Clinical Biomechanics最新文献_第3页

Age-dependence of semitendinosus tendon properties used for anterior cruciate ligament reconstruction differs in males and females 用于前十字韧带重建的半腱肌腱特性的年龄依赖性在男性和女性中有所不同

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2024-08-17 DOI: 10.1016/j.clinbiomech.2024.106329

Background

The semitendinosus tendon is one of the most used autografts in anterior cruciate ligament reconstruction. Although recent evidence indicates that young patients, especially in females, may experience high rates of revision and residual instability, the reasons for the inferior outcomes in these patients remain unclear. To address this issue, we aimed to compare the mechanical properties of the semitendinosus tendon used for anterior cruciate ligament reconstruction in male and female patients of various ages.

Methods

The semitendinosus tendons harvested from 31 male and 29 female patients who underwent anterior cruciate ligament reconstruction surgery using the semitendinosus tendon autografts were used in this study. Using the distal part of the harvested semitendinosus tendon, the extent of cyclic loading-induced elongation (i.e., the extent of the increase in slack length) and the Young's modulus were measured during cyclic tensile testing.

Findings

Spearman correlation analyses revealed that the Young's modulus (|ρ| = 0.725, P < 0.001), but not elongation (|ρ| ≤ 0.036, P ≥ 0.351) positively correlated with the patient age in male tendon samples. In contrast, for female tendon samples, the elongation (|ρ| ≥ 0.415, P ≤ 0.025), but not the Young's modulus (|ρ| = 0.087, P = 0.655) negatively correlated with the patient age.

Interpretation

These results indicate that the semitendinosus tendon used for anterior cruciate ligament reconstruction in young male patients is compliant, whereas that in young female patients is susceptible to elongation induced by cyclic loading.

背景半腱肌腱是前交叉韧带重建中最常用的自体移植物之一。尽管最近的证据表明，年轻患者，尤其是女性患者，可能会经历较高的翻修率和残余不稳定性，但这些患者疗效较差的原因仍不清楚。为了解决这个问题，我们旨在比较不同年龄段的男性和女性患者用于前交叉韧带重建的半腱肌腱的机械性能。方法本研究使用了从 31 名男性患者和 29 名女性患者身上采集的半腱肌腱，这些患者接受了使用半腱肌腱自体移植物的前交叉韧带重建手术。使用采集的半腱肌腱远端部分，循环加载引起的伸长程度（即.....、研究结果皮尔曼相关分析表明，在男性肌腱样本中，杨氏模量（|ρ| = 0.725，P < 0.001）与患者年龄呈正相关，而伸长率（|ρ| ≤ 0.036，P ≥ 0.351）与患者年龄不呈正相关。相比之下，女性肌腱样本的伸长率（|ρ| ≥ 0.415，P ≤ 0.025）与患者年龄呈负相关，而杨氏模量（|ρ| = 0.087，P = 0.655）与患者年龄不呈负相关。

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引用次数: 0

Individuals with asymptomatic hallux valgus exhibit altered foot kinematics during gait regardless of their foot posture 无症状的足外翻患者在步态过程中会出现足部运动学改变，与足部姿势无关。

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2024-08-01 DOI: 10.1016/j.clinbiomech.2024.106319

Background

A flatfoot has been believed to be closely associated with the development of hallux valgus; however, the association is still controversial. Abnormal foot kinematics has been identified as a possible risk factor for the development of hallux valgus, but it remains unclear whether foot posture contributes to abnormal foot kinematics. This is the first study to investigate the differences in foot kinematics during gait between individuals with and without hallux valgus, while controlling for foot posture.

Methods

Twenty-five females with hallux valgus and 25 healthy females aged 18 to 22 were recruited. Foot posture was measured using normalized navicular height truncated and the leg-heel angle. Foot kinematic and kinetic data during gait were recorded by a three-dimensional motion capture system. To investigate the characteristics of foot kinematics in individuals with hallux valgus while controlling for foot posture, we used a propensity score matching method. The matching was obtained by using the 1:1 nearest-neighbor procedure and a caliper width of 0.2.

Findings

Twelve pairs were matched. Individuals with hallux valgus had significantly increased midfoot dorsiflexion from 56% to 80% during stance phase, rearfoot eversion from 53% to 71%, and forefoot abduction from 5% to 29% compared with control.

