Clinical Biomechanics最新文献_第5页

The effect of carbon fiber custom dynamic orthosis use and design on center of pressure progression and perceived smoothness in individuals with lower limb trauma 碳纤维定制动态矫形器的使用和设计对下肢创伤患者压力中心进展和感觉顺畅度的影响

IF 1.8 3区医学 Q2 Medicine

Clinical Biomechanics

Pub Date : 2024-06-04 DOI: 10.1016/j.clinbiomech.2024.106284

Sapna Sharma , Kirsten M. Anderson , Molly S. Pacha , Kierra J. Falbo , Clare Severe , Andrew H. Hansen , Brad D. Hendershot , Jason M. Wilken , CARBon Fiber Orthosis Research Network (CARBON)

Background

Carbon-fiber custom dynamic orthoses are used to improve gait and limb function following lower limb trauma in specialty centers. However, the effects of commercially available orthoses on center of pressure progression and patient perception of orthosis smoothness during walking are poorly understood.

Methods

In total, 16 participants with a unilateral lower extremity traumatic injury underwent gait analysis when walking without an orthosis, and while wearing monolithic and modular devices, in a randomized order. Device alignment, stiffness, participant rating of perceived device smoothness, center of pressure velocity, and ankle zero moment crossing were assessed.

Findings

The modular device was approximately twice as stiff as the monolithic device. Alignment, smoothness ratings, peak magnitude of center of pressure velocity, and zero moment crossing were not different between study devices. The time to peak center of pressure velocity occurred significantly later for the modular device compared to the monolithic and no orthosis conditions, with large effect sizes observed.

Interpretation

Commercially available orthoses commonly used to treat limb trauma affect the timing of center of pressure progression relative to walking without an orthosis. Despite multiple design differences, monolithic and modular orthoses included in this study did not differ with respect to other measures of center of pressure progression. Perceived smoothness ratings were approximately 40% greater with the study orthoses as compared to previous studies in specialty centers, which may be due to a more gradual center of pressure progression, as indicted by lower peak magnitude of center of pressure velocity with both study orthoses.

背景专科中心使用碳纤维定制动态矫形器来改善下肢创伤后的步态和肢体功能。方法共有 16 名单侧下肢外伤患者在未佩戴矫形器、佩戴整体式和模块式矫形器的情况下进行了步态分析。对矫形器的排列、硬度、参与者对矫形器平滑度的评价、压力中心速度和踝关节零力矩交叉进行了评估。对齐度、平滑度评分、压力中心速度峰值幅度和零力矩交叉点在研究设备之间没有差异。模块化装置达到压力中心速度峰值的时间明显晚于整体式装置和无矫形器条件下的时间，且观察到较大的效应大小。尽管在设计上存在多种差异，但本研究中的整体式矫形器和模块式矫形器在压力中心进展的其他测量方面并无不同。与之前在专科中心进行的研究相比，使用本研究中的矫形器所获得的平滑感评分要高出约 40%，这可能是由于压力中心的发展更为渐进，而这两种矫形器的压力中心速度峰值较低也说明了这一点。

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引用次数: 0

Elevated proinflammatory cytokines in response to mechanical stimulus are associated with reduced knee loading 2 years after anterior cruciate ligament reconstruction 前交叉韧带重建 2 年后，对机械刺激做出反应的促炎细胞因子升高与膝关节负荷减轻有关

IF 1.8 3区医学 Q2 Medicine

Clinical Biomechanics

Pub Date : 2024-06-01 DOI: 10.1016/j.clinbiomech.2024.106286

Arielle G. Fischer , Matthew R. Titchenal , Eleonora Migliore , Jessica L. Asay , Jennifer C. Erhart-Hledik , Thomas P. Andriacchi

Background

The aim of this study was to test the hypothesis that proinflammatory cytokines correlate with knee loading mechanics during gait following a mechanical walking stimulus in subjects 2 years after anterior cruciate ligament reconstruction. Elevated systemic levels of proinflammatory cytokines can be sustained for years after injury. Considering roughly 50% of these patients progress to Osteoarthritis 10–15 years after injury, a better understanding of the role of proinflammatory cytokines such as tumor necrosis factor-α and Interleukin-1β on Osteoarthritis risk is needed.

