Clinical Biomechanics最新文献_第7页

In silico clinical trial to predict the efficacy of alendronate for preventing hip fractures. 预测阿仑膦酸钠预防髋部骨折疗效的计算机临床试验。

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2025-10-29 DOI: 10.1016/j.clinbiomech.2025.106689

Sara Oliviero, Giacomo Savelli, Marco Viceconti, Antonino A La Mattina

Background: Hip fractures associated with osteoporosis are a major healthcare concern. Existing drugs have limited efficacy in reducing hip fractures. However, clinical trials require large cohorts and lengthy follow-up. Computational models could potentially improve the development of more effective treatments. The aim of this study was to validate an In Silico Trial (BoneStrength) by reproducing a published clinical trial on the efficacy of alendronate. The predicted number of fractures was compared to the clinical data.

Methods: A statistical atlas was used to generate a virtual cohort (N = 1050), with baseline characteristics replicating the reference trial. Treatment with alendronate was simulated by increasing bone mineral density over time. Fracture incidence was predicted using a Markov Chain process. The impact force associated with each fall was estimated with a multiscale stochastic model. Finite Element models were used to predict femur strength. A patient was considered fractured when the impact force exceeded femur strength.

Findings: In the placebo group, virtual patients (N = 1050) experienced 15 ± 4 hip fractures in four years, whereas in the reference trial 24 occurred for 2218 patients (11 for 1050 patients). In the alendronate arm, fractures were reduced to 10 ± 3 in the virtual cohort, while 19 were observed in 2214 patients (9 for 1050 patients).

Interpretation: The distribution of hip fracture incidence predicted by the model included the clinical data for both groups. This In Silico trial can be applied in the future to improve clinical trial design and drug development, enabling a virtual pathway to the efficacy assessment of bone drugs.

背景：与骨质疏松症相关的髋部骨折是一个主要的医疗保健问题。现有药物对减少髋部骨折的疗效有限。然而，临床试验需要大的队列和长时间的随访。计算模型有可能促进更有效治疗方法的发展。本研究的目的是通过复制已发表的关于阿仑膦酸钠疗效的临床试验来验证一项计算机试验（bonstrength）。将预测骨折数与临床数据进行比较。方法：使用统计图谱生成虚拟队列（N = 1050），其基线特征与参考试验相同。阿仑膦酸钠治疗是通过增加骨密度来模拟的。采用马尔可夫链过程预测骨折发生率。用多尺度随机模型估计每次坠落的撞击力。采用有限元模型预测股骨强度。当冲击力超过股骨强度时，患者被认为骨折。研究结果：在安慰剂组中，虚拟患者（N = 1050）在4年内经历了15±4次髋部骨折，而在参考试验中，2218例患者发生24次髋部骨折（1050例患者发生11次髋部骨折）。在虚拟队列中，阿仑膦酸臂骨折减少到10±3，而在2214例患者中观察到19例（1050例患者中观察到9例）。解释：模型预测的髋部骨折发生率分布包括两组的临床资料。这项In Silico试验可以在未来应用于改善临床试验设计和药物开发，为骨药物的疗效评估提供虚拟途径。

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引用次数: 0

Biomechanical models of lumbar spine degeneration: Methods, challenges, and clinical promise 腰椎退变的生物力学模型：方法、挑战和临床前景。

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2025-10-28 DOI: 10.1016/j.clinbiomech.2025.106675

Hamed Hani , Gregory G. Knapik , Eric C. Bourekas , William S. Marras

Background:

Lumbar disc degeneration is a leading cause of disability worldwide and a major contributor to low back pain. Biomechanical models have emerged as powerful tools to investigate the structural and mechanical changes associated with disc degeneration, offering insights that are difficult to obtain in vivo.

Methods:

This narrative review examines the progression of biomechanical modeling efforts in lumbar disc degeneration over the past decade. We reviewed studies from 2013 to 2024, focusing on both finite element and musculoskeletal modeling approaches. Key developments in model personalization, tissue degeneration simulation, and validation techniques were analyzed to assess their contribution to understanding spinal mechanics in degenerative states.

