[Influence of sport on isoinertial trunk muscle performance development: a 2 years prospective study]. / Activités sportives et dévelop- pement de la force isoinertielle du tronc chez les adolescents: étude prospective sur deux ans.

In this study, we investigate the relationship between either regular sports practice or a non sportive way of life, development of trunk muscle performance and occurrence of lower back pain between male schoolchildren. 93 schoolchildren were recruited, then stratified in 4 groups, according to sport practice or sedentary way of life. Participants were evaluated twice at an interval of 2 years with an interview, a physical examination and an evaluation of trunk muscle performance. We identified that basketball players have significantly better results and perfomance concerning isometric and isoinertial tests of trunk muscles than the other groups. Differences in trunk muscle performance exist following the practice of different types of sport. We can deduce that trunk muscle performance has some sport specificity.

Multiplanar variations in the structural characteristics of cancellous bone.

A quantitative serial sectioning technique and a video-imaging procedure were used to obtain precise (20-microns voxels, in a 5 mm x 6 mm x 7 mm test volume) digital images of lumbar vertebral cancellous bone specimens. Conventional stereological image analyses were performed on this data to determine multiplanar (bulk) and surface planar variations in cancellous structural properties. Based upon an error analysis of subgroups of the complete serial planar images, our findings suggest that, for a plane resolution of 20 microns, sectioning at an increment < or = 100 microns along an axis is necessary to obtain accurate data of bulk structural properties of cancellous bone. Planar structural variations obtained from the serial sections of cancellous bone revealed a high degree of complexity and heterogeneity of the bone architecture. Bone area centers deviated from the section centroid and showed a helical variation along the primary or superior--inferior loading axis of samples. In comparison with the base planes (perpendicular to the superior-inferior axis), the lateral planes (parallel to the superior-inferior axis) of spine samples showed smaller mean values of structural indices and a more oriented structure. This structural anisotropy may be related to the functional mechanical anisotropy of the samples.

The influence of bone volume fraction and ash fraction on bone strength and modulus.

Although bone strength and modulus are known to be influenced by both volume fraction and mineral content (ash fraction), the relative influence of these two parameters remains unknown. Single-parameter power law functions are used widely to relate bone volume or ash fraction to bone strength and elastic modulus. In this study we evaluate the potential for predicting bone mechanical properties with two-parameter power law functions of bone volume fraction (BV/TV) and ash fraction (alpha) of the form y = a(BV/TV)(b) alpha(c) (where y is either ultimate strength or elastic modulus). We derived an expression for bone volume fraction as a function of apparent density and ash fraction to perform a new analysis of data presented by Keller in 1994. Exponents b and c for the prediction of bone strength were found to be 1.92 +/- 0.02 and 2.79 +/- 0.09 (mean +/- SE), respectively, with r(2) = 0.97. The value of b was found to be consistent with that found previously, whereas the value of c was lower than values previously reported. For the prediction of elastic modulus we found b and c to be 2.58 +/- 0.02 and 2.74 +/- 0.13, respectively, with r(2) = 0.97. The exponent related to ash fraction was typically larger than that associated with bone volume fraction, suggesting that a change in mineral content will, in general, generate a larger change in bone strength and stiffness than a similar change in bone volume fraction. These findings are important for interpreting the results of antiresorptive drug treatments that can cause changes in both ash and bone volume fraction.

Young's modulus, bending strength, and tissue physical properties of human compact bone.

The Young's modulus, bending strength, apparent density, and ash content of 155 human compact bone bending specimens were determined. Both Young's modulus (E) and bending strength (S) were strongly correlated to tissue dry apparent density (rho a). Based upon the correlation coefficient (R) and the percent deviation of the data from the regression curve (% dev.), these correlations were best described by power law relationships: E infinity rho a 1.54 (R2 = 0.79, % dev. = 2.4) and S infinity rho a 2.18 (R2 = 0.80, % dev. = 6.4). Bending strength was related to Young's modulus raised to the 1.26 power, implying a nonlinear relationship for these variables. We found a weak correlation between ash content and the mechanical behavior of the compact bone specimens, particularly Young's modulus, but could not statistically justify formulation of a more complex multivariate power model incorporating both density and ash content. Regional variations in strength and stiffness along the femoral shaft and within the cortex were also noted and were attributed primarily to differences in apparent density. The relationships formulated for the mechanical behavior of human compact bone are discussed in terms of the results of previous investigations of the mechanical behavior of nonhuman compact bone and human cancellous bone.