Methods

Serum proinflammatory cytokines concentrations were measured in 21 subjects 2 years after unilateral ACLR from blood drawn at rest and 3.5 h after 30 min of walking. An optoelectronic system and a force plate measured subjects' knee kinetics. Correlations were tested between inflammatory marker response and knee extension and knee adduction moments.

Findings

Changes in proinflammatory cytokines due to mechanical stimulus were correlated (R = 0.86) and showed substantial variation between subjects in both cytokines at 3.5 h post-walk. Knee loading correlated with 3.5-h changes in tumor necrosis factor-α concentration (Knee extension moment: R = -0.5, Knee adduction moment: R = -0.5) and Interleukin-1β concentration (Knee extension moment: R = -0.44). However, no significant changes in concentrations were observed in tumor necrosis factor-α and Interleukin-1β when comparing baseline and post walking stimulus conditions.

Interpretation

The significant associations between changes in serum proinflammatory markers following a mechanical stimulus and gait metrics in subjects at risk for developing Osteoarthritis underscore the importance of investigating the interaction between biomarkers and biomechanical factors in Osteoarthritis development.

背景本研究的目的是检验前交叉韧带重建 2 年后的受试者在机械行走刺激下步态期间促炎细胞因子与膝关节负荷力学相关性的假设。促炎细胞因子的全身水平升高可在受伤后持续数年。考虑到这些患者中约有 50% 在受伤 10-15 年后发展为骨关节炎，因此需要更好地了解肿瘤坏死因子-α 和白细胞介素-1β 等促炎细胞因子对骨关节炎风险的作用。方法：对 21 名受试者进行血清促炎细胞因子浓度测量，这些受试者在单侧前交叉韧带重建 2 年后，分别在休息时和行走 30 分钟后 3.5 小时抽血。光电系统和测力板测量了受试者的膝关节运动能力。研究结果机械刺激引起的促炎细胞因子的变化具有相关性（R = 0.86），并且在步行后 3.5 小时两种细胞因子的变化在受试者之间存在很大差异。膝关节负荷与 3.5 小时后肿瘤坏死因子-α 浓度（膝关节伸展力矩：R = -0.5，膝关节内收力矩：R = -0.5）和白细胞介素-1β 浓度（膝关节伸展力矩：R = -0.44）的变化相关。在机械刺激后血清促炎标志物的变化与骨关节炎高危人群的步态指标之间的显著关联强调了研究骨关节炎发展过程中生物标志物与生物力学因素之间相互作用的重要性。

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引用次数: 0

Structural modification and biomechanical analysis of lumbar disc prosthesis: A finite element study 腰椎间盘假体的结构改造和生物力学分析：有限元研究

IF 1.8 3区医学 Q2 Medicine

Clinical Biomechanics

Pub Date : 2024-06-01 DOI: 10.1016/j.clinbiomech.2024.106266

Haibo Ke , Yuan Guo , Xushu Zhang , Long Yin , Wenbin Nie , Yibo Zhao , Bin Zhao , Kai Zhang , Yunpeng Wen , Binping Ji , Ming Zhang

Background

Most ball-in-socket artificial lumbar disc implanted in the spine result in increased hypermobility of the operative level and overloading of the facet joint.

Methods

A finite element model was established and validated for the lumbar spine (L1-L5). The structure of the Mobidisc prosthesis was modified, resulting in the development of two new intervertebral disc prostheses, Movcore and Mcopro. The prostheses were implanted into the L3/L4 level to simulate total disc replacement, and the biomechanical properties of the lumbar spine model were analyzed after the operation.

Findings

Following the implantation of the prostheses, the mobility of operative level, peak stress of lumbar spine models, and peak stress of facet joint increased. The performance of mobility was found to be more similar between Movcore and Mobidisc. The mobility and facet joint peak stress of the Mcopro model decreased progressively with an increase in the Young's modulus of the artificial annulus during flexion, extension, and lateral bending. Among all the models, the Mcopro50 model had the mobility closest to the intact model. It showed a 3% decrease in flexion, equal range of motion in extension, a 9% increase in left lateral bending, a 7% increase in right lateral bending, and a 3% decrease in axial rotation.

Interpretation

The feasibility of the new intervertebral disc prostheses, Movcore and Mcopro, has been established. The Mcopro prosthesis, which features an artificial annular structure, offers significant advantages in terms of reduced mobility of the operative level and peak stress of facet joint.