Interpretation

Individuals with hallux valgus have a flexible foot that cannot suppress the dynamic deformation of the rearfoot and midfoot during gait. To suppress the development of hallux valgus, interventions that aim to prevent dynamic deformations of the rearfoot and midfoot during gait may be necessary, regardless of their static foot posture.

背景：扁平足一直被认为与足外翻的发生密切相关；然而，这种关联仍存在争议。足部运动学异常已被确定为可能导致足外翻的风险因素，但足部姿势是否会导致足部运动学异常仍不清楚。这是第一项在控制足部姿势的前提下研究患有和未患有足外翻的个体在步态过程中足部运动学差异的研究：方法：研究人员招募了 25 名患有足外翻的女性和 25 名 18-22 岁的健康女性。足部姿势是通过截断的归一化舟骨高度和腿-轮角度来测量的。步态过程中的足部运动学和动力学数据由三维运动捕捉系统记录。为了研究足外翻患者的足部运动学特征，同时控制足部姿势，我们采用了倾向得分匹配法。匹配采用 1:1 近邻程序和 0.2.Findings 的卡尺宽度：结果：有 12 对进行了匹配。与对照组相比，患有足外翻的患者在站立阶段中足外翻从 56% 增加到 80%，后足内翻从 53% 增加到 71%，前足外展从 5% 增加到 29%：解释：足外翻患者的足部弹性较差，无法抑制后足和中足在步态过程中的动态变形。为了抑制足外翻的发展，可能有必要采取干预措施，以防止后足和中足在步态过程中发生动态变形，而不管他们的足部静态姿势如何。

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引用次数: 0

An ex vivo sequential ligament transection model of flatfoot 扁平足的体外顺序韧带横切模型

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2024-08-01 DOI: 10.1016/j.clinbiomech.2024.106302

Background

The ligaments implicated in the earliest stages of developing a progressive collapsing foot deformity are poorly understood. Commonly employed cadaveric flatfoot models are created from simultaneous transection of multiple ligaments, making it difficult to assess early changes in pressure distribution from ligaments critical for maintaining load distribution. A serial transection of ligaments may provide insight into changes in pressure distribution under the foot to identify a potential combination of ligaments that may be involved in early deformities.

Methods

Specimens were loaded using a custom designed axial and tendon loading system. Plantar pressure data for the forefoot and hindfoot were recorded before and after six sequential ligament complex transections.

Findings

Sectioning the plantar fascia (first) and short/long plantar ligaments (second) failed to generate appreciable differences in load distribution. Dividing the spring ligament (third) led to changes in hindfoot load distribution with a shift towards the lateral column indicative of hindfoot valgus angulation. All subsequent conditions resulted in similar patterns in hindfoot plantar load distribution. An anterior shift in the center of pressure only occurred after transection of all six ligament complexes.

Interpretation

Loss of the plantar fascia and short/long plantar ligaments are not critical in maintaining plantar load distribution or contact area. However, the additional loss of the spring ligament caused notable changes in hindfoot load distribution, indicating the combination of these three ligament complexes is particularly critical for preventing peritalar subluxation. Minimal changes in load distribution occurred when performing additional transections to reach a complete flatfoot deformity.

背景人们对韧带在足部渐进性塌陷畸形早期发展过程中的作用知之甚少。常用的尸体扁平足模型是通过同时横断多条韧带制作的，因此很难评估对维持负荷分布至关重要的韧带压力分布的早期变化。对韧带进行连续横断可深入了解足底压力分布的变化，从而确定可能参与早期畸形的潜在韧带组合。研究结果对足底筋膜（第一次）和短/长足底韧带（第二次）进行横切并不能产生明显的负荷分布差异。分割弹簧韧带（第三次）导致后足负荷分布发生变化，向外侧柱移动，表明后足外翻成角。随后的所有条件都导致了类似的后足跖部负荷分布模式。解释足底筋膜和短/长足底韧带的缺失对于维持足底负荷分布或接触面积并不重要。然而，弹簧韧带的额外损失会导致后足负重分布发生显著变化，这表明这三种韧带复合物的结合对于预防跖周脱位尤为重要。在进行额外横断以达到完全平足畸形时，负荷分布的变化极小。

