

Interpretation

Within the tested range, varus–valgus alignment, rather than elbow flexion angle, primarily determines the magnitude of interosseous membrane -mediated load transfer. These findings provide biomechanical insight relevant to understanding injury mechanisms and may inform alignment considerations during rehabilitation or immobilization.

背景：前臂骨间膜有助于在桡骨和尺骨之间分配负荷，但肘关节屈曲和外翻对准对负荷转移的综合影响尚不清楚。本研究旨在量化内翻和外翻载荷下肘关节屈曲角度骨间膜介导的载荷传递。方法采用特制的张力/压缩力传感器对7只新鲜冷冻前臂进行测试，以记录通过桡骨和尺骨传递的载荷。在控制的内翻和外翻载荷下，将标本放置在0-90°的多个肘关节屈曲角度。根据同步力数据计算骨间膜载荷传递率，并进行统计学比较（Wilcoxon sign -rank检验）。结果内翻载荷下骨间膜载荷传递率明显高于外翻载荷（平均±SD: 24.4±14.8% vs 10.1±7.9%,p < 0.001）。在测试的弯头弯曲角度中，弯曲对两种对齐条件下的负载传递率没有显著影响。在测试范围内，内翻对准，而不是肘关节屈曲角度，主要决定骨间膜介导的负荷转移的大小。这些发现提供了与理解损伤机制相关的生物力学见解，并可能为康复或固定期间的对齐考虑提供信息。

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引用次数: 0

Relationship between hip flexor tightness and low back pain in non-care-seeking individuals 非求医个体髋屈肌紧绷与腰痛的关系。

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2025-12-13 DOI: 10.1016/j.clinbiomech.2025.106739

Kira Eimiller , Matthew Vraa , Kemery Sigmund , Matthew Zellmer

Background

Low back pain (LBP) is a prevalent musculoskeletal condition with significant economic consequences (Wu et al., 2020). Despite evidence of functional limitations, non-care-seeking individuals with LBP remain an under-researched population (Vraa et al., 2022). Hip flexor tightness has been proposed as a potential contributor to LBP due to its role in altered biomechanics and compensatory lumbar movements (Kim & Shin, 2020). Tight hip flexors are frequently assumed to contribute to LBP, yet the nature of the relationship is unclear. The objective of this study was to examine the relationship between hip flexor tightness and LBP severity in individuals with and without LBP who have not sought medical care.

Methods

A cross-sectional study of 118 adults (aged 20–61) assessed hip flexor range of motion (ROM) using the Modified Thomas Test and low back pain severity using the Modified Oswestry Disability Index. Between-group comparisons and generalized linear models examined the relationship between ROM, LBP presence, and disability.

Findings

LBP participants had significantly reduced ROM (4 ± 9° vs. 8 ± 9°, p = 0.003). However, in the adjusted generalized linear model, only BMI remained a significant predictor of hip flexor ROM (p = 0.011), while LBP status was not independently associated with hip flexor ROM (p = 0.180).

Interpretation

Reduced hip flexor ROM was observed in non-care-seeking individuals with LBP but was not independently predictive after adjustment. BMI was the only significant factor associated with hip flexor ROM, underscoring the multifactorial nature of LBP.

背景：腰痛（LBP）是一种常见的肌肉骨骼疾病，具有显著的经济后果（Wu etal ., 2020）。尽管有功能限制的证据，但不寻求治疗的腰痛患者仍然是一个研究不足的人群（Vraa等人，2022）。髋关节屈肌紧绷被认为是腰痛的潜在因素，因为它在改变生物力学和补偿性腰椎运动中的作用（Kim & Shin, 2020）。紧臀屈肌通常被认为是导致腰痛的原因，但这种关系的本质尚不清楚。本研究的目的是在没有寻求医疗护理的有和没有腰痛的个体中检查髋屈肌紧绷和腰痛严重程度之间的关系。方法：对118名成年人（20-61岁）进行横断面研究，使用改良Thomas测试评估髋屈肌活动范围（ROM），使用改良Oswestry残疾指数评估腰痛严重程度。组间比较和广义线性模型检验了ROM、LBP存在和残疾之间的关系。结果：LBP患者的ROM显著降低（4±9°vs. 8±9°，p = 0.003）。然而，在调整后的广义线性模型中，只有BMI仍然是髋屈肌ROM的显著预测因子（p = 0.011），而腰痛状态与髋屈肌ROM没有独立相关性（p = 0.180）。解释：在没有求医的腰痛患者中观察到髋屈肌活动度降低，但调整后不能独立预测。BMI是与髋屈肌ROM相关的唯一重要因素，强调了腰痛的多因素性质。

