Clinical Biomechanics最新文献_第5页

A biomechanical study comparing combined S1AI and S3AI trajectories to other pelvic fixation techniques: A finite element analysis 一项比较S1AI和S3AI联合轨迹与其他骨盆固定技术的生物力学研究：有限元分析。

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2025-11-22 DOI: 10.1016/j.clinbiomech.2025.106712

William Sheppard , Arpan A. Patel , Colin Rhoads , Landon Reading , Theodore Rudic , Joshua Wiener , Matthew Magro , Lauren M. Boden , Thomas Olson , Jason Savage , Michael Steinmetz , Edin Nevzati , Alexander Spiessberger

Background

Pelvic fixation is fundamental to multi-level spinal fusion constructs. Established techniques include conventional iliac, S1-alar-iliac (S1AI), S2-alar-iliac (S2AI), and S3-alar-iliac (S3AI) fixation. Novel porous sacral-alar-iliac (SAI) screws with integrated tulips are increasingly used in long constructs requiring bilateral pelvic fixation. The optimal pelvic fixation strategy remains debated. Conventional techniques include iliac screws and sacral-alar-iliac (SAI) variants, while combined constructs such as S1AI + S3AI remain underexplored. This study presents a finite element analysis (FEA) comparing the biomechanical impact of various fixation methods, with emphasis on combined S1AI + S3AI fixation.

Methods

Six L1–pelvis FEA models were created: one noninstrumented control (V1) and five instrumented variants—iliac screw (V2), S1AI (V3), S2AI (V4), 8.5 mm S1AI + S3AI (V5), and 10.5 mm S1AI + S3AI (V6). L5-S1 interbody fusion was modelled in all constructs. Loading conditions included flexion, axial-compression, and lateral bending at 100 N, 200 N, and 300 N. Von Mises Stress (VMS) and range of motion (ROM) were analyzed.

Findings

All instrumented constructs reduced ROM versus control. V3 had the lowest ROM but showed construct imbalances internally, cranial to caudal. V6 offered the most uniform ROM reduction. V5 and V6 exhibited the lowest pelvic VMS; V2–V4 had higher stress than control. Instrumentation stress localized to L5-S1 in all variants, with V3 showing bilateral S1AI instrumentation stress. V5 and V6 demonstrated the most favorable stress profiles throughout.

Interpretation

Combined S1AI + S3AI fixation outperformed other pelvic constructs biomechanically, with reduced stress and improved ROM distribution. These findings support its use in long spinal fusions to enhance construct durability and may help guide surgical decision-making. Additional, clinical studies are needed to validate these findings.

背景：骨盆固定是多层脊柱融合的基础。已建立的技术包括传统的髂、s1 -髂翼（S1AI）、s2 -髂翼（S2AI）和s3 -髂翼（S3AI）固定。新型多孔骶-翼-髂（SAI）螺钉集成郁金香越来越多地用于需要双侧骨盆固定的长结构。最佳骨盆固定策略仍有争议。传统技术包括髂螺钉和骶翼髂（SAI）变体，而S1AI + S3AI等组合结构仍未得到充分研究。本研究通过有限元分析（FEA）比较了不同固定方法的生物力学影响，重点研究了S1AI + S3AI联合固定。方法：建立6个l1 -骨盆有限元模型：1个非固定对照（V1）和5个固定异型——髂螺钉（V2）、S1AI （V3）、S2AI （V4）、8.5 mm S1AI + S3AI （V5）和10.5 mm S1AI + S3AI （V6）。所有模型均模拟L5-S1椎间融合。在100n、200n和300n的载荷条件下，对小鼠进行了屈曲、轴向压缩和侧弯加载，分析了Von Mises应力（VMS）和运动范围（ROM）。结果：与对照组相比，所有置入的组织都减少了ROM。V3的ROM最低，但表现出内部结构不平衡，从颅到尾。V6提供了最均匀的ROM减少。V5和V6表现出最低的盆腔VMS；V2-V4组的应激高于对照组。所有变异的仪器应力都局限于L5-S1， V3显示双侧S1AI仪器应力。V5和V6在整个过程中表现出最有利的应力分布。解释：S1AI + S3AI联合固定在生物力学上优于其他骨盆结构，减少了压力，改善了ROM分布。这些发现支持其在长脊柱融合中的应用，以提高结构的耐久性，并可能有助于指导手术决策。此外，还需要临床研究来验证这些发现。