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引用次数: 0

The clinical utility of the prone hip extension test in the diagnosis of motor control impairments associated with low back pain: A cross-sectional study using motion capture and electromyography 俯卧伸髋试验在诊断与腰背痛相关的运动控制障碍方面的临床实用性：使用动作捕捉和肌电图的横断面研究

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2024-08-01 DOI: 10.1016/j.clinbiomech.2024.106317

Background

The prone hip extension test is used as a clinical tool to diagnose specific motor control impairments that have been identified in individuals with chronic low back pain. However, conventional protocols for performing the test are subjective and lack evidence for their effectiveness. The objective of the current study was to quantify lumbopelvic motion and muscle activation during this test and identify which motor control patterns best distinguish individuals with low back pain from asymptomatic controls.

Methods

18 individuals with sub-acute or chronic low back pain and 32 asymptomatic controls performed the prone hip extension test while a 3D motion capture system measured lumbar and pelvic movement patterns and an electromyography system measured the muscle activation patterns of the paraspinal, gluteus maximus, and hamstring muscles. A three-stage statistical analysis was performed, the final stage being a stepwise logistic regression analysis aimed at identifying the movement and muscle activation pattern variables that best distinguished the two groups.

Findings

The final regression model included three lumbar kinematic variables and several electromyographic amplitude variables for the gluteus maximus and hamstring muscles during right-sided prone hip extension. The final model correctly classified 86.7 % of the control group and 83.3 % of the low back pain group.

Interpretation

The subject of asymmetrical gluteus maximus and hamstring muscle activation appears to be a potentially interesting area for future research on the utility of the prone hip extension test as a clinical tool in diagnosing motor control impairments associated with low back pain.

背景俯卧伸髋试验是一种临床工具，用于诊断慢性腰痛患者的特定运动控制障碍。然而，进行该测试的传统方法比较主观，而且缺乏有效的证据。方法 18 名亚急性或慢性腰痛患者和 32 名无症状对照者进行了俯卧伸髋测试，同时三维运动捕捉系统测量了腰部和骨盆的运动模式，肌电图系统测量了脊柱旁肌、臀大肌和腘绳肌的肌肉激活模式。研究结果最终的回归模型包括三个腰部运动学变量以及右侧俯卧伸髋时臀大肌和腘绳肌的几个肌电图振幅变量。解释臀大肌和腘绳肌不对称激活的问题似乎是未来研究的一个潜在有趣领域，即俯卧伸髋测试作为诊断与腰痛相关的运动控制障碍的临床工具的实用性。

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引用次数: 0

Dynamic gait stability in people with mild to moderate Parkinson's disease 轻度至中度帕金森病患者的动态步态稳定性。

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2024-08-01 DOI: 10.1016/j.clinbiomech.2024.106316

Background

Falls are a serious health threat for people with Parkinson's disease. Dynamic gait stability has been associated with fall risk. Developing effective fall prevention interventions requires a sound understanding of how Parkinson's disease affects dynamic gait stability. This study compared dynamic gait stability within the Feasible Stability Region framework between people with and without Parkinson's disease during level walking at a self-selected speed.

Methods

Twenty adults with Parkinson's disease and twenty age- and gender-matched healthy individuals were recruited. Dynamic gait stability at two gait instants: touchdown and liftoff, was assessed as the primary outcome measurement. Spatiotemporal gait parameters, including stance phase duration, step length, gait speed, and cadence were determined as explanatory variables.

Findings

People with Parkinson's disease walked more slowly (p < 0.001) with a shorter step (p = 0.05), and prolonged stance phase (p = 0.04) than their healthy peers with moderate to large effect sizes. Dynamic gait stability did not show any group-associated differences (p > 0.36).

Interpretation

Despite the different gait parameters between groups, people with Parkinson's disease exhibited similar dynamic gait stability to their healthy counterparts. To compensate for the potential dynamic gait stability deficit resulting from slow gait speed, individuals with Parkinson's disease adopted a short step length to shift the center of mass motion state closer to the Feasible Stability Region. Our findings could provide insight into the impact of Parkinson's disease on the control of dynamic gait stability.