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引用次数: 0

Effect of gait pattern on patellofemoral joint stress during walking in individuals with patellar instability 步态方式对髌骨不稳患者行走时髌骨股骨关节应力的影响。

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2025-12-12 DOI: 10.1016/j.clinbiomech.2025.106738

Delaney M. McNeese , Caitlin E. Conley , Austin V. Stone , Cale Jacobs , Brian Noehren , Meredith K. Owen

Background

Patellar instability is a common injury among young, active individuals resulting in increased risk for future patellofemoral osteoarthritis. The purpose of this study is to quantify the effect of gait pattern on patellofemoral joint stress in those with patellar instability.

Methods

Individuals with patellar instability (n = 17) completed an instrumented gait analysis. A mathematical model, with sagittal plane knee angle and knee moment as inputs, was used to estimate patellofemoral joint stress during stance. Individuals were grouped by presenting with an extension dominant knee moment or a flexion dominant knee moment. Patellofemoral joint stress and knee and hip mechanics were compared between affected limbs. The injured limb of the extension dominant group was also compared to matched healthy control participants.

Findings

Extension dominant and flexion dominant groups had similar patellofemoral joint stress magnitudes (p = 0.37) throughout stance phase, but the flexion dominant group reached peak stress at a significantly later percentage of stance (p < 0.05) and at a smaller knee flexion angle (p < 0.05). There were no significant differences in peak or timing of patellofemoral joint stress or knee angle at peak stress between the extension dominant group and a matched set of healthy controls, but differences in other knee and hip mechanics were present.

Interpretation

The flexion dominant group's peak patellofemoral joint stress occurred later in stance placing it above the trochlear groove, perhaps loading cartilage unaccustomed to high magnitudes, and may contribute to the development of patellofemoral osteoarthritis through impaired adaptation to altered loading.

背景：髌骨不稳定是年轻人中常见的损伤，导致未来髌骨骨关节炎的风险增加。本研究的目的是量化步态模式对髌骨不稳患者髌骨股骨关节应力的影响。方法：髌骨不稳患者（n = 17）完成了器械步态分析。以矢状面膝关节角度和膝关节力矩为输入，建立数学模型估算站立时髌骨股骨关节应力。个体被分组，呈现以伸展为主的膝关节时刻或屈曲为主的膝关节时刻。髌骨股骨关节应力和膝关节及髋关节力学比较。伸展优势组的受伤肢体也与匹配的健康对照组进行了比较。结果：在整个站立阶段，伸展优势组和屈曲优势组的髌股关节应力大小相似（p = 0.37），但屈曲优势组在站立时达到峰值应力的比例明显较晚(p)。屈曲优势组髌骨股骨关节应力峰值发生在体位较晚的位置，置于滑车槽上方，可能是负载软骨不习惯高强度，并可能通过对改变负载的适应受损而导致髌骨股骨骨关节炎的发展。

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引用次数: 0

A novel method for screening diabetic peripheral neuropathy using fused surface electromyogram signal and mechanomyography signal 一种利用肌电信号和肌力图信号融合筛查糖尿病周围神经病变的新方法。

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2025-12-11 DOI: 10.1016/j.clinbiomech.2025.106737

Yanbin Guo , Mingyue Wang , Guoping Wang , Wenxuan Sun , Xiao-Jian Han , Lingjuan Li , Xin-Hui Qu , Zibo Feng

Background

Diabetes peripheral neuropathy (DPN), one of the most common complications in people with diabetes, can seriously undermine their quality of life. Early detection and treatment of DPN is of great significance to the diabetes population. Nerve conduction studies, the gold standard for diagnosing DPN, causes substantial discomfort for people and requires specialized personnel and expensive equipment, making it challenging to implement as a mass screening tool for DPN.