Findings:

Recent advancements have enabled more accurate representations of intervertebral disc pathology, incorporating subject-specific imaging, detailed tissue behavior, and complex loading scenarios. While finite element models have improved in capturing disc-level mechanical changes, musculoskeletal models have advanced in simulating whole-body dynamics and compensatory mechanisms. However, gaps remain in integrating these approaches and validating models against in vivo measurements. Few studies have directly linked modeling outcomes with clinical decision-making or patient-specific interventions.

Interpretation:

Biomechanical models have significantly improved our understanding of lumbar disc degeneration and its mechanical consequences. Future efforts should prioritize multimodal validation, integration of imaging and motion capture data, and development of clinically actionable models. Advancing these tools may enable more personalized and predictive approaches to spine care and support novel therapeutic strategies.

背景：腰椎间盘退变是世界范围内致残的主要原因，也是腰痛的主要原因。生物力学模型已成为研究与椎间盘退变相关的结构和力学变化的有力工具，提供了难以在体内获得的见解。方法：本文回顾了过去十年来腰椎间盘退变生物力学建模的进展。我们回顾了2013年至2024年的研究，重点关注有限元和肌肉骨骼建模方法。分析了模型个性化、组织变性模拟和验证技术的关键进展，以评估它们对理解退行性状态下脊柱力学的贡献。研究结果：最近的进展使椎间盘病理更准确的表征成为可能，包括特定对象的成像、详细的组织行为和复杂的加载场景。虽然有限元模型在捕获椎间盘水平的力学变化方面有所改进，但肌肉骨骼模型在模拟全身动力学和代偿机制方面取得了进展。然而，在整合这些方法和根据体内测量验证模型方面仍然存在差距。很少有研究将建模结果与临床决策或患者特异性干预直接联系起来。解释：生物力学模型显著提高了我们对腰椎间盘退变及其力学后果的理解。未来的工作应优先考虑多模式验证，成像和运动捕捉数据的整合，以及临床可操作模型的开发。推进这些工具可以使脊柱护理更加个性化和预测性的方法，并支持新的治疗策略。

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引用次数: 0

Differences in gait kinematics and kinetics between patients 1 year after total hip or knee arthroplasty and healthy controls 全髋关节或膝关节置换术后1年患者与健康对照者步态运动学和动力学的差异

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2025-10-28 DOI: 10.1016/j.clinbiomech.2025.106691

Franziska Schmitter , Corina Nüesch , David Koch , Karl Stoffel , Petros Ismailidis , Annegret Mündermann

Background

Patients undergoing unilateral total hip arthroplasty (THA) or total knee arthroplasty (TKA) often develop osteoarthritis (OA) of the contralateral knee or hip joint. The aim of the study was to compare gait kinematics and kinetics in joints of the contralateral and ipsilateral side of patients after THA or TKA to controls.

Methods

103 participants (45 THA; 30 TKA; 28 controls) completed three-dimensional instrumented gait analysis. Differences in lower extremity kinematic and kinetic trajectories between each patient group and controls were analyzed using statistical parametric mapping with t-tests (p < 0.05).

Findings

Compared to controls, patients after TKA had greater hip flexion and ankle dorsiflexion angles during terminal stance and pre-swing and greater knee adduction during terminal stance and lower ankle dorsiflexion moments on the contralateral side. On the ipsilateral side, patients with TKA had greater sagittal ankle angles during loading response, greater hip angles in terminal stance and lower ankle moments than controls. THA patients had smaller hip adduction angles during loading response and larger knee flexion angles during early stance on the ipsilateral side. Patients after TKA walked slower than controls, whereas patients after THA walked at similar speeds.

Interpretation

Differences in kinematic and kinetic patterns compared to controls were not only evident in the operated joint but also in the adjacent and contralateral joints in patients after TKA, but only in the ipsilateral joints in patients after THA. This suggests that 1 year after surgery, patients after THA recover faster in the contralateral joints than patients after TKA.