背景：跌倒严重威胁帕金森病患者的健康。动态步态稳定性与跌倒风险有关。要制定有效的跌倒预防干预措施，就必须充分了解帕金森病如何影响动态步态稳定性。本研究比较了帕金森病患者和非帕金森病患者在以自选速度平地行走时，在可行稳定性区域框架内的动态步态稳定性：方法：招募 20 名帕金森病成人患者和 20 名年龄和性别匹配的健康人。主要结果是评估两个步态瞬间（着地和起步）的动态步态稳定性。时空步态参数，包括步态相位持续时间、步长、步速和步幅被确定为解释变量：结果：帕金森病患者行走速度更慢（P 0.36）：尽管组间步态参数不同，但帕金森病患者表现出的动态步态稳定性与健康患者相似。为了弥补因步速慢而导致的潜在动态步态稳定性缺陷，帕金森病患者采用了较短的步长，以使质心运动状态更接近可行稳定性区域。我们的研究结果可以让人们深入了解帕金森病对动态步态稳定性控制的影响。

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引用次数: 0

Clinical gait analysis reveals altered walking patterns in critical Covid 19 survivors 临床步态分析显示，危重的 Covid 19 幸存者的行走模式发生了改变。

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2024-08-01 DOI: 10.1016/j.clinbiomech.2024.106318

Background

Covid-19 has dramatically increased the number of admissions in intensive care units due to respiratory complications. In some cases, the arousal of neurological impairments, such as peripheral neuropathies, have been revealed. The purpose of this research was to characterize the gait pattern and muscle activity changes in Covid-19 survivors compared to physiological gait.

Methods

Twelve post-Covid-19 participants admitted to intensive care units and twelve non-disabled controls were considered. Kinematics, kinetics and surface electromyographic data were collected for each participant during walking. Post Covid-19 participants were further divided into two sub-groups, according to the number of days spent in the intensive care units. Lower limb joint angles, moments and powers were extracted as well as the muscle activity of four muscles bilaterally, the spatial, temporal and spatiotemporal parameters of gait and the ground reaction forces. The extracted variables were compared through OneWay-ANOVA or Kruskal-Wallis tests where appropriate (p < 0.05).

Findings

Overall, the considered parameters revealed statistically significant reduction in gait speed, cadence, range of motion in the sagittal plane, anteroposterior and vertical ground reaction forces between pathological and control participants. Larger alterations of the gait patterns were highlighted in the post-Covid-19 group hospitalized in intensive care units longer than 35 days, where a reduced muscle activity was observed on all the analyzed muscles.

Interpretation

Results suggested that the severity of gait impairments in post-Covid-19 participants might be correlated with intensive care units-bedding period. Gait biomechanics assessment could be adopted in the clinical decision-making process to improve treatment protocols in post-Covid-19 survivors.

背景：Covid-19 使重症监护病房因呼吸系统并发症而入院的人数急剧增加。在一些病例中，神经系统损伤（如周围神经病）被暴露出来。本研究的目的是将 Covid-19 存活者的步态模式和肌肉活动变化与生理步态进行比较：方法：研究对象为 12 名入住重症监护室的 Covid-19 后幸存者和 12 名非残疾对照者。收集了每位参与者行走时的运动学、动力学和表面肌电图数据。根据在重症监护室度过的天数，Covid-19 后参与者被进一步分为两个亚组。提取了下肢关节角度、力矩和功率，以及双侧四块肌肉的肌肉活动、步态的空间、时间和时空参数以及地面反作用力。在适当的情况下，通过单向方差分析或 Kruskal-Wallis 检验对提取的变量进行比较（P 结果）：总体而言，所考虑的参数显示，病理参与者和对照组参与者的步速、步幅、矢状面运动范围、前后和垂直地面反作用力均有统计学意义上的显著降低。在重症监护室住院超过35天的Covid-19后组中，步态发生了更大的变化，所有分析肌肉的活动均有所减少：结果表明，Covid-19 后参与者步态障碍的严重程度可能与重症监护室的住院时间有关。步态生物力学评估可用于临床决策过程，以改进对Covid-19后幸存者的治疗方案。