Methods

Here, a novel, non-invasive and convenient screening method for DPN is proposed. In the proposed method, surface electromyography and mechanomyography data are acquired in a non-invasive and painless manner from people’ dorsalis pedis muscles. The acquired data are then processed by means of downsampling, motion data extraction, and subsequently converted into images, which are utilized for diagnosing DPN or non-DPN by a convolutional neural network.

Findings

The proposed method is developed based on actual data from 167 people with diabetes. After 4-fold cross validation of the method, the mean accuracy, sensitivity and specificity are evaluated to be 96.15 %, 91.39 % and 98.78 % with variances of 0.003 %, 0.017 % and 0.00014 %, respectively. Furthermore, the method is preliminary tested on 21 people with diabetes, resulting in accuracy, sensitivity and specificity of 95.48 %, 90.91 % and 98.88 %, respectively. Notably, the screening process for a single diabetic using this method can be completed in under 10 min. The results above demonstrate the efficacy of the method in diagnosing DPN.

Interpretation

The proposed method has the considerable potential for noninvasive and convenient screening of DPN without requiring professionals or expensive equipment.

背景：糖尿病周围神经病变（DPN）是糖尿病患者最常见的并发症之一，严重影响患者的生活质量。DPN的早期发现和治疗对糖尿病人群具有重要意义。神经传导研究是诊断DPN的金标准，但它会给患者带来很大的不适，需要专业人员和昂贵的设备，因此很难将其作为DPN的大规模筛查工具。方法：提出一种新颖、无创、方便的DPN筛查方法。在提出的方法中，以非侵入性和无痛的方式从人的足背肌肉中获得表面肌电图和肌力图数据。采集到的数据通过下采样、运动数据提取等方式进行处理，随后转换成图像，通过卷积神经网络用于诊断DPN或非DPN。研究结果：提出的方法是基于167名糖尿病患者的实际数据开发的。方法经4倍交叉验证，平均准确度为96.15%，灵敏度为91.39%，特异度为98.78%，方差分别为0.003%,0.017%,0.00014%。并对21例糖尿病患者进行了初步试验，准确度为95.48%，灵敏度为90.91%，特异性为98.88%。值得注意的是，使用这种方法对单个糖尿病患者的筛选过程可以在10分钟内完成。以上结果证明了该方法诊断DPN的有效性。该方法在不需要专业人员或昂贵设备的情况下，具有非侵入性和方便的DPN筛查的巨大潜力。

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引用次数: 0

Patellofemoral pain is associated with complex gait deviations captured by an artificial intelligence-derived gait index 髌股疼痛与人工智能衍生的步态指数捕获的复杂步态偏差有关。

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2025-12-11 DOI: 10.1016/j.clinbiomech.2025.106735

Gabriel Jacob Navarro , Tadeu Aldrovando Bryhy de Albuquerque , Cid André Fidelis-de-Paula-Gomes , Cintia Lopes Ferreira , João Carlos Ferreira Correa , Gabor Jószef Barton , Paulo Roberto Garcia Lucareli

Background

Patellofemoral pain (PFP) in active women is associated with gait adaptations. The Movement Deviation Profile (MDP) summarises deviations in multi-segment kinematic deviation, but it is unclear how the magnitude of deviation relates to pain. We investigated the relationship between MDP and pain intensity during walking.

Methods

In a retrospective, laboratory-based study, we analysed three-dimensional gait data from women with PFP (n = 571) alongside matched asymptomatic controls for reference modelling. Pain intensity was rated on a 0–10 visual analogue scale (VAS). Typical gait was defined from controls; Euclidean distances across 13 kinematic curves yielded the mean MDP (MDP_mean). We used linear regression, and the results remained consistent after controlling for the year of data collection and addressing heteroskedasticity in the standard errors.

