Clinical Biomechanics最新文献_第4页

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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引用次数: 0

In silico analysis of fixation device strain patterns in the postoperative proximal femur: Effects of bone quality during gait. 股骨术后近端固定装置应变模式的计算机分析：步态中骨质量的影响。

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2025-11-27 DOI: 10.1016/j.clinbiomech.2025.106724

Yogesh Kumaran, Sophia Soehnlen, Christopher Haritos, Sanam Jhaveri, Sudharshan Tripathi, Humza Shaikh, Stephanie Di Stasi, Carmen E Quatman

Background: Proximal femur fracture fixation fundamentally alters load transfer, which can trigger adverse bone remodeling, particularly after healing in osteoporotic bone. While previous studies have focused on early fixation stability or acute fracture healing, the long-term mechanical environment after fracture consolidation remains poorly understood. This study examines implant-specific strain behavior in the post-healed state to identify patterns that may predispose to late-stage implant failure or remodeling.

Methods: Subject-specific finite-element models were created from CT scans of a healthy 22-year-old and an osteoporotic 90-year-old female. Cannulated screws (CS), a dynamic hip screw (DHS), and a femoral neck system (FNS) were virtually implanted in each model and subjected to simulated gait loading. Maximum implant stresses and regional principal strains across the proximal femur were quantified throughout the stance phase.

Findings: The FNS demonstrated the highest maximum von Mises stresses in both normal and osteoporotic bone, notably at the anti-rotation screw and bolt interface. In osteoporotic bone, the FNS exhibited significantly higher tensile (mean 0.36 % ± 0.22 %) and compressive strains (mean - 0.41 % ± 0.28 %) compared to CS and DHS implants, while in normal bone, FNS strains were comparable to intact femur strains. The CS model showed reduced peak strains and stresses throughout the gait cycle compared to DHS and FNS.

Interpretation: This study provides a comparative assessment of healed-state strain distributions across common fixation constructs. By characterizing these environments, these data establish a biomechanical framework and highlight the interplay between implant design and bone quality. Further population-based studies are required to refine implant selection.

背景：股骨近端骨折固定从根本上改变了负荷转移，这可能引发不利的骨重塑，特别是在骨质疏松骨愈合后。虽然以前的研究主要集中在早期固定稳定性或急性骨折愈合，但骨折巩固后的长期力学环境仍然知之甚少。本研究检查了愈合后状态下种植体特有的应变行为，以确定可能导致晚期种植体失败或重塑的模式。方法：对一名健康的22岁女性和一名骨质疏松的90岁老年女性进行CT扫描，建立特定对象的有限元模型。在每个模型中虚拟植入空心螺钉（CS）、动态髋关节螺钉（DHS）和股骨颈系统（FNS），并进行模拟步态负荷。在整个站立阶段，对股骨近端最大种植体应力和区域主应变进行量化。结果：FNS在正常骨和骨质疏松骨中均显示最大von Mises应力，特别是在防旋转螺钉和螺栓界面处。在骨质疏松性骨中，FNS的拉伸应变（平均0.36%±0.22%）和压缩应变（平均- 0.41%±0.28%）明显高于CS和DHS植入物，而在正常骨中，FNS应变与完整股骨应变相当。与DHS和FNS相比，CS模型显示整个步态周期的峰值应变和应力降低。解释：本研究对不同固定结构的愈合状态应变分布进行了比较评估。通过描述这些环境，这些数据建立了生物力学框架，并强调了种植体设计与骨质量之间的相互作用。需要进一步的以人群为基础的研究来完善植入物的选择。

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引用次数: 0

Comparison of prosthetic/limb alignment, soft tissue balance, and clinical outcomes between two different prostheses in ground kinematically aligned total knee arthroplasty 地面运动对齐全膝关节置换术中两种不同假体的假肢/肢体对齐、软组织平衡和临床结果的比较

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2025-11-23 DOI: 10.1016/j.clinbiomech.2025.106710

Tomoyuki Matsumoto , Naoki Nakano , Masanori Tsubosaka , Kazunari Ishida , Tomoyuki Kamenaga , Yuichi Kuroda , Shinya Hayashi , Hirotsugu Muratsu , Ryosuke Kuroda

Background

Kinematically aligned total knee arthroplasty has gained popularity. This study aimed to evaluate kinematic alignment targeting the neutral ground mechanical axis (ground kinematic alignment) through a comparison between two modern prostheses.