背景：接受单侧全髋关节置换术（THA）或全膝关节置换术（TKA）的患者通常会发生对侧膝关节或髋关节骨关节炎（OA）。该研究的目的是比较THA或TKA患者与对照组后对侧和同侧关节的步态运动学和动力学。方法103例受试者（全髋关节置换术45例，全髋关节置换术30例，对照组28例）完成三维仪器步态分析。采用统计参数映射和t检验分析各组患者与对照组下肢运动和动力学轨迹的差异（p < 0.05）。结果：与对照组相比，TKA后患者在终末站立时髋屈曲和踝关节背屈角度更大，在终末站立时预摆和膝关节内收更大，对侧踝关节背屈力矩更大。在同侧，与对照组相比，TKA患者在负荷反应时具有更大的踝关节矢状角、更大的终站髋关节角和更低的踝关节力矩。THA患者在负荷反应时髋关节内收角度较小，在同侧站立早期膝关节屈曲角度较大。全髋关节置换术后的患者走路速度比对照组慢，而全髋关节置换术后的患者走路速度与对照组相似。与对照组相比，运动学和动力学模式的差异不仅在手术关节中明显，而且在TKA后患者的邻侧和对侧关节中也明显，但仅在THA后患者的同侧关节中。这表明术后1年，THA术后患者对侧关节恢复速度快于TKA术后患者。

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引用次数: 0

Mechanoadaptive collagen fiber reorientation in the spinal dura mater under biaxial stretch: Implications for protective mechanisms 双轴拉伸下硬脑膜中机械适应性胶原纤维的重新定位：保护机制的意义。

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2025-10-24 DOI: 10.1016/j.clinbiomech.2025.106688

Soichiro Nishikawa , Atsutaka Tamura

Background

The spinal dura mater plays an important role in maintaining the mechanical integrity of the central nervous system by enclosing cerebrospinal fluid (CSF) and protecting the spinal cord. Structurally, the dura mater primarily comprises collagen fibers. However, the orientation and mechanical response of these fibers to deformation remain poorly understood. Understanding these structural behaviors is crucial for elucidating the dura's biomechanical function and its vulnerability to injury, including CSF leakage.

Methods

The present study aimed to elucidate the dynamic behavior of the collagen fiber orientation in the spinal dura mater under biaxial tensile loading. We quantified the orientation angle distributions and analyzed their realignment patterns under different loading ratios using a custom-built polarization imaging system combined with stereomicroscopic observation.

Findings

The results suggest that collagen fiber reorganization plays an essential role in the ability of the spinal dura mater to withstand mechanical stress, acting as an important mechanism for energy dissipation and structural protection. Notably, fiber alignment changes were sensitive to the direction and magnitude of the applied load, implying that regional tissue properties are closely linked to the local mechanical environments.

Interpretation

The quantitative insights obtained in this study will help inform the development of subject-specific finite element models, enabling a more accurate simulation of mechanical failure and CSF leakage. Ultimately, these models could contribute to improved strategies for predicting, preventing, and treating dural injuries in clinical and biomechanical applications.

背景：脊髓硬脑膜通过封闭脑脊液和保护脊髓，在维持中枢神经系统的机械完整性方面起着重要作用。在结构上，硬脑膜主要由胶原纤维组成。然而，这些纤维对变形的取向和力学响应仍然知之甚少。了解这些结构行为对于阐明硬脑膜的生物力学功能及其对损伤（包括脑脊液渗漏）的脆弱性至关重要。方法：研究双轴拉伸载荷下硬脑膜内胶原纤维取向的动态行为。我们利用定制的偏振成像系统结合立体显微镜观察，量化了取向角的分布，并分析了它们在不同加载比下的重新排列模式。结果表明，胶原纤维重组在脊膜承受机械应力的能力中起着至关重要的作用，是能量耗散和结构保护的重要机制。值得注意的是，纤维取向的变化对施加载荷的方向和大小很敏感，这意味着区域组织特性与局部机械环境密切相关。解释：本研究中获得的定量见解将有助于为特定主题的有限元模型的开发提供信息，从而能够更准确地模拟机械故障和CSF泄漏。最终，这些模型有助于在临床和生物力学应用中改进预测、预防和治疗硬脑膜损伤的策略。

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引用次数: 0

Associations of quadriceps activation during step-up with pain during movement and physical function in people with knee osteoarthritis 膝关节骨性关节炎患者在运动疼痛和身体功能增强过程中股四头肌激活的关联。

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2025-10-22 DOI: 10.1016/j.clinbiomech.2025.106683

Ehyun Kim, Soyoung Lee, Jason Dolinsky, Baekdong Cha, Deepak Kumar

Background

Movement-evoked pain, and excessive muscle activation and co-activation during daily activities such as stair climbing are characteristic of knee osteoarthritis. Our objective was to examine the association between muscle activation and coactivation during step-up with pain during step-up and self-reported physical function in people with knee osteoarthritis.