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引用次数: 0

Association between cup fixation screw and iliopsoas impingement after total hip arthroplasty 全髋关节置换术后髋臼杯固定螺钉与髂腰肌撞击的关系

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2024-08-01 DOI: 10.1016/j.clinbiomech.2024.106315

Background

Iliopsoas impingement after total hip arthroplasty can result not only from acetabular cup but also from cup fixation screw. However, research addressing this screw impingement is scarce, leaving the details undetermined. This study aimed to elucidate the incidence and threshold of symptomatic iliopsoas impingement attributable to protrusion of the cup fixation screw into the iliopsoas muscle and to evaluate its impact on postoperative radiographic imaging findings and patient-reported outcome measures.

Methods

A total of 152 hips were included in this study. The symptomatic threshold of screw protrusion was determined using a receiver operating characteristic curve, and patients were divided into low-protrusion and high-protrusion groups using this threshold. The area and Hounsfield Unit values of the iliopsoas muscle on CT and the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire postoperatively were investigated.

Findings

10 hips (6.5%) were exhibited symptoms of IPI in this series. The threshold for screw protrusion length was identified as 6.4 mm. Patients in the high protrusion group exhibited significantly larger area and lower Hounsfield Unit values of the iliopsoas muscle. In addition, the high protrusion group revealed significantly lower scores (total, pain, movement, mental). Furthermore, subscales scores (pain, movement) in the high protrusion group didn't improve from 3 months to 12 months postoperatively with significance.

Interpretation

This study underscores the imperative for surgeons to consider the length of the cup fixation screw. This careful consideration is crucial for mitigating the incidence of postoperative iliopsoas impingement and enhancing total hip arthroplasty outcomes.

背景全髋关节置换术后的髂腰肌撞击不仅可能来自髋臼杯，也可能来自髋臼杯固定螺钉。然而，针对这种螺钉撞击的研究却很少，导致细节无法确定。本研究旨在阐明髋臼杯固定螺钉突入髂腰肌导致症状性髂腰肌撞击的发生率和阈值，并评估其对术后影像学检查结果和患者报告结果的影响。采用接收者操作特征曲线确定螺钉突出的症状阈值，并以此阈值将患者分为低突出组和高突出组。研究还调查了髂腰肌在 CT 上的面积和 Hounsfield 单位值，以及术后日本骨科协会髋关节疾病评估问卷。螺钉突出长度的临界值为 6.4 毫米。高突入组患者的髂腰肌面积明显增大，Hounsfield 单位值明显降低。此外，高突度组的评分（总分、疼痛、运动、精神）也明显较低。此外，从术后 3 个月到 12 个月，高突度组的子量表评分（疼痛、运动）没有明显改善。这项研究强调了外科医生必须考虑髋臼杯固定螺钉的长度，这对于减少术后髂腰肌撞击的发生率和提高全髋关节置换术的疗效至关重要。

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引用次数: 0

Females with hip pain walk with altered kinematics at peaks and throughout the gait cycle 髋关节疼痛的女性在高峰期和整个步态周期的行走运动学都发生了改变

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2024-08-01 DOI: 10.1016/j.clinbiomech.2024.106314

Background

Females with acetabular dysplasia and/or labral tears (hip pain) exhibit altered walking kinematics, with studies reporting mixed results in sagittal and frontal planes compared to pain-free controls, often conducting only discrete analyses and warranting further investigation. The objective of this study was to investigate discrete and continuous hip and pelvic kinematics between females with and without hip pain in two walking conditions.

Methods

We collected kinematic walking data from 69 females (35 with hip pain, 34 controls) using motion capture and an instrumented treadmill in two conditions: preferred and fast (125% preferred). We used a general linear model and one-dimensional statistical parametric mapping to conduct discrete and continuous analyses comparing kinematics between groups, with and without adjustment for gait speed.

Findings

The hip pain group walked with reduced peak hip extension (Preferred: P = .046, Cohen's d = 0.41; Fast: P = .028, d = 0.48) and greater peak anterior pelvic tilt (Preferred: P = .011, d = 0.57; Fast: P = .012, d = 0.58) compared to controls. From continuous analyses, the hip pain group walked with reduced hip extension during terminal stance (Fast: P = .040), greater anterior pelvic tilt throughout (Preferred: P = .007; Fast: P = .004), and greater contralateral pelvic drop (Preferred: P = .045) during midstance. Adjusting for speed slightly affected p-values, but significance was retained for all prior variables except pelvic drop.