Methods

This cohort study included 82 consecutive patients (46 Persona® and 36 ATTUNE® prostheses) who underwent unilateral ground kinematically aligned total knee arthroplasty using a portable navigation system for varus osteoarthritis. After 1:1 propensity score matching, 56 patients with comparable demographic data were matched between groups. Patellar orientation, hip-knee-ankle angle, coronal femoral/tibial component alignment, and joint line orientation angle were compared between the groups. Intra-operative patellar tracking and soft tissue balance, including joint component gap and varus/valgus balance, were also compared. At 1 year postoperatively, clinical outcomes, including range of motion and 2011 Knee Society Score, were compared.

Findings

Radiological parameters including patellar shift and tilt were not significantly different between the groups, however the ratio of intraoperative lateral retinacular release to adjust patellar tracking was significantly higher in the Persona group than in the ATTUNE group. While both groups showed similar pattern of intra-operative soft tissue balance, the ATTUNE group showed a more stable joint component gap in the shallow range of flexion and a smaller lateral laxity in deep flexion than the Persona group (p < 0.05). There were no significant differences in clinical outcomes between the groups.

Interpretation

Ground kinematically aligned total knee arthroplasty using Persona or ATTUNE prostheses showed similar intra-operative and postoperative results; however, consideration should also be given to the characteristics between the models.

运动对齐全膝关节置换术已经得到了广泛的应用。本研究旨在通过两种现代假体的比较来评估针对中性地面机械轴的运动学对齐（地面运动学对齐）。方法本队列研究包括82例连续患者（46例Persona®假体和36例ATTUNE®假体），这些患者使用便携式导航系统接受单侧地面运动学对齐全膝关节置换术治疗内翻性骨关节炎。1:1倾向评分匹配后，56例具有可比人口统计学数据的患者组间匹配。髌骨定向、髋关节-膝关节-踝关节角、冠状股/胫骨组件对准、关节线定向角组间比较。术中髌骨跟踪和软组织平衡，包括关节构件间隙和内翻/外翻平衡，也进行了比较。在术后1年，比较临床结果，包括活动范围和2011年膝关节社会评分。放射学参数包括髌骨移位和倾斜在两组间无显著差异，但术中外侧支持带释放调整髌骨追踪的比例在Persona组明显高于ATTUNE组。虽然两组术中软组织平衡模式相似，但与Persona组相比，ATTUNE组在浅屈曲范围内的关节构件间隙更稳定，在深屈曲范围内的外侧松弛更小（p < 0.05）。两组临床结果无显著差异。使用Persona或ATTUNE假体的地面运动学对齐全膝关节置换术显示出相似的术中和术后结果；但是，还应考虑到模式之间的特点。

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引用次数: 0

Pain, fear, and movement: Cognitive-behavioural connections in patellofemoral pain 疼痛、恐惧和运动：髌骨痛的认知-行为联系。

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2025-11-22 DOI: 10.1016/j.clinbiomech.2025.106716

Otávio Henrique Cardoso Leite , Gabriel Jacob Navarro , Nara Lourdes Moreno Rodrigues , Cid André Fidelis de Paula Gomes , Gábor József Barton , Caio Sain Vallio , Paulo Roberto Garcia Lucareli

Background

Kinesiophobia, or fear of movement, is common in individuals with musculoskeletal pain, especially in those with patellofemoral pain, and it can lead to increased functional limitations. Although pain self-efficacy is known to affect kinesiophobia, the link between psychological factors and physical aspects such as movement patterns and pain intensity remains uncertain. This study aimed to assess the relationships between kinesiophobia and cognitive-behavioural factors, pain, and functional domains in participants with patellofemoral pain.

Methods

This was an observational, cross-sectional study involving 66 participants with patellofemoral pain who underwent assessments of cognitive-behavioural factors, self-reported pain, knee-related function, and movement function. Generalized linear models were used to examine the relationship between kinesiophobia and self-efficacy, pain catastrophizing, self-reported pain, knee-related function, and movement function measured by the Movement Deviation Profile.

Findings

The general linear model demonstrated that self-efficacy and the Movement Deviation Profile were predictors of kinesiophobia. The final model confirmed a notable inverse association between self-efficacy and kinesiophobia, with a 0.31-point decrease in kinesiophobia for each one-point increase in the Pain Self-Efficacy Questionnaire score. Regarding the Movement Deviation Profile, each one-degree increase in the movement deviation pattern was associated with a 0.24-point increase in kinesiophobia scores.

Interpretation

Kinesiophobia can decrease self-efficacy and lead to movement avoidance, negatively impacting perceived ability and physical function. Our findings emphasise the complex nature of kinesiophobia. Improving self-efficacy might help lessen fear-related avoidance, while movement patterns should be interpreted carefully by distinguishing between adaptive and maladaptive behaviours.