Methods

We used data from participants with symptomatic knee OA (n = 43) who performed five 30-s step-up bouts. Maximum pain during step-up (range 0–10) was recorded as movement-evoked pain. We assessed mean vastus medialis and medial hamstrings activation during the ascent phase of step-up, normalized to activation during a maximum voluntary isometric contraction, using surface electromyography (EMG). We also derived muscle coactivation over the same period. Physical function was assessed using the McMaster Universities Osteoarthritis Index (WOMAC) Physical Function scale. We used hierarchical regression models to examine the additional contributions of EMG measures to movement-evoked pain and WOMAC scores in addition to age, sex, BMI, and quadriceps peak torque.

Findings

Greater vastus medialis activation during step-up was associated with lower movement-evoked pain (β = −0.47, p < 0.01, model R² = 0.28), explaining 18 % additional variance beyond age, sex, BMI, and isometric quadriceps torque. Similarly, greater vastus medialis activation was related to better WOMAC physical function (β = −0.35, p = 0.04, model R² = 0.36), explaining 8 % additional variance beyond age, sex, BMI, isometric quadriceps torque, and movement-evoked pain.

Interpretation

Greater vastus medialis activation may be a compensatory strategy to reduce pain during step-up and improve function in knee osteoarthritis.

背景：膝关节骨关节炎的特征是运动引起的疼痛，以及在爬楼梯等日常活动中过度的肌肉激活和协同激活。我们的目的是检查膝关节骨性关节炎患者在增强过程中肌肉激活和协同激活与疼痛和自我报告的身体功能之间的关系。方法：我们使用的数据来自有症状的膝关节OA患者（n = 43），他们进行了5次30秒的强化训练。上升过程中的最大疼痛（范围0-10）被记录为运动诱发的疼痛。我们使用表面肌电图（EMG）评估了在加速上升阶段的平均股内侧肌和内侧腘绳肌激活，标准化到最大自主等长收缩期间的激活。我们还推导出了同一时期的肌肉协同激活。使用麦克马斯特大学骨关节炎指数（WOMAC）身体功能量表评估身体功能。除了年龄、性别、BMI和股四头肌峰值扭矩外，我们使用分层回归模型来检验肌电图测量对运动诱发疼痛和WOMAC评分的额外贡献。研究结果：在加速过程中，更大的股内侧肌激活与较低的运动引起的疼痛相关（β = -0.47, p 2 = 0.28），解释了18%的额外方差，超出了年龄、性别、BMI和等长股四头肌扭矩。同样，更大的股内侧肌激活与更好的WOMAC物理功能相关（β = -0.35, p = 0.04，模型R2 = 0.36），解释了8%的额外方差，超出了年龄、性别、BMI、等长股四头肌扭矩和运动引起的疼痛。解释：更大的股内侧肌激活可能是一种代偿策略，可以减轻膝关节骨关节炎加重过程中的疼痛并改善功能。

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引用次数: 0

ASTM biomechanical study comparing the AxioMed lumbar viscoelastic disc to human lumbar disc data ASTM生物力学研究比较AxioMed腰粘弹性椎间盘与人类腰椎间盘数据。

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2025-10-22 DOI: 10.1016/j.clinbiomech.2025.106686

Kingsley R. Chin , Sukanya Chebrolu , Roger D. Sung , Jeffrey R. Carlson , Mark W. McFarland , Erik Spayde , William M. Costigan , Sandra Thompson , Vito Lore , Kari B. Zimmers , Hope Estevez , Swapnil Pangarkar , Aditya Humad , Chukwunonso C. Ilogu , Jason A. Seale

Background

Artificial disc replacements aim to preserve motion in patients with lumbar disc degeneration, but most do not replicate the natural stiffness of the healthy human lumbar disc. Existing ball-and-socket designs often permit excessive motion and fail to provide the nonlinear, load-dependent stiffness that characterize native spinal biomechanics. To date, no in vitro study has directly compared the stiffness of a viscoelastic total disc replacement (VTDR) to that of the natural lumbar disc under physiologic conditions.