背景：大多数植入脊柱的球窝人工腰椎间盘都会导致手术水平的过度活动和关节面的超负荷：方法：建立并验证了腰椎（L1-L5）的有限元模型。方法：为腰椎（L1-L5）建立了一个有限元模型并进行了验证。对 Mobidisc 假体的结构进行了修改，从而开发出两种新型椎间盘假体：Movcore 和 Mcopro。将假体植入 L3/L4 水平以模拟椎间盘全置换，并分析了术后腰椎模型的生物力学特性：结果：植入假体后，手术水平的活动度、腰椎模型的峰值应力以及面关节的峰值应力均有所增加。Movcore和Mobidisc的活动度表现更为相似。在屈曲、伸展和侧弯过程中，随着人工环的杨氏模量的增加，Mcopro 模型的活动度和关节面峰值应力逐渐减小。在所有模型中，Mcopro50 模型的活动度最接近完整模型。它的屈曲活动度减少了3%，伸展活动度相同，左侧弯曲增加了9%，右侧弯曲增加了7%，轴向旋转减少了3%：新型椎间盘假体 Movcore 和 Mcopro 的可行性已经得到证实。Mcopro假体具有人工环状结构，在降低手术水平的活动度和面关节的峰值应力方面具有显著优势。

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引用次数: 0

Does spinopelvic alignment affect femoral head cartilage and the proximal femoral physis in slipped capital femoral epiphysis? A finite element analysis 旋转骨盆对位会影响股骨头软骨和股骨近端骨骺吗？有限元分析

IF 1.8 3区医学 Q2 Medicine

Clinical Biomechanics

Pub Date : 2024-06-01 DOI: 10.1016/j.clinbiomech.2024.106269

Yogesh Kumaran , Muzammil Mumtaz , Carmen Quatman , Julie Balch-Samora , Sophia Soehnlen , Brett Hoffman , Sudharshan Tripathi , Norihiro Nishida , Vijay K. Goel

Background

Slipped capital femoral epiphysis is a prevalent pediatric hip disorder. Recent studies suggest the spine's sagittal profile may influence the proximal femoral growth plate's slippage, an aspect not extensively explored. This study utilizes finite element analysis to investigate how various spinopelvic alignments affect shear stress and growth plate slip.

Methods

A finite element model was developed from CT scans of a healthy adult male lumbar spine, pelvis, and femurs. The model was subjected to various sagittal alignments through reorientation. Simulations of two-leg stance, one-leg stance, walking heel strike, ascending stairs heel strike, and descending stairs heel strike were conducted. Parameters measured included hip joint contact area, stress, and maximum growth plate Tresca (shear) stress.

Findings

Posterior pelvic tilt cases indicated larger shear stresses compared to the anterior pelvic tilt variants except in two leg stance. Two leg stance resulted in decreases in the posterior tilted pelvi variants hip contact and growth plate Tresca stress compared to anterior tilted pelvi, however a combination of posterior pelvic tilt and high pelvic incidence indicated larger shear stresses on the growth plate. One leg stance and heal strike resulted in higher shear stress on the growth plate in posterior pelvic tilt variants compared to anterior pelvic tilt, with a combination of posterior pelvic tilt and high pelvic incidence resulting in the largest shear.

Interpretation

Our findings suggest that posterior pelvic tilt and high pelvic incidence may lead to increased shear stress at the growth plate. Activities performed in patients with these alignments may predispose to biomechanical loading that shears the growth plate, potentially leading to slip.

背景股骨头骺滑脱是一种常见的小儿髋关节疾病。最近的研究表明，脊柱的矢状剖面可能会影响股骨近端生长板的滑动，但这一问题尚未得到广泛探讨。本研究利用有限元分析来研究各种脊柱骨盆排列如何影响剪切应力和生长板滑移。方法根据健康成年男性腰椎、骨盆和股骨的 CT 扫描结果建立有限元模型。该模型通过调整方向进行了各种矢状排列。模拟了两腿站立、单腿站立、行走时脚跟着地、上楼梯时脚跟着地和下楼梯时脚跟着地。测量参数包括髋关节接触面积、应力和最大生长板 Tresca（剪切）应力。研究结果与骨盆前倾的变体相比，骨盆后倾的情况下剪切应力更大，但双腿站立的情况除外。与骨盆前倾相比，双腿站立导致骨盆后倾变体髋关节接触和生长板 Tresca 应力下降，但骨盆后倾和骨盆高入射角组合表明生长板上的剪切应力更大。我们的研究结果表明，骨盆后倾和骨盆高入射率可能会导致生长板上的剪切应力增加。具有这些排列方式的患者所进行的活动可能会导致生物力学负荷，对生长板造成剪切，从而可能导致滑脱。