Findings

In women with PFP, the mean MDP was 13.17° (95 % CI: 12.93°–13.41°), and the mean VAS was 6.03 (95 % CI: 5.91–6.15). Each 1-point increase in VAS corresponded to an approximately 1.99° increase in MDP_mean (R² = 0.92). This relationship remained consistent even after adjusting for the year (β = 1.98°; 95 % CI: 1.93–2.04; p < 0.001), suggesting that changes over time did not influence the observed association.

Interpretation

In women with PFP, higher pain intensity is closely linked to more significant gait deviations, underlining the clinical importance of MDP as a quick measure of movement change. Although the retrospective nature prevents causal conclusions, the strength and consistency of the link indicate that pain level can serve as a useful marker for kinematic deviations during gait analysis.

背景：运动女性髌骨股痛（PFP）与步态适应有关。运动偏差轮廓（MDP）总结了多节段运动偏差的偏差，但偏差的大小与疼痛的关系尚不清楚。我们研究了步行时MDP与疼痛强度的关系。方法：在一项基于实验室的回顾性研究中，我们分析了571名PFP女性的三维步态数据，并与匹配的无症状对照进行了参考建模。疼痛强度评分为0-10分视觉模拟评分（VAS）。从对照组定义典型步态；通过13条运动曲线的欧氏距离得到平均MDP （MDPmean）。我们使用线性回归，在控制数据收集年份和处理标准误差中的异方差后，结果保持一致。结果：PFP患者的平均MDP为13.17°（95% CI: 12.93°-13.41°），平均VAS为6.03 （95% CI: 5.91-6.15）。VAS每增加1点，MDPmean增加约1.99°（R2 = 0.92）。即使经过一年的调整，这种关系仍然保持一致（β = 1.98°；95% CI: 1.93-2.04; p）解释：在PFP女性中，较高的疼痛强度与更显著的步态偏差密切相关，强调了MDP作为快速测量运动变化的临床重要性。虽然回顾性的性质阻止了因果结论，但这种联系的强度和一致性表明，疼痛程度可以作为步态分析中运动学偏差的有用标记。

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引用次数: 0

Corrigendum to "Strain in vertebral artery during passive cervical range of motion and spinal manipulation therapy: A systematic review and meta-analysis" [Clinical Biomechanics 130 (2025) 106685]. “被动颈椎活动度和脊柱推拿治疗期间椎动脉应变：系统回顾和荟萃分析”[临床生物力学130(2025)106685]的勘误表。

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2025-12-09 DOI: 10.1016/j.clinbiomech.2025.106721

Caroline Fagundes, Felipe Coutinho Kullmann Duarte, Walter Herzog

引用次数: 0

Detecting the pterygomaxillary disjunction using an instrumented hammer: A cadaveric study 用器械锤检测翼颌分离：一项尸体研究。

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2025-12-09 DOI: 10.1016/j.clinbiomech.2025.106736

Manon Bas dit Nugues , Giuseppe Rosi , Charles Henri Flouzat-Lachaniette , Gaoussou Toure , Guillaume Haiat

Background

In many maxillofacial surgeries, the surgeon must perform a pterygomaxillary disjunction in order to separate the jaw from the skull. The disjunction is performed using an osteotome which is impacted with a hammer until its tip crosses through the pterygoid plates. To determine whether the disjunction has occurred and avoid complications, surgeons still rely on their proprioception.

Methods

The aim of this study is to validate a vibroacoustic set-up constituted by an instrumented hammer equipped with a force sensor, aiming at detecting if the disjunction has occurred. To do so, fourteen osteotomies were performed in anatomical subject jaws. For each impact, the force signal was recorded and analyzed. A classification algorithm (Support Vector Machine method coupled with a cost matrix) was developed based on indicators extracted from the signal to determine whether the disjunction had occurred. Impacts were classified into two classes, one before and the other after the osteotome had crossed the pterygoid plates. To avoid undetected disjunctions a cost matrix was added to the algorithm. The coefficients from the matrix were chosen using by minimizing the Negative Likelihood Ratio.