Methods

Ten AxioMed® lumbar VTDRs were tested using standardized ASTM protocols in a physiologic environment (PBS at 37 ± 3 °C). Axial compression, flexion-extension, axial rotation and compressive shear stiffness were measured using servohydraulic test systems. An additional five implants underwent static axial loading up to 20,000 N. All values were compared to published stiffness ranges for the healthy human lumbar disc.

Findings

Axial stiffness ranged from 2.56 to 3.48 kN/mm, overlapping the reported native range of 0.5 to 2.5 kN/mm. Flexion-extension stiffness (1.69–2.14 Nm/deg) matched the physiologic range (0.8–2.5 Nm/deg). Rotation stiffness (0.79–0.83 Nm/deg) was lower than native values (2.0–9.6 Nm/deg), resulting in greater rotational mobility. Compressive shear stiffness (0.49–0.59 kN/mm) fell within the native lumbar disc range (0.4–0.7 kN/mm). All implants withstood static compression to 20,000 N without structural failure.

Interpretation

These findings show that the AxioMed® VTDR reproduces lumbar disc stiffness more closely than prior designs. The ability to replicate both compliant and stiff loading zones suggests improved biomechanical performance and segmental stability, supporting its use as a potential alternative to spinal fusion.

背景：人工椎间盘置换术的目的是保持腰椎间盘退变患者的运动，但大多数不能复制健康人腰椎间盘的自然硬度。现有的球窝式设计通常允许过度运动，不能提供固有脊柱生物力学特征的非线性、负载相关刚度。迄今为止，没有体外研究直接比较生理条件下粘弹性全椎间盘置换术（VTDR）与自然腰椎间盘的刚度。方法：10个AxioMed®腰椎vtdr在生理环境（37±3°C PBS）中采用标准化的ASTM方案进行测试。采用伺服液压测试系统测量了轴向压缩、弯曲-拉伸、轴向旋转和压剪刚度。另外5个植入物承受高达20,000 n的静态轴向载荷，所有数值与已公布的健康人腰椎间盘的刚度范围进行比较。结果：轴向刚度范围为2.56至3.48 kN/mm，与报道的0.5至2.5 kN/mm的范围重叠。屈伸刚度（1.69 ~ 2.14 Nm/deg）符合生理范围（0.8 ~ 2.5 Nm/deg）。旋转刚度（0.79-0.83 Nm/deg）低于原生值（2.0-9.6 Nm/deg），导致更大的旋转迁移率。压缩剪切刚度（0.49-0.59 kN/mm）落在腰椎间盘原生范围内（0.4-0.7 kN/mm）。所有植入物均可承受20,000 N的静态压缩，无结构破坏。解释：这些发现表明，AxioMed®VTDR比以前的设计更能再现腰椎间盘僵硬度。复制柔顺和僵硬载荷区的能力表明，生物力学性能和节段稳定性得到改善，支持其作为脊柱融合的潜在替代方案。

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引用次数: 0

STRAIN in vertebral artery during passive cervical range of motion and spinal manipulation therapy: A systematic review and meta-analysis 被动颈椎活动度和脊柱推拿治疗期间椎动脉劳损：一项系统回顾和荟萃分析

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2025-10-22 DOI: 10.1016/j.clinbiomech.2025.106685

Caroline Fagundes , Felipe Coutinho Kullmann Duarte , Walter Herzog

Objective

To identify and synthesize studies examining the strain on the vertebral artery (VA) during cervical spinal manipulation therapy (cSMT). Additionally, we compared VA strains induced by cSMT with passive range of motion (ROM) across different cervical spine levels and VA segments.

Design

A systematic review and meta-analysis were conducted following PRISMA guidelines and registered with PROSPERO (CRD42024591457).