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引用次数: 0

Biomechanical role of bone grafting for calcaneal fracture fixation in the presence of bone defect: A finite element analysis 骨缺损情况下骨移植在小腿骨骨折固定中的生物力学作用：有限元分析

IF 1.8 3区医学 Q2 Medicine

Clinical Biomechanics

Pub Date : 2024-06-01 DOI: 10.1016/j.clinbiomech.2024.106278

Zhihao Su , Ming Ding , Ning Zhu , James Chung-Wai Cheung , Duo Wai-Chi Wong , Wanju Sun , Ming Ni

Background

The purpose of this study was to compare the biomechanical stress and stability of calcaneal fixations with and without bone defect, before and after bone grafting, through a computational approach.

Methods

A finite element model of foot-ankle complex was reconstructed, impoverished with a Sanders III calcaneal fracture without bone defect and with moderate and severe bone defects. Plate fixations with and without bone grafting were introduced with walking stance simulated. The stress and fragment displacement of the calcaneus were evaluated.

Findings

Moderate and severe defect increased the calcaneus stress by 16.11% and 32.51%, respectively and subsequently decreased by 10.76% and 20.78% after bone grafting. The total displacement was increased by 3.99% and 24.26%, respectively by moderate and severe defect, while that of posterior joint facet displacement was 86.66% and 104.44%. The former was decreased by 25.73% and 35.96% after grafting, while that of the latter was reduced by 88.09% and 84.78% for moderate and severe defect, respectively.

Interpretation

Our finite element prediction supported that bone grafting for fixation could enhance the stability and reduce the risk of secondary stress fracture in cases of bone defect in calcaneal fracture.

背景本研究的目的是通过计算方法，比较有骨缺损和无骨缺损、植骨前后小腿骨固定的生物力学应力和稳定性。方法重建了一个足踝复合体的有限元模型，该模型为无骨缺损的桑德斯 III 型小腿骨骨折，以及中度和重度骨缺损。在模拟行走姿态的情况下，采用了带植骨和不带植骨的钢板固定。结果中度和重度骨缺损使小腿骨应力分别增加了 16.11% 和 32.51%，植骨后分别减少了 10.76% 和 20.78%。中度和重度缺损使总移位分别增加了3.99%和24.26%，而后关节面移位则分别增加了86.66%和104.44%。我们的有限元预测结果表明，植骨固定可增强稳定性，降低小关节骨折骨质缺损患者继发应力性骨折的风险。

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引用次数: 0

Biomechanical improvements in gait following medial pivot knee implant surgery 内侧枢轴膝关节植入手术后步态的生物力学改善

IF 1.8 3区医学 Q2 Medicine

Clinical Biomechanics

Pub Date : 2024-06-01 DOI: 10.1016/j.clinbiomech.2024.106267

D. Dabirrahmani , S. Farshidfar , J. Cadman , H. Shahidian , L. Kark , J. Sullivan , R. Appleyard

Background

Total knee replacements are used to improve function and reduce pain in patients with advanced osteoarthritis. The medially stabilising implant is designed to mimic a healthy knee. This study aims to provide a comprehensive analysis of the kinematics and kinetics of a medially stabilising knee implant, comparing it to a healthy control group, as well as to its pre-operative state and the contralateral limb.

Methods

Sixteen total knee replacement patients and ten healthy participants were recruited. Patients underwent testing 4–6 weeks before surgery and repeated the same tests 12 months after surgery. Healthy participants completed the same tests at a single time point. All participants completed three walking trials: kinematics was captured with eight cameras; kinetics with in-ground force plates. Subject-specific musculoskeletal models were developed in OpenSim. Inverse kinematics and inverse dynamics were used to determine gait parameters. Joint angles and joint moments were evaluated using Statistical Parametric Mapping. Patient-reported outcome measures were also collected at both time points.