Interpretation

Kinematic differences between individuals with and without hip pain may provide insight into potential predisposing factors for hip pathology and/or compensations for pain or pathological processes. This work furthers understanding of altered movement patterns in individuals with hip pain and may inform physical therapy treatments.

背景患有髋臼发育不良和/或髋臼唇撕裂（髋关节疼痛）的女性会表现出行走运动学改变，与无痛对照组相比，研究报告在矢状面和额状面上的结果不一，通常只进行离散分析，值得进一步研究。本研究的目的是调查有髋关节疼痛和无髋关节疼痛的女性在两种行走条件下的离散和连续髋关节和骨盆运动学。方法我们使用运动捕捉和仪器跑步机收集了 69 名女性（35 名有髋关节疼痛，34 名对照组）在两种条件下的运动学行走数据：首选和快速（125% 首选）。与对照组相比，髋关节疼痛组行走时髋关节伸展峰值降低（首选：P = .046，Cohen's d = 0.41；快速：P = .028，d = 0.48），骨盆前倾峰值增大（首选：P = .011，d = 0.57；快速：P = .012，d = 0.58）。从连续分析结果来看，髋关节疼痛组在末期站立时髋关节伸展减少（快速：P = .040），整个骨盆前倾更大（首选：P = .007；快速：P = .004），中段站立时对侧骨盆下垂更大（首选：P = .045）。对速度的调整略微影响了 P 值，但除骨盆下垂外，所有先前变量的显著性均得以保留。释义髋关节疼痛患者与无髋关节疼痛患者之间的运动学差异可能有助于了解髋关节病变的潜在易感因素和/或疼痛或病理过程的代偿。这项研究加深了人们对髋关节疼痛患者运动模式改变的理解，并可为物理治疗提供参考。

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引用次数: 0

Lower limb kinematic changes during gait after hallux valgus surgery: A prospective observational study 足外翻手术后步态过程中的下肢运动学变化：前瞻性观察研究

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2024-07-14 DOI: 10.1016/j.clinbiomech.2024.106304

Background

Patients with hallux valgus are known to alter lower limb joint kinematics during gait. However, little information is available about gait changes following hallux valgus surgery. We aimed to longitudinally investigate lower limb kinematic changes at the mid and terminal stances of gait after hallux valgus surgery.

Methods

This prospective observational study included 11 female patients (17 feet), who underwent first metatarsal osteotomy. Gait analyses were performed preoperatively and 1- and 2-year postoperatively using a three-dimensional motion capture system. Toe-out angle, ankle, knee, and hip joint angles during gait were calculated from the recorded data. The spatiotemporal parameters and these angles at the mid and terminal stances of gait were statistically compared between preoperative and postoperative periods.

Findings

All spatiotemporal parameters remained unchanged postoperatively. The toe-out angle was significantly greater at 1- and 2-year postoperatively. The ankle pronation angle, the knee abduction angle, and the hip adduction angle at the mid and terminal stances of gait were smaller postoperatively compared to the preoperative. These angular changes showed a similar trend at 1 and 2 years postoperatively. However, the postoperative changes of the sagittal joint angles were relatively small.

Interpretation

Hallux valgus surgery can affect the toe-out angle and the lower limb coronal kinematics at the mid and terminal stances of gait in patients with hallux valgus. However, surgical correction of hallux valgus deformity did not directly improve the gait characteristics in patients with hallux valgus.