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引用次数: 0

Discrimination of independent walking by spatiotemporal gait parameter variability in patients with hemiparesis following stroke 脑卒中后偏瘫患者独立行走的时空步态参数变异性鉴别。

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2025-11-21 DOI: 10.1016/j.clinbiomech.2025.106711

Taishi Kikkawa , Kouta Kunitomo , Tsubasa Mitsutake , Takeshi Imura , Ryo Tanaka

Background

Gait variability in spatiotemporal parameters, a measure related to gait stability, is associated with fall risk in patients with stroke. Assessing gait variability may also be critical for independent walking in patients with hemiparesis following stroke. However, it remains unclear whether gait variability can discriminate between independent walking. This study aimed to evaluate the efficacy of gait variability indicators in discriminating independent walking in patients with hemiparesis following stroke.

Methods

This cross-sectional study included 135 patients with hemiparesis following stroke (94 training and 41 validation samples). Gait variability indicators, calculated as the coefficient of variation (CV), included stride time, step time, single support time, and step length. Independent walking was assessed using the Functional Ambulation Category (FAC) and classified into independent and non-independent groups. Discriminant performance was evaluated using the area under the receiver operating characteristic curve (AUROC) and cutoff values, analyzed separately for the training and validation samples.

Findings

The AUROC values for gait variability indicators were above 0.8, indicating moderate discrimination accuracy. The cutoff values were 4.32 % for stride time CV, 6.08 % for step time CV, 7.82 % for single support time CV, and 9.97 % for step length CV. The training and validation samples showed equivalent discrimination performance.

Interpretation

Gait variability indicators demonstrated moderate accuracy in discriminating independent walking in patients with hemiparesis following stroke. These findings highlight the effectiveness of gait stability assessment for discriminating walking independence in this population.

背景：时空参数的步态变异性是一种与步态稳定性相关的测量方法，与卒中患者跌倒风险相关。评估步态变异性对于卒中后偏瘫患者的独立行走也至关重要。然而，步态变异是否能区分独立行走尚不清楚。本研究旨在评价步态变异性指标在判别脑卒中偏瘫患者独立行走中的作用。方法：本横断面研究纳入135例脑卒中后偏瘫患者（94例训练样本和41例验证样本）。步态变异性指标以变异系数（CV）计算，包括步幅时间、步幅时间、单次支撑时间和步幅长度。独立行走采用功能行走分类（FAC）进行评估，并分为独立组和非独立组。使用受试者工作特征曲线下面积（AUROC）和截止值来评估判别性能，并分别对训练样本和验证样本进行分析。结果：步态变异性指标AUROC值均在0.8以上，判别准确率中等。步长CV的截止值为4.32%，步长CV为6.08%，单支撑时间CV为7.82%，步长CV为9.97%。训练样本和验证样本具有相当的识别性能。解释：步态变异性指标在判别卒中后偏瘫患者独立行走方面表现出中等的准确性。这些发现强调了步态稳定性评估在鉴别该人群行走独立性方面的有效性。

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引用次数: 0

Free-living physical activity levels in children with cerebral palsy 脑瘫儿童的自由生活体力活动水平

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2025-11-21 DOI: 10.1016/j.clinbiomech.2025.106713

Maija Piiparinen , Pedro Valadão , Tiina Savikangas , Ying Gao , Francesco Cenni , Taija Finni

Background

Cerebral Palsy (CP) is a common motor disorder in children, leading to reduced physical activity (PA) and increased health risks. To complement traditional PA methods (e.g. accelerometers, self-reports), electromyography (EMG) provides physiologically relevant information on muscle activity during free-living. This study used EMG for assessing daily muscle activity in individuals with CP and their typically developing (TD) peers.

Methods

Shorts with embedded EMG electrodes and hip-worn tri-axial accelerometer recorded daily PA in 8 children with spastic CP (mean age 14y 7mo, Gross Motor Function Classification System (GMFCS) I (n = 5), III (n = 3)) and 6 TD children (mean age 15y 4mo) during free-living. Daily EMG activity levels are reported as a percentage of mean EMG amplitude during the 6MWT. Inactivity time and light, moderate and vigorous PA are reported relative to recording time using established cut-off values for accelerometry, and EMG amplitude categorized based on a two-minute average from the middle of 6MWT.

Findings

Free-living EMG inactivity (CP: 58.4 %, TD: 50.4 %) and activity levels did not differ statistically between CP and TD groups. Accelerometry showed a greater inactivity time than EMG in CP (p = 0.021) and TD (p = 0.010) groups. In CP, few statistically significant differences were observed between legs, muscles, and GMFCS levels.