Findings

Spatiotemporal results indicate significant differences in velocity and step length between pre-operative patients and control participants. Differences are observed in the adduction angles between the contralateral and ipsilateral limbs pre-operatively. Postoperatively, there was an increase in the 1st peak flexion moment, reduced adduction moment and reduced internal rotation moment. In PROMs, patients all report improvements in pain levels and high satisfaction levels following surgery.

Interpretations

Following medial stabilising total knee arthroplasty, patients displayed improved clinical parameters and joint moments reflecting a shift towards more normal, healthy gait.

背景全膝关节置换术用于改善晚期骨关节炎患者的功能和减轻疼痛。内侧稳定型假体的设计旨在模拟健康膝关节。本研究旨在对内侧稳定膝关节假体的运动学和动力学进行全面分析，并将其与健康对照组、术前状态和对侧肢体进行比较。患者在手术前 4-6 周接受测试，手术 12 个月后重复同样的测试。健康参与者在一个时间点完成同样的测试。所有参与者都完成了三次行走试验：运动学试验由八台摄像机拍摄；动力学试验由地面测力板拍摄。在 OpenSim 中开发了特定受试者的肌肉骨骼模型。反运动学和反动力学用于确定步态参数。关节角度和关节力矩采用统计参数映射法进行评估。研究结果时空结果表明，术前患者和对照组参与者在速度和步长方面存在显著差异。术前，对侧肢体和同侧肢体的内收角存在差异。术后，第一屈曲力矩峰值增大，内收力矩减小，内旋力矩减小。在PROMs中，患者均表示术后疼痛程度有所改善，满意度较高。释义内侧稳定型全膝关节置换术后，患者的临床参数和关节力矩均有所改善，反映出患者的步态更加正常、健康。

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引用次数: 0

Corrigendum to “Promising results of a non-invasive measurement of knee implant loosening using a loading device, CT-scans and 3D image analysis” [Clinical Biomechanics volume 104, 105930, April 2023, 105930] 利用加载装置、CT 扫描和三维图像分析对膝关节植入物松动进行无创测量的有希望的结果"[《临床生物力学》第 104 卷，105930，2023 年 4 月，105930]的更正。

IF 1.8 3区医学 Q2 Medicine

Clinical Biomechanics

Pub Date : 2024-06-01 DOI: 10.1016/j.clinbiomech.2024.106283

Arthur J. Kievit , George S. Buijs , Johannes G.G. Dobbe , Maaike A. Ter Wee , Gino M.M.J. Kerkhoffs , Geert J. Streekstra , Matthias U. Schafroth , Leendert Blankevoort

引用次数: 0

Human-in-the-loop optimization of rocker shoe to reduce plantar pressure and collision work simultaneously 人在回路中优化摇摆鞋，同时减少足底压力和碰撞功

IF 1.8 3区医学 Q2 Medicine

Clinical Biomechanics

Pub Date : 2024-06-01 DOI: 10.1016/j.clinbiomech.2024.106282

R.R. Kurnianto , J.M. Hijmans , C. Greve , H. Houdijk

Background

Rocker shoes can be used to reduce foot pressure and adjust lower limb kinetics for various patient population, such as people with diabetic peripheral neuropathy. Selecting adequate properties of the rocker sole is of great importance for its efficacy. This study investigated the capability of human-in-the-loop optimization (HILO) to individually optimize apex position and angle of rocker shoe to reduce peak pressure and collision work simultaneously.

Methods

Peak pressure, kinetic, and kinematic data were recorded from 10 healthy participants while walking at preferred speed wearing rocker shoes with adjustable apex position and angle. An evolutionary algorithm was used to find optimal apex parameters to reduce both peak pressure in medial forefoot and collision work. The optimized shoe (HILO shoe) was compared with generic optimal rocker settings (Chapman settings) and normal shoe.

Findings

Compared to normal shoe, the HILO shoe had lower plantar pressure (p_HILO = 0.007; p_Chapman = 0.044) and Chapman shoe showed higher collision work (p_HILO = 0.025; p_Chapman = 0.014). Both HILO and Chapman shoe had smaller push-off work than normal shoe (p_HILO = 0.001; p_Chapman < 0.001) with the Chapman shoe exhibited earlier push-off onset (p_HILO = 0.257; p_Chapman = 0.016).