背景众所周知，足外翻患者在步态过程中会改变下肢关节的运动学特性。然而，关于足外翻手术后步态变化的信息却很少。我们的目的是纵向研究足外翻手术后步态中段和末段的下肢运动学变化。方法这项前瞻性观察研究纳入了11名女性患者（17足），她们都接受了第一跖骨截骨术。使用三维运动捕捉系统进行术前、术后 1 年和 2 年的步态分析。根据记录的数据计算了步态过程中的脚趾外展角、踝关节、膝关节和髋关节角度。对术前和术后步态中期和末期的时空参数和这些角度进行了统计比较。术后 1 年和 2 年，趾外翻角度明显增大。与术前相比，术后步态中期和末期的踝关节前伸角度、膝关节外展角度和髋关节内收角度都变小了。这些角度的变化在术后1年和2年呈现出相似的趋势。解释：足外翻手术会影响足外翻患者步态中段和末段的趾外展角度和下肢冠状运动学。然而，手术矫正足外翻畸形并不能直接改善足外翻患者的步态特征。

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引用次数: 0

Contributions of capsular releases to femoral exposure in total hip arthroplasty via the direct anterior approach 在通过直接前路进行的全髋关节置换术中，关节囊释放对股骨暴露的贡献。

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2024-07-05 DOI: 10.1016/j.clinbiomech.2024.106303

Shuyang Han , Zackary Byrd , Sabir K. Ismaily , Luis E. Delgadillo , Adam M. Freedhand , David Rodriguze-Quintana , Philip C. Noble

Background

In total hip arthroplasty via the direct anterior approach, appropriate exposure is critical to allow preparation of the femur. The objective of this study was to explore the optimal soft tissue releases needed to allow broaching of the femur through a combination of experimental tests and computer simulations.

Methods

Fourteen full-body cadaveric specimens were included in this study. Total hip arthroplasty was performed via the direct anterior approach with the femur at 20° adduction and 20°extension. Soft tissue releases were performed sequentially, namely, the transverse iliofemoral ligament, descending iliofemoral ligament, ischio-femoral ligament, conjoint tendon, and obturator externus. After each release, the femur mobility was assessed by applying a 6 Nm external rotation torque and a 120 N distraction force. Subsequently, using specimen-specific models and models of the broach and handle, the broach passage after each release was simulated, and the release that allowed broach passage was analyzed.

Findings

The average external rotation after releasing the transverse and descending iliofemoral ligaments increased by 14.1° ± 6.1° and 13.8° ± 5.3°. With subsequent soft tissue releases, the rotational mobility increased incrementally, though the impact decreased. Impingement between the broach passage and the pelvis was mainly at the anterior superior iliac spine and the anterior inferior iliac spine. The volume of impingement decreased from 4.8 ± 4.5 cm³ after resection of the femoral head to 1.8 ± 1.6 cm³ and 1.2 ± 1.9 cm³ after release of the transverse and descending iliofemoral ligament, respectively.

Interpretation

With sequential soft-tissue releases, the femur mobility increased incrementally. However, the number of releases needed for each femur varied extensively between specimens. Most (10/14) femurs became accessible after the release of the ilio-femoral or ischio-femoral ligament.

背景：在通过直接前路进行的全髋关节置换术中，适当的暴露对于股骨的准备至关重要。本研究的目的是通过实验测试和计算机模拟相结合的方法，探索股骨拉削所需的最佳软组织释放量：本研究包括 14 个全身尸体标本。通过直接前方入路进行全髋关节置换术，股骨内收 20°，外展 20°。软组织松解按顺序进行，即髂股横韧带、髂股降韧带、峡股韧带、联合肌腱和闭孔肌外侧。每次松解后，通过施加 6 牛米的外旋扭矩和 120 牛米的牵引力来评估股骨的活动度。随后，使用标本专用模型以及拉刀和手柄模型，模拟了每次松解后拉刀的通过情况，并分析了允许拉刀通过的松解情况：结果：松解髂股横韧带和髂股降韧带后，平均外旋增加了 14.1° ± 6.1° 和 13.8° ± 5.3°。随着后续软组织的松解，旋转活动度逐渐增加，但冲击力有所下降。拉刀通道与骨盆之间的撞击主要位于髂前上棘和髂前下棘。股骨头切除后，撞击体积从 4.8 ± 4.5 cm3 减少到 1.8 ± 1.6 cm3，髂股横韧带和髂股降韧带松解后，撞击体积分别为 1.2 ± 1.9 cm3：通过连续的软组织松解，股骨活动度逐渐增加。然而，每个股骨所需的松解次数因标本而异。大多数（10/14）股骨在髂股韧带或髂股韧带松解后即可活动。

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引用次数: 0