Interpretation

Free-living EMG monitoring did not reveal excessive muscle activity in individuals with CP during daily activities compared to TD peers. EMG detects light PA that accelerometry may underestimate, offering a more detailed view of daily muscle use.

脑性麻痹（CP）是儿童常见的运动障碍，导致身体活动（PA）减少和健康风险增加。为了补充传统的PA方法（如加速度计、自我报告），肌电图（EMG）提供了自由生活期间肌肉活动的生理学相关信息。这项研究使用肌电图来评估CP患者和他们的正常发育（TD）同龄人的日常肌肉活动。方法在自由生活期间，8例痉挛性CP患儿(平均年龄14 ~ 7月龄，粗大运动功能分类系统（GMFCS） I级（n = 5）、III级（n = 3）和6例TD患儿（平均年龄15 ~ 4月龄）的每日PA均由嵌入EMG电极的短板和髋部佩戴的三轴加速度计记录。每日肌电活动水平以6MWT期间平均肌电振幅的百分比报告。相对于记录时间，使用已建立的加速度测量临界值报告了不活动时间、轻度、中度和剧烈PA，并根据从6MWT中间开始的两分钟平均值对肌电振幅进行了分类。自由生活肌电不活动（CP: 58.4%, TD: 50.4%）和活动水平在CP组和TD组之间无统计学差异。CP组（p = 0.021）和TD组（p = 0.010）的静止时间比肌电图长。在CP方面，腿部、肌肉和GMFCS水平之间几乎没有统计学上的显著差异。与TD同龄人相比，自由生活的肌电图监测并未显示CP患者在日常活动中肌肉活动过度。肌电图可以检测到加速度计可能低估的轻PA，从而提供更详细的日常肌肉使用情况。

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引用次数: 0

Bilateral balance improves in low and high fall risk groups after unilateral total ankle arthroplasty 单侧全踝关节置换术后，低跌倒风险组和高跌倒风险组的双侧平衡得到改善

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2025-11-21 DOI: 10.1016/j.clinbiomech.2025.106719

Robyn M. Hansen , Samantha I. Weiss , Sara L. Arena , Robin M. Queen

Background

Ankle osteoarthritis (OA) affects ∼1 % of the global population and impairs postural stability, increasing fall risk. Total ankle arthroplasty (TAA) is one of the most common surgical treatments, but balance impairments may persist post-op. The study examined differences in load symmetry across time for patients with ankle OA and post-TAA at low (LFR) or high fall risk (HFR) and then compared these groups with healthy controls.

Methods

All participants completed a balance assessment consisting of four static stances: shoulder width (BS), feet together (BFT), semi-tandem, and tandem. Fall risk was determined pre-operatively. Ground reaction forces were collected using force plates (AMTI, Watertown, MA) and load symmetry was calculated using the normalized symmetry index (NSI). A mixed effects model analyzed interactions between group (LFR, HFR) and time (pre-op, post1yr, post2yr) for the BS and BFT stances. A chi-square analysis examined changes in fall risk group assignment over time. Differences between healthy controls and the LFR and HRF groups at post2yr were examined with a mixed effects model.

Findings

HFR participants showed a significant decrease in average NSI from pre-op to post1yr (p < 0.001) and post2yr (p = 0.001) for BS. BFT NSI decreased significantly from pre-op to post2yr. The chi-square test indicated a significant shift toward LFR classification at post2yr (p = 0.021). At post2yr, there were no significant NSI differences between LFR, HFR, and controls.

Interpretations

TAA improves load symmetry during quiet standing, with high fall risk participants showing the most pronounced changes, indicating the potential to reduce fall risk in post-TAA older adults.

踝关节骨关节炎（OA）影响全球约1%的人口，并损害姿势稳定性，增加跌倒风险。全踝关节置换术（TAA）是最常见的手术治疗之一，但术后平衡障碍可能持续存在。该研究检查了踝关节OA患者和taa后患者在低（LFR）或高跌倒风险（HFR）下的负荷对称性随时间的差异，然后将这些组与健康对照组进行比较。方法所有参与者完成了由四种静态姿势组成的平衡评估：肩宽（BS）、双脚并拢（BFT）、半双人和双人。术前确定跌倒风险。采用力板（AMTI、Watertown、MA）收集地基反力，采用归一化对称指数（NSI）计算荷载对称性。混合效应模型分析了组（LFR、HFR）和时间（术前、术后1年、术后2年）对BS和BFT立场的相互作用。卡方分析检查了跌倒风险组分配随时间的变化。采用混合效应模型检查健康对照组与LFR和HRF组在2年后的差异。发现shfr参与者显示BS的平均NSI从术前到术后1年（p < 0.001）和术后2年（p = 0.001）显著下降。BFT NSI从术前到术后2年显著下降。卡方检验显示，2年后LFR分类发生了显著变化（p = 0.021）。2年后，LFR、HFR和对照组之间没有显著的NSI差异。taa改善了安静站立时的负荷对称性，高跌倒风险参与者表现出最明显的变化，表明taa后老年人跌倒风险降低的潜力。