Interpretation

The Human-in-the-loop optimization approach resulted in individualized apex settings which performed on average similar to Chapman settings but, were superior in selected cases. In these cases, medial forefoot could be further offloaded with apex angles larger than generic settings. The larger apex angle might increase the external ankle moment arm and push-off work. However, there is limited room for improvement on collision work compared to generic settings.

背景摇摆鞋可用于减轻足部压力和调整下肢动力学，适用于不同的患者人群，如糖尿病周围神经病变患者。选择合适的摇摆鞋底性能对其功效至关重要。本研究调查了人环优化（HILO）的能力，以单独优化摇摆鞋的顶点位置和角度，从而同时降低峰值压力和碰撞功。方法记录了 10 名健康参与者穿着顶点位置和角度可调的摇摆鞋以首选速度行走时的峰值压力、动力学和运动学数据。使用进化算法找到最佳的顶点参数，以降低前脚掌内侧的峰值压力和碰撞功。研究结果与普通鞋相比，HILO鞋的足底压力较低（pHILO = 0.007；pChapman = 0.044），而Chapman鞋的碰撞功较高（pHILO = 0.025；pChapman = 0.014）。HILO 和 Chapman 鞋的推脱功均小于普通鞋（pHILO = 0.001；pChapman = 0.001），而 Chapman 鞋的推脱开始时间更早（pHILO = 0.257；pChapman = 0.016）。在这些情况下，如果顶角比一般设置大，前脚掌内侧可以进一步卸载。较大的顶角可能会增加外踝力矩臂和推脱功。不过，与一般设置相比，碰撞功的改进空间有限。

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引用次数: 0

Plantar pressure reduction in the heel region through self-adjusting insoles with a heel cup in standard and individualized rocker shoes 在标准和个性化摇摆鞋中使用带后跟杯的自动调节鞋垫，减轻后跟部位的足底压力

IF 1.8 3区医学 Q2 Medicine

Clinical Biomechanics

Pub Date : 2024-06-01 DOI: 10.1016/j.clinbiomech.2024.106281

Athra Malki , Mahdieh Hajibozorgi , Gijsbertus J. Verkerke , Rienk Dekker , Juha M. Hijmans

Background

Effectiveness of therapeutic footwear in reducing peak pressure in persons with diabetes and loss of protective sensation to prevent diabetic foot ulcers varies due to manual production and possible changing foot structure. A previous two-way approach to address this issue, featuring individualized 3D-printed rocker midsoles and self-adjusting insoles, proved effective in the forefoot but less in the heel. To address this, new insoles incorporating a heel cup are developed.

Methods

In-shoe pressure was measured, while persons with diabetes and loss of protective sensation with high peak pressure (≥ 200 kPa) in the heel walked on a treadmill with control and individualized rocker shoe paired with control and new insole.

Findings

Generalized estimating equations revealed significant decrease in peak pressure in the proximal heel with the new insole alone and combined with rocker shoe compared to rocker shoe alone. For the distal heel, significant decrease in peak pressure is shown with the combination of new insole and rocker shoe compared to control shoe. For the forefoot and toes (excluding hallux) significant decrease in peak pressure is shown using the rocker shoe alone or combined with the heel cup compared to control shoe.

Interpretation

The new insole paired with rocker shoe is effective in reducing peak pressure in the distal heel. To have similar (or more) success in proximal heel, one could replace the rocker midsole with more compliant materials. The rocker shoe used separately or combined with a heel cup effectively reduces the peak pressure in the forefoot and other toes.

背景治疗鞋在降低糖尿病患者的峰值压力和保护性感觉丧失以预防糖尿病足溃疡方面的效果因手工制作和可能发生的足部结构变化而各不相同。以前解决这一问题的双向方法，即个性化 3D 打印摇杆中底和自动调节鞋垫，被证明对前足有效，但对后跟效果较差。方法测量鞋内压力，糖尿病患者和保护性感觉缺失且足跟压力峰值较高（≥ 200 kPa）的患者在跑步机上行走时，分别穿上对照组和个性化摇摆鞋，再搭配对照组和新鞋垫。结果广义估算方程显示，与单独穿摇摆鞋相比，单独使用新鞋垫和与摇摆鞋组合使用新鞋垫可显著降低足跟近端压力峰值。就远端脚跟而言，与对照鞋相比，新鞋垫和摇摆鞋组合的压力峰值明显下降。就前脚掌和脚趾（不包括脚后跟）而言，与对照鞋相比，单独使用摇摆鞋或与跟杯结合使用摇摆鞋可显著降低压力峰值。要想在脚跟近端取得类似（或更多）的效果，可以用顺应性更强的材料代替摇摆中底。单独使用或与跟杯结合使用的摇摆鞋可有效降低前脚掌和其他脚趾的压力峰值。