背景：运动恐惧症，或运动恐惧，在肌肉骨骼疼痛患者中很常见，特别是髌骨疼痛患者，它可导致功能限制增加。虽然已知疼痛自我效能会影响运动恐惧症，但心理因素与身体方面（如运动模式和疼痛强度）之间的联系仍不确定。本研究旨在评估运动恐惧症与髌股疼痛参与者的认知行为因素、疼痛和功能域之间的关系。方法：这是一项观察性横断面研究，涉及66名髌骨疼痛患者，他们接受了认知行为因素、自我报告的疼痛、膝关节相关功能和运动功能的评估。使用广义线性模型来检验运动恐惧症与自我效能、疼痛灾难化、自我报告的疼痛、膝关节相关功能和运动偏离剖面测量的运动功能之间的关系。结果：一般线性模型显示自我效能感和运动偏差谱是运动恐惧症的预测因子。最后的模型证实了自我效能和运动恐惧症之间的显著负相关，疼痛自我效能问卷得分每增加1分，运动恐惧症就会减少0.31分。关于运动偏差曲线，运动偏差模式每增加1度，运动恐惧症得分就会增加0.24分。解读：运动恐惧症会降低自我效能，导致运动回避，对感知能力和身体功能产生负面影响。我们的发现强调了运动恐惧症的复杂性。提高自我效能感可能有助于减少与恐惧相关的回避，而运动模式应该通过区分适应和不适应行为来仔细解释。

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引用次数: 0

Gait assessment of osteosarcoma patients undergoing total knee arthroplasty: Influence of abduction-adduction angles in knee prostheses 全膝关节置换术后骨肉瘤患者的步态评估：膝关节假体外展-内收角度的影响。

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2025-11-22 DOI: 10.1016/j.clinbiomech.2025.106714

Rui Xu , Shiyu Zhang , Jingwen Chen , Mingyong Gu , Juan Du , Lin Meng , Jingyu Zhang , Dong Ming

Background

Bone tumors often affect the knee, necessitating total knee arthroplasty for functional restoration. While rotating hinge prostheses enable biaxial movement, an ideal design should replicate natural multi-axis motion. A proposed ball-axis prosthesis with an open coronal plane has undergone in vitro finite element validation but lacks in vivo assessment. This study aims to deeply explore the influence of abduction-adduction freedom of the open prosthesis knee joint on the gait function of patients in vivo.

Methods

We recruited 8 patients with ball-axis prostheses, 8 with rotating hinge knee prostheses, and 8 healthy controls to collect three-dimensional motion data and ground reaction forces during normal gait. The joint angles and moments of the lower extremities were calculated using the musculoskeletal model. The characteristic parameters of the joint angle and moment curves were calculated, and one-way analysis of variance was used to evaluate the mean differences between groups.

Findings

Compared to the rotating hinge prosthesis, the ball-axis prosthesis exhibited significantly lower gait speed, peak knee flexion during the swing phase, and peak anterior ground reaction force (p = 0.030, p = 0.010, p = 0.018). Despite the opened coronal plane freedom, there was no significant difference in gait abduction-adduction range compared to the rotating hinge prosthesis or healthy controls.

Interpretation

This study indicates the patients with ball-axis prosthesis had weaker propulsion and did not expand the abduction–adduction range as expected. The in vivo gait analysis of ball-axis prostheses provides a valuable reference for future prosthetic design improvements.

背景：骨肿瘤经常影响膝关节，需要全膝关节置换术来恢复功能。虽然旋转铰链假肢可以实现双轴运动，但理想的设计应该复制自然的多轴运动。一种开放冠状面球轴假体已经进行了体外有限元验证，但缺乏体内评估。本研究旨在深入探讨开放式人工膝关节内展自由对患者体内步态功能的影响。方法：选取8例球轴假体患者、8例旋转铰链膝关节假体患者和8名健康对照者，采集正常步态下的三维运动数据和地面反作用力。采用肌肉骨骼模型计算下肢关节角和力矩。计算关节角、弯矩曲线的特征参数，采用单因素方差分析评价组间均值差异。结果：与旋转铰链假体相比，球轴假体在摆动阶段的步态速度、膝关节屈曲峰值和前地反力峰值均显著降低（p = 0.030, p = 0.010, p = 0.018）。尽管打开了冠状面自由，但与旋转铰链假体或健康对照组相比，步态外展-内收范围没有显著差异。解释：本研究表明，球轴假体患者的推进力较弱，并没有像预期的那样扩大外展-内收范围。球轴假体的体内步态分析为今后改进假体设计提供了有价值的参考。

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