{"title":"Bilateral balance improves in low and high fall risk groups after unilateral total ankle arthroplasty","authors":"Robyn M. Hansen , Samantha I. Weiss , Sara L. Arena , Robin M. Queen","doi":"10.1016/j.clinbiomech.2025.106719","DOIUrl":"10.1016/j.clinbiomech.2025.106719","url":null,"abstract":"<div><h3>Background</h3><div>Ankle osteoarthritis (OA) affects ∼1 % of the global population and impairs postural stability, increasing fall risk. Total ankle arthroplasty (TAA) is one of the most common surgical treatments, but balance impairments may persist post-op. The study examined differences in load symmetry across time for patients with ankle OA and post-TAA at low (LFR) or high fall risk (HFR) and then compared these groups with healthy controls.</div></div><div><h3>Methods</h3><div>All participants completed a balance assessment consisting of four static stances: shoulder width (BS), feet together (BFT), semi-tandem, and tandem. Fall risk was determined pre-operatively. Ground reaction forces were collected using force plates (AMTI, Watertown, MA) and load symmetry was calculated using the normalized symmetry index (NSI). A mixed effects model analyzed interactions between group (LFR, HFR) and time (pre-op, post1yr, post2yr) for the BS and BFT stances. A chi-square analysis examined changes in fall risk group assignment over time. Differences between healthy controls and the LFR and HRF groups at post2yr were examined with a mixed effects model.</div></div><div><h3>Findings</h3><div>HFR participants showed a significant decrease in average NSI from pre-op to post1yr (<em>p</em> < 0.001) and post2yr (<em>p</em> = 0.001) for BS. BFT NSI decreased significantly from pre-op to post2yr. The chi-square test indicated a significant shift toward LFR classification at post2yr (<em>p</em> = 0.021). At post2yr, there were no significant NSI differences between LFR, HFR, and controls.</div></div><div><h3>Interpretations</h3><div>TAA improves load symmetry during quiet standing, with high fall risk participants showing the most pronounced changes, indicating the potential to reduce fall risk in post-TAA older adults.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":"131 ","pages":"Article 106719"},"PeriodicalIF":1.4,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Relation of vertical ground reaction forces while walking to contralateral structural worsening in adults with unilateral knee osteoarthritis: the Multicenter Osteoarthritis Study 成人单侧膝骨关节炎患者行走时垂直地面反作用力与对侧结构恶化的关系：多中心骨关节炎研究

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2025-11-21 DOI: 10.1016/j.clinbiomech.2025.106718

Patrick Corrigan , Cara L. Lewis , Kerry E. Costello , Deepak Kumar , David T. Felson , Tuhina Neogi , Kathryn L. Bacon , Michael P. LaValley , Ali Guermazi , Frank Roemer , Michael C. Nevitt , Cora E. Lewis , James C. Torner , Joshua J. Stefanik

Background

It is unclear why knee osteoarthritis (KOA) progresses from a unilateral to bilateral joint disease. This study aimed to evaluate relations between vertical ground reaction forces (VGRFs) while walking and structural worsening in the unaffected limb of adults with unilateral KOA.

Methods

Discrete metrics were extracted from the unaffected limb VGRF signal while walking at a self-selected speed. Structural worsening of the unaffected knee was evaluated over 2 years with radiographs (primary) and MRIs (secondary). Logistic regression models evaluated associations between VGRF metrics and structural worsening outcomes, while adjusting for relevant covariates. Similar relations were evaluated in adults without OA in either knee to determine if VGRF metrics uniquely relate to contralateral structural worsening in adults with unilateral KOA.

Findings

In adults with unilateral KOA (n = 262), VGRFs were not associated with radiographic joint space narrowing within the tibiofemoral compartments of the unaffected knee. Additionally, VGRFs were not associated with MRI-detected cartilage loss in the medial tibiofemoral compartment. However, for the lateral tibiofemoral compartment, higher vertical loading and unloading rates were protective against cartilage loss (Odd ratios (OR) = 0.31–0.47), while larger vertical impulses and valley magnitudes were associated with increased odds of cartilage loss (OR = 2.50 and 2.26, respectively). No relations were found in adults without OA in either knee (n = 985).