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引用次数: 0

Biomechanical investigation of a customized interspinous spacer system in the treatment of degenerative disc diseases: A finite element analysis 治疗椎间盘退行性疾病的定制棘间垫系统的生物力学研究：有限元分析

IF 1.8 3区医学 Q2 Medicine

Clinical Biomechanics

Pub Date : 2024-05-18 DOI: 10.1016/j.clinbiomech.2024.106270

Gaiping Zhao , Zhehua Jiang , Eryun Chen , Tong Ma , Jie Wu , Chengli Song , Weiqi Li

Background

A novel interspinous fixation system based on anatomical parameters and incorporating transfacetopedicular screws, was developed to treat degenerative disc diseases. The biomechanical characteristics of the novel system were evaluated using finite element analysis in comparison to other classical interspinous spacers.

Methods

The L1-S1 lumbar spine finite element models were surgically implanted with the novel system, Coflex and DIAM devices at the L4/L5 segment to assess the range of motion, the pression distribution of intervertebral disc, the peak stresses on the spinous process and implant during various motions.

Findings

Range of motions of the L4/L5 surgical segment were reduced by 29.13%, 61.27%, 77.35%, 33.33%, and the peak stresses of intervertebral disc were decreased by 36.82%, 67.31%, 73.00%, 69.57% for the novel system in flexion, extension, lateral bending, and axial rotation when compared with the Coflex, and they were declined by 34.53%, 57.86%, 75.81%, 25.21%; 36.22%, 67.31%, 75.01%, 71.40% compared with DIAM. The maximum stresses of the spinous process were 29.93 MPa, 24.66 MPa, 14.45 MPa, 24.37 MPa in the novel system, and those of Coflex and DIAM were 165.3 MPa, 109 MPa, 84.79 MPa, 47.66 MPa and 52.59 MPa, 48.78 MPa, 50.27 MPa, 44.16 MPa during the same condition.

Interpretation

Compared to other interspinous spacer devices, the novel interspinous fixation system demonstrated excellent stability, effectively distributing load on the intervertebral disc, and reducing the risk of spinous process fractures. The personalized design of the novel interspinous fixation system could be a viable option for treating degenerative disc diseases.

背景为治疗椎间盘退行性疾病，开发了一种基于解剖学参数并结合经椎间隙螺钉的新型椎间隙固定系统。方法在 L1-S1 腰椎有限元模型的 L4/L5 节段手术植入新型系统、Coflex 和 DIAM 装置，以评估各种运动时的运动范围、椎间盘的压力分布、棘突和植入物的峰值应力。结果 L4/L5 手术节段的运动范围分别减少了 29.13%、61.27%、77.35% 和 33.33%，椎间盘的峰值应力分别减少了 36.82%、67.31%、73.00% 和 69.57%。与Coflex相比，新型系统在屈曲、伸展、侧弯和轴向旋转时的峰值应力分别降低了36.82%、67.31%、73.00%、69.57%，与DIAM相比，分别降低了34.53%、57.86%、75.81%、25.21%、36.22%、67.31%、75.01%、71.40%。在相同条件下，新型系统的棘突最大应力分别为 29.93 MPa、24.66 MPa、14.45 MPa、24.37 MPa，Coflex 和 DIAM 的最大应力分别为 165.3 MPa、109 MPa、84.79 MPa、47.66 MPa 和 52.59 MPa、48.78 MPa、50.27 MPa、44.16 MPa。释义与其他椎间隙装置相比，新型椎间隙固定系统具有良好的稳定性，能有效分散椎间盘的负荷，降低棘突骨折的风险。个性化设计的新型椎间孔固定系统可作为治疗椎间盘退行性疾病的可行方案。

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