Findings

The algorithm was able to distinguish impacts before and after the disjunction with an accuracy of 96 %. Moreover, the instrumented hammer was able to detect the disjunction with a maximum delay of two impacts.

Interpretation

These results pave the way for the development of a per-operative decision support system for the pterygomaxillary disjunction.

背景：在许多颌面外科手术中，外科医生必须进行翼颌分离术以使颌骨与颅骨分离。用锤子撞击取骨器进行分离，直到其尖端穿过翼状钢板。为了确定是否发生分离并避免并发症，外科医生仍然依赖于他们的本体感觉。方法：本研究的目的是验证一个振动声学装置，该装置由一个装有力传感器的仪器锤组成，旨在检测是否发生了分离。为此，在解剖对象颌骨上进行了14次截骨手术。对于每次撞击，力信号被记录和分析。基于从信号中提取的指标，开发了一种分类算法（支持向量机方法与代价矩阵相结合）来确定是否发生了分离。撞击分为两类，一类是骨切块穿过翼状骨板之前的撞击，另一类是骨切块穿过翼状骨板之后的撞击。为了避免未检测到的不相交，在算法中加入了代价矩阵。通过最小化负似然比的方法选择矩阵中的系数。结果：该算法能够区分分离前后的影响，准确率为96%。此外，仪器锤能够以两次冲击的最大延迟检测到分离。解释：这些结果为翼颌分离的术前决策支持系统的发展铺平了道路。

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引用次数: 0

Gait analysis and prediction in Parkinson's disease using rhythmic auditory stimulation: A data-driven approach with machine learning models 节律性听觉刺激对帕金森病的步态分析和预测：基于机器学习模型的数据驱动方法

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2025-12-02 DOI: 10.1016/j.clinbiomech.2025.106725

Jingyuan Lin

Background

Gait disturbance is a core feature of Parkinson's disease (PD), contributing to mobility loss and fall risk. Rhythmic auditory stimulation (RAS) can improve gait, yet response varies across patients. This study evaluated RAS effects on gait and developed a model to predict responders.

Methods

Three hundred PD patients were enrolled and assigned to RAS or control groups. Gait data were collected with a 3D motion capture system and force plates, and baseline assessments included UPDRS-III and MoCA score. Clinical and gait features (stride length, speed, swing time, double support) were analyzed. Paired analyses compared pre- and post-RAS changes. Machine learning models (Random Forest, XGBoost, SVM) were trained on demographic and baseline gait data to predict RAS responsiveness, defined as improvement in gait speed and double support time.

Findings

Among the 171 patients in the RAS group, 116 (67.8 %) were identified as responders based on improvements in gait speed and double support time.The RAS group showed significant improvements in gait speed (+0.14 m/s), stride length (+0.10 m), and reductions in double support (−0.026 s) and variability (−0.012), all p < 0.001. Among models, Random Forest classifier demonstrated the best balanced performance (AUC = 0.713, accuracy = 0.71, F1 = 0.64, recall = 0.87), outperforming SVM and XGBoost models. Feature importance highlighted UPDRS-III, stride length, MoCA score, and gait asymmetry as key predictors.

Interpretation

RAS significantly enhances gait performance in PD, though with individual variability. A data-driven machine learning framework enables reasonable prediction of responders, supporting personalized gait rehabilitation strategies in clinical practice.