Interpretation

VGRF metrics lack the ability to predict medial tibiofemoral structural worsening in knees without OA. However, vertical impulse and valley magnitude can assist with identifying contralateral knees at risk for lateral tibiofemoral cartilage loss in those with unilateral KOA.

目前尚不清楚为什么膝骨关节炎（KOA）从单侧关节疾病发展为双侧关节疾病。本研究旨在评估成人单侧KOA患者行走时的垂直地面反作用力（VGRFs）与未受影响肢体结构恶化之间的关系。方法对未受影响肢体以自选速度行走时的VGRF信号进行离散度量提取。2年内通过x线片（原发性）和mri（继发性）评估未受影响膝关节的结构恶化情况。逻辑回归模型评估了VGRF指标与结构性恶化结果之间的关联，同时调整了相关协变量。在双膝无骨性关节炎的成人中评估了类似的关系，以确定VGRF指标是否与单侧骨性关节炎成人的对侧结构恶化有独特的关系。结果：在单侧KOA成人（n = 262）中，VGRFs与未受影响膝关节胫骨股腔内关节间隙狭窄无关。此外，VGRFs与mri检测到的内侧胫股间室软骨丢失无关。然而，对于外侧胫股间室，较高的垂直加载和卸载率对软骨丢失具有保护作用（奇比(OR) = 0.31-0.47），而较大的垂直脉冲和谷值与软骨丢失的几率增加有关（OR分别= 2.50和2.26）。成人双膝无骨性关节炎无相关性（n = 985）。解释：vgrf指标缺乏预测无OA膝内侧胫股结构恶化的能力。然而，垂直脉冲和谷大小可以帮助识别单侧KOA患者的对侧膝关节有外侧胫股软骨丢失的风险。

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引用次数: 0

Evaluation of calcium phosphate bone cement in augmenting screw hole defects in the ulna: A biomechanical study 磷酸钙骨水泥加固尺骨螺钉孔缺损的生物力学研究。

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2025-11-21 DOI: 10.1016/j.clinbiomech.2025.106717

Wasim Awal , Randy Bindra , Giuseppe Pastore , Lawrence Baartz , Alastair Quinn , David Saxby

Background

Following ulnar shortening osteotomies, plates are often removed due to discomfort or irritation. The screw holes left after plate removal act as stress risers and predispose the bone to fracture. To our knowledge, calcium phosphate cement (CPC) is yet to be investigated for its use in reinforcing screw holes. The aim of this study was to determine if filling screw holes with CPC in a synthetic anatomical ulna model will improve its immediate mechanical strength compared to leaving screw holes unfilled.

Methods

Eighteen synthetic anatomical ulna models were randomly divided into three equal groups. The control group was left unaltered, the drilled group received six 3.5 mm screw holes, and the CPC group had the six 3.5 mm screw holes filled with CPC. All bones were subjected to torsional loading until failure. Peak torque at failure, stiffness, and energy absorption were measured.

Findings

Compared to the drilled group, the CPC group had greater peak torque, stiffness, and energy absorption. Group effects on peak torque and stiffness were moderate (eta squared = 0.12 for both) but did not reach statistical significance (p = 0.37 and 0.38, respectively). A statistically significant group effect was found for energy absorption (p < 0.001); but post-hoc analysis revealed no difference between the drilled and CPC groups.

Interpretation

Effect sizes suggest CPC may improve mechanical performance, albeit modestly. Clinicians may consider using CPC for reinforcing screw holes after plate removal in bones like the ulna when refracture is of concern.

背景：尺侧截骨术后，由于不适或刺激，钢板常被移除。取下钢板后留下的螺钉孔充当应力发生器，使骨头容易骨折。据我们所知，磷酸钙水泥（CPC）在螺钉孔加固中的应用还有待研究。本研究的目的是确定在合成尺骨解剖模型中，与不填充螺钉孔相比，用CPC填充螺钉孔是否会提高其即时机械强度。方法：合成尺骨解剖模型18只，随机分为3组。对照组保持不变，钻孔组置入6个3.5 mm螺钉孔，CPC组置入6个3.5 mm螺钉孔。所有骨骼均承受扭转载荷直至破坏。测量了失效时的峰值扭矩、刚度和能量吸收。结果表明：与钻孔组相比，CPC组具有更高的峰值扭矩、刚度和能量吸收。组对峰值扭矩和刚度的影响中等（两者的eta平方均= 0.12），但未达到统计学意义（p分别= 0.37和0.38）。在能量吸收方面发现了统计学上显著的群体效应(p)解释：效应大小表明CPC可能改善机械性能，尽管幅度不大。当担心再骨折时，临床医生可能会考虑使用CPC在骨（如尺骨）取出钢板后加固螺钉孔。