Literature search

The search was performed in May 2025 across SCOPUS, PubMed, MEDLINE, Web of Science, LILACS, SciELO, and the Index to Chiropractic Literature.

Study selection criteria

Studies that focused on VA strain during cSMT and passive ROM. Risk of bias was assessed using the Anatomical Quality Assessment (AQUA) Tool.

Data synthesis

Data extraction included descriptive, methodological, VA strain, and interventional details. Meta-analysis was performed for studies comparing VA strain between cSMT and ROM.

Results

ix studies met the inclusion criteria, with four providing data for meta-analysis. cSMT consistently produced lower VA strain (up to 3.8 %) compared to passive ROM (up to 12.5 %) in the V3 segment (C0–C2). Meta-analysis revealed greater strain during ROM compared to cSMT, particularly during rotation (standardized mean difference [SMD] = 1.05).

Conclusion

This systematic review and meta-analysis provide consistent evidence that cSMT induces less strain on the VA, particularly within the V3 segment, compared to passive cervical ROM. Although the evidence comes from studies conducted in human cadaveric specimens, the robustness of the methodologies and the consistency of findings across studies contribute to the growing body of biomechanical evidence supporting the relative safety of cSMT with respect to VA strain.

目的对颈椎推拿治疗（cSMT）过程中椎动脉（VA）的应变进行鉴定和综合研究。此外，我们比较了cSMT与被动活动度（ROM）在不同颈椎水平和VA节段上引起的VA应变。DesignA按照PRISMA指南进行系统评价和荟萃分析，并在PROSPERO注册（CRD42024591457）。文献检索检索于2025年5月在SCOPUS、PubMed、MEDLINE、Web of Science、LILACS、SciELO和脊椎推拿文献索引中进行。研究选择标准研究集中在cSMT和被动ROM期间的VA应变。使用解剖质量评估（AQUA）工具评估偏倚风险。数据综合数据提取包括描述性、方法学、VA应变和介入细节。结果6项研究符合纳入标准，4项研究为meta分析提供数据。与无源ROM（高达12.5%）相比，cSMT在V3段（C0-C2）中始终产生较低的VA应变（高达3.8%）。荟萃分析显示，与cSMT相比，ROM期间的应变更大，特别是在旋转期间（标准化平均差[SMD] = 1.05）。本系统综述和荟萃分析提供了一致的证据，表明与被动颈椎ROM相比，cSMT对VA的应变更小，特别是在V3节段。尽管证据来自于对人体尸体标本的研究，但方法的稳健性和研究结果的一致性有助于越来越多的生物力学证据支持cSMT对VA应变的相对安全性。

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引用次数: 0

Ultrasound elastography in the assessment of rigidity in Parkinson's disease: A scoping review 超声弹性成像在帕金森病硬度评估中的应用：范围综述

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2025-10-17 DOI: 10.1016/j.clinbiomech.2025.106680

Mahyar Behraznia , Massimiliano Ditroilo , Tina Smith

Background

In individuals with Parkinson's disease (PD), rigidity is a form of muscle hypertonia which manifests as muscular stiffness, leading to altered mechanical properties of muscle tissue. Ultrasound elastography (UE) is an emerging diagnostic imaging technology that can assess muscle stiffness. This scoping review aims to evaluate the current literature on muscular rigidity in PD as measured by UE, examine existing UE assessment methodologies, and propose future directions when measuring muscular rigidity in PD using UE.

Methods

This scoping review was conducted following specific guidelines and searching these databases: Scopus, PubMed, Web of Science Core Collection, MEDLINE and CINAHL Ultimate.

Findings

Ten studies were included after screening, using either strain elastography (SE) or shear wave elastography (SWE) to measure muscular rigidity in PD. Muscular rigidity was typically greater in individuals with PD compared to controls, with minimal bilateral differences within PD patients. UE-derived muscular rigidity was associated with clinical manifestations of PD, and rigidity was influenced by joint angle, medications, and therapeutic interventions. However, the included studies assessed rigidity using a wide range of methodologies (e.g., protocol design, system specification, and acquisition methods), which restricts comparability.