步态障碍是帕金森病（PD）的核心特征，导致行动能力丧失和跌倒风险。节律性听觉刺激（RAS）可以改善步态，但不同患者的反应不同。本研究评估了RAS对步态的影响，并建立了预测反应者的模型。方法将300例PD患者分为RAS组和对照组。步态数据通过3D运动捕捉系统和力板收集，基线评估包括UPDRS-III和MoCA评分。分析临床和步态特征（步幅、速度、摇摆时间、双支撑）。配对分析比较了ras前后的变化。机器学习模型（Random Forest, XGBoost， SVM）在人口统计学和基线步态数据上进行训练，以预测RAS反应性，定义为步态速度和双支撑时间的改善。在RAS组的171例患者中，根据步态速度和双支撑时间的改善，116例（67.8%）被确定为应答者。RAS组在步速（+0.14 m/s）、步长（+0.10 m）、双支撑（- 0.026 s）和变异性（- 0.012）方面均有显著改善，p均为0.001。其中，Random Forest分类器表现出最佳的平衡性能（AUC = 0.713，准确率= 0.71,F1 = 0.64，召回率= 0.87），优于SVM和XGBoost模型。特征重要性强调UPDRS-III，步幅长度，MoCA评分和步态不对称是关键预测因子。ras可显著提高PD患者的步态表现，但存在个体差异。数据驱动的机器学习框架能够合理预测响应者，支持临床实践中的个性化步态康复策略。

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引用次数: 0

Combining automated mechanical peripheral stimulation and treadmill exercise for gait rehabilitation in Parkinson's disease: A randomized controlled trial 结合自动机械外周刺激和跑步机运动对帕金森病的步态康复：一项随机对照试验。

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2025-11-27 DOI: 10.1016/j.clinbiomech.2025.106722

Claudiane Arakaki Fukuchi , Vinícius Christianini Moreno , Carlos Augusto Kalva-Filho , Antonio Roberto Zamunér , Daniel Boari Coelho , Fabio Augusto Barbieri

Background

Treadmill exercise improves step length and velocity in Parkinson's disease (PD) but may not fully address all critical elements of gait, such as double support, which is closely associated with fall risk. Treadmill exercise combined with additional non-pharmacological strategies has the potential to yield a more comprehensive therapeutic approach. The application of automated mechanical peripheral stimulation (AMPS) has been identified as a potential intervention for gait rehabilitation, demonstrating efficacy in enhancing walking speed in PD. In principle, pre-activating sensory pathways via AMPS could prime the motor system for enhanced engagement during treadmill training. This study aimed to investigate the acute effects of AMPS combined with treadmill exercise in individuals with PD.

Methods

This randomized controlled trial involved fifteen individuals with PD (69.6 ± 5.1 years, MoCA: 27.3 ± 3.6 pts., UDPRS: 31.0 ± 6.9 pts., H&Y: 1–3). Each participant visited the lab four times: once for clinical assessment and three times to undergo intervention conditions – AMPS, Exercise, and AMPS+Exercise - in a randomized order. A seven-day washout period was implemented between each intervention session. Gait assessment was conducted before and after each intervention.

Findings

Repeated measure ANOVA revealed a main effect of time for step length and step velocity (both p < 0.05), with higher values post-intervention. After statistically controlling for baseline in step velocity, the Exercise showed greater adjusted post-intervention value than AMPS+Exercise condition (p = 0.031).

Interpretation

Although AMPS has emerged as a non-pharmacological technique to improve gait spatiotemporal parameters in individuals with PD, its combination with treadmill exercise did not yield superior effects in this acute protocol.

背景：跑步机运动可以改善帕金森病（PD）患者的步长和速度，但可能不能完全解决步态的所有关键因素，如双重支撑，这与跌倒风险密切相关。跑步机运动结合其他非药物策略有可能产生更全面的治疗方法。自动机械外周刺激（AMPS）的应用已被确定为步态康复的潜在干预措施，证明其在提高PD患者行走速度方面的有效性。原则上，通过AMPS预先激活感觉通路可以使运动系统在跑步机训练期间增强参与。本研究旨在探讨AMPS联合跑步机运动对PD患者的急性影响。方法：本随机对照试验纳入15例PD患者（69.6±5.1年，MoCA: 27.3±3.6分）。，平均得分：31.0±6.9分。， h&y: 1-3)。每个参与者访问实验室四次：一次进行临床评估，三次接受干预条件- AMPS，运动和AMPS+运动-按随机顺序。每次干预之间有7天的洗脱期。在每次干预前后进行步态评估。结果：重复测量方差分析揭示了时间对步长和步速的主要影响（两者都是p）解释：尽管AMPS已经成为一种非药物技术，可以改善PD患者的步态时空参数，但在这种急性方案中，它与跑步机运动的结合并没有产生优越的效果。