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引用次数: 0

Dual-energy X-ray absorptiometry based biofidelic finite element models for simulating falls to the hip: Impact of trochanteric soft tissue thickness on fracture risk. 基于双能x线吸收仪的模拟髋关节跌落的生物有限元模型：粗隆软组织厚度对骨折风险的影响。

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2025-11-21 DOI: 10.1016/j.clinbiomech.2025.106720

Dheeraj Jha, Anitha D Praveen, Alexander Baker, Anita Fung, Vee San Cheong, Preeti Gupta, Ecosse L Lamoureux, Namki Hong, Yumie Rhee, Vanessa Jean Wen Koh, Halldór Pálsson, William R Taylor, Angelique Wei-Ming Chan, Stephen J Ferguson, Benedikt Helgason

Background: We predicted the fracture outcomes of simulated falls from standing height using biofidelic finite element models of older adults in Singapore. We further investigated the influence of trochanteric soft tissue thickness, measured from scans and equations estimating standing trochanteric soft tissue thickness from DXA and BMI, on predicted fracture outcomes.

Methods: Biofidelic finite element models were built using DXA scans from 280 older Singaporean adults enrolled in the Targeted Assessment and Recruitment of Geriatrics for Effective Fall Prevention Treatments study. Models were created using different trochanteric soft tissue thickness: measured from 3D optical scans in standing (reference), measured from whole-body DXA, estimated from whole-body DXA, and estimated from BMI. Predicted fracture outcomes from sideways falls were compared across these models.

Findings: The number of predicted hip fractures was higher among Chinese participants compared to Indians (females: 2.4×, males: 2.3×) and Malays (females: 2.5×, males: 1.3×). Trochanteric soft tissue thickness was the dominant factor influencing impact force and force attenuation at the greater trochanter. The whole-body DXA model had a 26 % false prediction rate compared to the reference model, while the models using estimated values from whole-body DXA and BMI had false prediction rates of 1 % and 9 %, respectively.

Interpretation: Biofidelic finite element models built using image data captures population-based differences in hip fracture risk for the three main ethnic groups in Singapore. In the absence of 3D optical scans, predicting soft tissue shapes based on whole-body DXA scans, commonly available in clinical practice, yields similar fracture predictions based on simulated falls.

背景：我们使用新加坡老年人的生物密度有限元模型预测了从站立高度模拟跌倒的骨折结果。我们进一步研究了粗隆软组织厚度的影响，通过扫描测量和从DXA和BMI估计站立粗隆软组织厚度的方程，对预测骨折结果的影响。方法：利用DXA扫描对280名参加有效预防跌倒治疗的针对性评估和招募老年病学研究的新加坡老年人建立生物有限元模型。使用不同的粗隆软组织厚度创建模型：通过站立时的3D光学扫描测量（参考），通过全身DXA测量，通过全身DXA估计，以及通过BMI估计。对这些模型进行了横向跌落导致的骨折预测结果的比较。研究结果：与印度人（女性：2.4倍，男性：2.3倍）和马来人（女性：2.5倍，男性：1.3倍）相比，华人参与者预测髋部骨折的数量更高。粗隆软组织厚度是影响大粗隆冲击力和冲击力衰减的主要因素。与参考模型相比，全身DXA模型的错误预测率为26%，而使用全身DXA和BMI估计值的模型的错误预测率分别为1%和9%。解释：利用图像数据建立的生物统计学有限元模型捕获了新加坡三个主要民族在髋部骨折风险方面基于人群的差异。在没有3D光学扫描的情况下，基于全身DXA扫描预测软组织形状（通常在临床实践中可用），基于模拟跌倒产生类似的骨折预测。

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引用次数: 0

Limitations of standard gait models for the precise and accurate evaluation of prosthetic knee joints regarding their functional quality, reliability, reproducibility and safety 标准步态模型在假肢膝关节功能质量、可靠性、可重复性和安全性方面的局限性

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2025-11-21 DOI: 10.1016/j.clinbiomech.2025.106715

Eva Pröbsting , Michael Ernst , Harald Böhm , Thomas Schmalz , Veit Schopper , Barbara Pobatschnig , Malte Bellmann

Background

Accurate motion analysis of prosthetic knee joints is essential for optimizing component design, improving gait restoration, and evaluating clinical performance. Sagittal knee angles and moments are key biomechanical parameters for assessing joint function. This study determined these parameters using various gait models and validated the results against sensor data from the prosthetic knee, supporting more reliable gait analysis and potential improvements in patient outcomes.