Significance and interpretation

UE demonstrates strong potential as a non-invasive tool for quantifying muscular rigidity in PD, which is increased in these patients. Nevertheless, small sample sizes and inconsistent methodologies undermine definitive conclusions. Future studies should adhere to the methodological recommendations outlined in this review, including the adoption of standardised protocols, larger sample sizes, and robust longitudinal and reliability designs.

在帕金森病患者（PD）中，肌肉僵硬是一种肌肉强直的形式，表现为肌肉僵硬，导致肌肉组织机械特性的改变。超声弹性成像（UE）是一种新兴的诊断成像技术，可以评估肌肉僵硬。本综述旨在评估目前关于UE测量PD肌肉刚性的文献，检查现有的UE评估方法，并提出未来使用UE测量PD肌肉刚性的方向。方法采用Scopus、PubMed、Web of Science Core Collection、MEDLINE和CINAHL Ultimate等数据库进行文献综述。筛选后纳入了10项研究，使用应变弹性成像（SE）或剪切波弹性成像（SWE）测量PD患者的肌肉刚性。与对照组相比，PD患者的肌肉刚性通常更大，PD患者的双侧差异很小。ue源性肌肉强直与PD的临床表现相关，且强直受关节角度、药物和治疗干预的影响。然而，纳入的研究使用广泛的方法（例如，协议设计，系统规范和获取方法）评估刚性，这限制了可比性。意义和解释ue显示了强大的潜力，作为一种非侵入性的工具来量化PD患者的肌肉僵硬，在这些患者中肌肉僵硬增加。然而，小样本量和不一致的方法削弱了确定的结论。未来的研究应遵循本综述中提出的方法学建议，包括采用标准化方案、更大的样本量、稳健的纵向和可靠性设计。

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引用次数: 0

Can RYSEN-induced supportive, propelling and impeding forces enhance gait stability, speed and propulsion in individuals with incomplete spinal cord injury? rysen诱导的支持力、推进力和阻碍力能否增强不完全性脊髓损伤患者的步态稳定性、速度和推进力？

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2025-10-14 DOI: 10.1016/j.clinbiomech.2025.106681

Sanne Ettema , Tom J.W. Buurke , Sina David , Coen A.M. van Bennekom , Han Houdijk

Background

The RYSEN body weight support (BWS) gait training system provides vertical BWS, on top of which mediolateral and anteroposterior forces can be added during overground walking. To assess to what extent these forces can enhance gait stability, speed and propulsion in individuals with an incomplete spinal cord injury (iSCI), this study aimed to investigate the effect of BWS with(out) the addition of mediolateral and anteroposterior forces on step parameters and muscular control.

Methods

Fifteen individuals with iSCI and fifteen able-bodied individuals completed multiple overground walking conditions: unsupported walking and walking with BWS with(out) mediolateral and anteroposterior forces. Step length, step width (variability), single stance time and walking speed were determined using motion capture data. Muscular control was assessed using electromyography. Linear mixed-effect models were used to analyse the (interaction) effects of condition and group on step parameters. Statistical parametric mapping was used to analyse muscular control.

Findings

Providing BWS and the addition of mediolateral forces increased single stance time (range: +0.05–0.06 s) and decreased step width (−0.05 m) and ankle muscle activity in individuals with iSCI. Adding anterior forces increased walking speed (range: +0.19–0.25 m/s) in individuals with iSCI. Adding posterior forces did not lead to additional changes.

Interpretation

BWS and the addition of mediolateral and anterior forces induced gait adaptations that indicated improved gait stability and speed. Therefore, these forces show promise for targeted gait training in individuals with iSCI. Further research is needed to evaluate the long-term training effects of each of these forces.