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引用次数: 0

Fluted stem designs enhance surgical precision and primary stability in cementless revision hip arthroplasty – A cadaver study 凹槽干设计提高手术精度和初级稳定性在无骨水泥翻修髋关节置换术-一项尸体研究

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2025-11-27 DOI: 10.1016/j.clinbiomech.2025.106723

Julius M. Boettcher , Kay Sellenschloh , Ana Cruz Pardos , Gerd Huber , Benjamin Ondruschka , Michael M. Morlock

Background

Cortical contact of the stem is a key determinant for primary stability in cementless revision hip arthroplasty. This matched-pair cadaveric study evaluated whether implant designs that increase cortical contact improve primary fixation of cementless revision stems

Methods

Ten paired femora received either a tapered monoblock RECLAIM™ stem with advanced spline (RAS) geometry or an identically sized prototype solid stem. Axial seating and rotation were recorded using dynamic image correlation during implantation. Specimens were cyclically loaded up to 200 % body weight, after which torque-to-failure was measured

Findings

Both designs showed mean micromotion <50 μm during cyclic loading, consistently favourable for osseointegration. However, solid stems rotated more during implantation than RAS stems (3.6 ± 5.0° vs. 0.5 ± 0.6°, p = 0.088). The cortical contact area of the solid stems was 43.6 % larger than RAS stems (p < 0.001) without an impact on superior fixation: Axial subsidence and rotation during cyclic loading did not differ significantly between the designs but two solid-stem specimens fractured under high loading. Torque-to-failure of the RAS stems was 38.7 ± 7.5 nm, exceeding that of solid stems by 24.3 % (p = 0.032)

Interpretation

These findings suggest that maximising circumferential contact by implant design alone cannot compensate for irregularities of the femoral canal. Whereas solid stems wedge firmly only at the cost of positioning accuracy and increased fracture risk, the thin splines of the RAS design engage the cortex progressively, guide the implant to the planned depth, and augment torsional resistance without excessive press-fit. Tapered stems with cortex-indenting splines improve primary stability in cementless revision hip arthroplasty more effectively than increasing contact area alone.

背景：在无骨水泥翻修髋关节置换术中，椎体皮质接触是初始稳定性的关键决定因素。这项配对的人体研究评估了增加皮质接触的植入物设计是否能改善无骨水泥翻修系统的初级固定。方法配对的股骨接受具有高级样条（RAS）几何形状的锥形单块RECLAIM™假体或相同尺寸的原型实体假体。在植入过程中使用动态图像相关记录轴向定位和旋转。研究结果表明，两种设计在循环加载过程中均表现出平均微动<；50 μm，始终有利于骨整合。然而，在植入过程中，实心茎比RAS茎旋转更多（3.6±5.0°vs 0.5±0.6°，p = 0.088）。实体干的皮质接触面积比RAS干大43.6% (p < 0.001)，但对上固定没有影响：在循环加载期间轴向沉降和旋转在设计之间没有显著差异，但两个实体干样本在高载荷下断裂。RAS柄的扭矩到失效为38.7±7.5 nm，比实体柄高出24.3% （p = 0.032）。这些结果表明，仅通过植入物设计最大化周向接触不能补偿股管的不规则性。实心柄楔入只会降低定位精度和增加骨折风险，而RAS设计的细样条会逐渐与皮质接合，引导植入物到达计划深度，并在不过度压合的情况下增加抗扭性。锥形柄与皮质缩进样条相比单独增加接触面积更有效地改善无骨水泥翻修髋关节置换术的初级稳定性。

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