Methods

Nineteen above-knee amputees walked at three self-selected speeds while gait was analyzed using optoelectronic cameras and force plates. Sagittal prosthetic knee moment and angle were calculated with four different models: Plug-in Gait, adapted Clinical Cleveland, 2D-model and a new 3D-model developed for analysis of transfemoral amputees. Simultaneously, prosthetic knee sensor angle and moment data were recorded.

Findings

The mean sagittal knee angle and moment waveforms from all models closely match the sensor data, reflected by low root mean square errors, with the new developed model showing the smallest values. The most precise (most often lowest reproducibility coefficient) sagittal knee angle and moment is shown with the new model. For the sagittal knee angle the highest accuracy (most often lowest mean deviation) is also determined with this model. For the knee moment, the new model, the 2D-model and Plug-in Gait equally frequently show the smallest mean deviation.

Interpretation

Relevant parameters of prosthetic knee joints can be determined using gait analysis, but not all models have the level of accuracy and precision required for evaluating prosthetic knee joints. The new model shows the most reliable data.

膝关节假体的准确运动分析对于优化部件设计、改善步态恢复和评估临床性能至关重要。膝关节矢状角和力矩是评估关节功能的关键生物力学参数。本研究使用各种步态模型确定了这些参数，并根据假膝的传感器数据验证了结果，支持更可靠的步态分析和患者预后的潜在改善。方法19例膝上截肢者以自行选择的3种速度行走，采用光电相机和测力仪对步态进行分析。通过四种不同的模型：插入式步态、适应临床克利夫兰、2d模型和为分析经股截肢者而开发的新3d模型，计算了矢状面假肢膝关节的力矩和角度。同时记录假体膝关节传感器的角度和力矩数据。所有模型的平均矢状膝关节角和矩波形与传感器数据接近，均方误差较低，新模型的值最小。新模型显示了最精确的矢状膝关节角和力矩（通常是最低的再现系数）。对于矢状膝关节角的最高精度（通常是最低的平均偏差）也由该模型确定。对于膝关节力矩，新模型、2d模型和插入式步态同样频繁地显示出最小的平均偏差。通过步态分析可以确定假体膝关节的相关参数，但并非所有模型都具有评估假体膝关节所需的准确度和精度水平。新模型显示了最可靠的数据。

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引用次数: 0

Biomechanical evaluation of anterolateral ligament anatomical variants in anterior cruciate ligament-injured and reconstructed knee joints 前交叉韧带损伤和重建膝关节前外侧韧带解剖变异的生物力学评价。

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2025-11-20 DOI: 10.1016/j.clinbiomech.2025.106709

Jia Qiu , Jiasheng Shao , Shenglin Li , Chenxuan Liu , Yuan Guo , Zeng Li , Jian Song

Background

The anterolateral ligament (ALL) has structural diversity and is often injured concurrently with anterior cruciate ligament (ACL) tears. At present, the effect of ALL structural diversity on combined injury and associated reconstruction remains unclear.

Methods

A finite element model of the knee joint with combined ACL-ALL injuries was established and validated against experimental data from the pig knee joints. Three distinct ALL types (I, II, and III), classified by their femoral insertion site relative to the lateral collateral ligament (LCL), were modeled. Simulations were performed under ACL-intact, ACL-injured, ACL-deficient, and ACL-reconstructed conditions during tibial loading in flexion/extension, internal/external rotation, and varus/valgus to assess kinematics and ligament stresses.

Findings

ALL function was type-dependent. Following ACL deficiency, tibial internal rotation posed the highest risk of ALL injury. During ACL-ALL reconstruction, Type III ALL most effectively enhanced internal rotation stability and reduced peak stress in the hamstring tendon graft.

Interpretation

The ALL is a key stabilizer against internal rotation. ACL failure makes internal rotation a primary mechanism for ALL injury. For reconstruction, placing the ALL femoral insertion postero-proximal to the LCL optimizes biomechanical outcomes by improving stability and load-sharing.