背景：RYSEN体重支持（BWS）步态训练系统提供垂直的BWS，在此基础上，可以在地上行走时增加中外侧和前后侧力。为了评估这些力量在多大程度上可以增强不完全性脊髓损伤（iSCI）患者的步态稳定性、速度和推进力，本研究旨在探讨BWS与（或）添加中外侧和前后侧力对步参数和肌肉控制的影响。方法：15名iSCI患者和15名健全者完成多种地面行走条件：无支撑行走和有BWS行走（外）中外侧和前后侧力。通过动作捕捉数据确定步长、步宽（可变性）、单站时间和步行速度。肌肉控制用肌电图评估。采用线性混合效应模型分析了条件和组对阶跃参数的（交互）影响。统计参数映射用于分析肌肉控制。结果：在iSCI患者中，提供BWS和增加中外侧力量增加了单站时间（范围：+0.05-0.06 s），减少了步宽（-0.05 m）和踝关节肌肉活动。增加前路力可提高iSCI患者的行走速度（范围：+0.19-0.25 m/s）。增加后侧力不会导致额外的变化。解释：BWS和中外侧力和前侧力的增加诱导步态适应，表明步态稳定性和速度得到改善。因此，这些力量显示了iSCI患者有针对性的步态训练的希望。需要进一步的研究来评估这些力量的长期训练效果。

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引用次数: 0

From structure to function: Biomechanical markers of symptomatic flatfoot during running and a single leg drop and hop 从结构到功能：跑步和单腿下降和跳跃时症状性扁平足的生物力学标志。

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2025-10-14 DOI: 10.1016/j.clinbiomech.2025.106682

Nicolas Haelewijn , Filip Staes , Evie Vereecke , Kevin Deschamps

Background

Static classification of flatfoot fails to explain why some individuals develop symptoms while others do not. Although altered foot kinematics have been documented, few studies directly compare symptomatic and asymptomatic individuals, and none have examined multi-segment joint kinetics during sport activities. This study aimed to examine multi-segment biomechanical and intrinsic foot muscle differences between symptomatic and asymptomatic individuals with flexible flatfoot during running and a single-leg drop-hop task, and to explore their clinical relevance.

Methods

Seventeen symptomatic and seventeen asymptomatic individuals with flexible flatfoot were matched for age, sex, and BMI. Multi-segment foot kinematics and kinetics were captured during running and a single-leg drop-hop. Morphology and strength of intrinsic and extrinsic foot muscles were assessed using ultrasound. Group differences were evaluated using a linear mixed-effects model.

Findings

Symptomatic individuals exhibited altered frontal plane ankle kinematics and reduced range of motion in the sagittal plane, particularly during the drop-hop task. Kinetic deficits included reduced power generation and absorption at the ankle and Chopart joints, and decreased MTP-I power absorption during running. Significant reductions in quadratus plantae and flexor digitorum longus muscle morphology were observed in the symptomatic group compared to the asymptomatic group. No differences were detected at the Lisfranc joint.

Interpretation

Symptomatic flexible flatfoot presents with task- and joint-specific functional deficits in both biomechanics and foot muscle morphology. Our findings support a shift from structural assessment toward performance-based clinical evaluation. Sport-specific rehabilitation should address neuromuscular control, joint power, and foot core function in dynamic contexts.

背景：扁平足的静态分类不能解释为什么有些人有症状而另一些人没有。虽然有文献记载足部运动学改变，但很少有研究直接比较有症状和无症状的个体，也没有研究在体育活动中检查多节段关节动力学。本研究旨在研究有症状和无症状的柔性扁平足患者在跑步和单腿落跳任务中多节段生物力学和内在足肌的差异，并探讨其临床相关性。方法：选取17例有症状和17例无症状的柔性扁平足患者，按年龄、性别和BMI进行匹配。多段足部运动学和动力学捕获在跑步和单腿落体跳。用超声评估足部内外肌的形态和强度。采用线性混合效应模型评估组间差异。结果：有症状的个体表现为踝关节前部运动改变和矢状面运动范围缩小，特别是在跳落任务期间。动力缺陷包括踝关节和Chopart关节的发电和吸收减少，以及跑步时MTP-I功率吸收减少。与无症状组相比，有症状组的跖方肌和指长屈肌形态明显减少。在Lisfranc关节处未发现差异。解释：有症状的柔性扁平足在生物力学和足部肌肉形态方面表现为任务和关节特异性功能缺陷。我们的研究结果支持从结构评估向基于绩效的临床评估的转变。运动特异性康复应解决动态环境下的神经肌肉控制、关节力量和足部核心功能。

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引用次数: 0