背景：前外侧韧带（ALL）结构多样，常与前交叉韧带（ACL）撕裂同时损伤。目前，ALL结构多样性对合并损伤及相关重建的影响尚不清楚。方法：建立ACL-ALL合并损伤的膝关节有限元模型，并结合猪膝关节的实验数据进行验证。三种不同的ALL类型（I， II和III），根据其相对于外侧副韧带（LCL）的股骨止点进行分类，并进行建模。在屈伸、内旋、外翻和内翻/外翻的胫骨负荷下，分别在acl完整、acl损伤、acl缺陷和acl重建的情况下进行模拟，以评估运动学和韧带应力。结果：所有功能都是类型依赖的。ACL缺陷后，胫骨内旋造成ALL损伤的风险最高。在ACL-ALL重建中，III型ALL最有效地增强了内旋稳定性并降低了腘肌腱移植物的峰值应力。解释：ALL是防止内旋的关键稳定剂。ACL失效使得内旋成为ALL损伤的主要机制。对于重建，将ALL股骨止点置于LCL后近端，通过改善稳定性和负荷分担来优化生物力学结果。

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引用次数: 0

Biomechanical effects of disc cement for lumbar locking interbody cementation: Finite-element mobility analysis and debris-removing reamer design 椎间盘骨水泥对腰椎锁定椎间骨水泥的生物力学效应：有限元可动性分析和碎片去除铰刀设计。

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2025-11-14 DOI: 10.1016/j.clinbiomech.2025.106708

Kung-Chia Li , Che-Wei Liu , Yu-Kun Xu , Chun-Ming Chen , Shang-Chih Lin

Background

Before locking interbody cementation, debris from the reamed disc should be thoroughly cleared to increase the cement volume and decrease its flow resistance to the vertebrae.

Methods

A finite element lumbosacral model was used to assess the biomechanical effects of five different disc cement sizes on disc mobility. A new reamer featuring staggered, barbed, and multilayered cutting edges, along with spiral and conical profiles, was designed and 3D-printed to enhance debris removal. Biomechanical and clinical tests were performed using synthetic and patient discs to compare the debris weights removed by the standard drill bit and the 3D-printed reamer.

Findings

Cement size significantly affected disc mobility beyond the impact of torsional factors alone. Larger cement volumes produced a more stable cage-cement foundation and reduced sagittal and coronal motions by approximately 23.8 % compared to the standard 5 mm-thick cement coverage. The average weight of synthetic disc debris removed was 926.28 ± 49.71 mg with the 3D-printed reamer versus only 63.04 ± 4.86 mg with the standard drill bit (p < 0.01). When the drill bit was withdrawn, debris easily slipped from the spiral cutting edge. In contrast, drill bits failed to retain debris effectively, whereas the reamer’s staggered and barbed features consistently hooked and removed disc material.

Interpretation

Implanting a 5 mm cage requires removing approximately 6 ml of disc material. A larger cement fill provides a more stable cage-cement interface. The 3D-printed reamer’s staggered barbs removed debris more efficiently than traditional drill bits.

背景：在锁定椎体间骨水泥之前，应彻底清除扩孔椎间盘的碎片，以增加骨水泥体积并减少其对椎骨的流动阻力。方法：采用有限单元腰骶模型评估五种不同椎间盘水泥尺寸对椎间盘活动度的生物力学影响。新型扩眼器具有交错、倒刺和多层刃口，以及螺旋和锥形轮廓，设计和3d打印以增强碎片清除。使用合成椎间盘和患者椎间盘进行生物力学和临床试验，比较标准钻头和3d打印铰刀去除的碎屑重量。结果：骨水泥尺寸显著影响椎间盘活动度，而不仅仅是扭转因素的影响。与标准的5毫米厚水泥覆盖相比，更大的水泥体积产生了更稳定的笼状水泥基础，减少了约23.8%的矢状和冠状运动。3d打印扩眼器去除合成椎间盘碎屑的平均重量为926.28±49.71 mg，而标准钻头仅为63.04±4.86 mg （p < 0.01）。当取出钻头时，碎屑很容易从螺旋切削刃上滑落。相比之下，钻头未能有效地保留碎屑，而扩眼器的交错和倒刺特征始终钩住并清除了圆盘材料。解释：植入一个5mm的保持器需要移除约6ml的椎间盘材料。较大的水泥充填体可提供更稳定的笼-水泥界面。3d打印铰刀的交错倒钩比传统钻头更有效地去除碎屑。

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引用次数: 0