Mechanical behavior of the human lumbar spine. I. Creep analysis during static compressive loading.

The in vitro viscoelastic "creep" behavior was examined in 18 cadaveric human lumbar motion segments subjected to static axial compressive loads. Axial deformation was followed for 30 min under constant applied load. Compressive material constants (moduli and viscosity coefficients) were then determined for each intervertebral disc using a linearization method based on a Taylor series expansion of experimental data for the "three parameter" viscoelastic creep model. The degree of disc degeneration and bone mineral content (BMC) were also assessed. Good correlation between the experimentally determined and model predicted strain values were found, with the average error less than 1%. We found that motion segments from older and more degenerated lumbar discs were less stable and had lower material constants than segments from younger and less degenerated discs. Material constants and BMC correlated closely, suggesting that an interdependency of disc and vertebral body properties exists. No correlation between the creep characteristics and disc height, disc area, segment level, or sex were noted.

Mechanical behavior of the human lumbar spine. II. Fatigue strength during dynamic compressive loading.

Seventeen cadaveric human lumbar motion segments from eight spines were cyclically loaded in vitro under axial compression. Loading frequency and magnitude were chosen to simulate rigorous activity within an in vivo physiological level. The load magnitude was determined as a percentage of the ultimate compressive load, the latter estimated from the bone mineral content (BMC) of lumbar vertebrae determined by dual-photon absorptiometry. Following testing, the degree of macroscopic disc degeneration was assessed and the type of fracture in each specimen was determined from serial sagittal sections. Fractures were found in all but one specimen. Three types of fractures were formed: the node of Schmorl and Junghanns (type I), central endplate fracture (type II), and a crush or burst fracture (type III). The results suggested that type I fractures were predominantly associated with segments with normal discs, type II fractures were found primarily in segments with moderately degenerated discs, and type III fractures were associated with segments that failed on the first cycle. Segment stiffness and fatigue strength (cycles to failure) were correlated with disc degeneration, age, and segment BMC, the latter an in vivo measure of bone density. Fatigue strength also decreased in proportion to a power coefficient with increasing relative stress (cyclic stress range/ultimate stress).

Geometric, elastic, and structural properties of maturing rat femora.

Geometric, elastic, and structural properties of growing rat femora were determined from bending and torsion tests followed by bone sectioning and measurement of areal properties. Rosette strain gages bonded to the bone surface measured the strain during testing. A computer generated elliptical cross-sectional representation of the cross section geometry was used for calculation of material and structural properties. All structural and material properties increased with increasing age, exhibiting age-related changes that were best represented by an allometric or "heterauxic" growth pattern (y = axb) up to maturity. The femoral axial, flexural, and torsional rigidity increased 5.7, 10.1, and 14.8 fold, respectively, during maturation from 21 to 119 days of age. The increase in whole bone rigidity during maturation was caused primarily by changes in geometry. The bone tissue tensile longitudinal elastic modulus and shear modulus approximately doubled, and the shear strength increased approximately fourfold over this same period. Following maturity, a much slower increase in bending and torsional properties was noted. The results suggest that bone structural properties are regulated by changes in both geometric and material properties.

Torsion and bending analysis of internal fixation techniques for femoral neck fractures: the role of implant design and bone density.

To evaluate pin/screw/plate fixation for management of femoral neck fractures, 39 proximal femora were tested in both torsion and flexion under physiological loading conditions. Three, four, or five implants of six commonly used multiple-fixation devices, and a sliding hip screw with and without an additional 6.5-mm cancellous screw were examined in paired femora. The intact and postfixation femora were initially subjected to a single applied moment, and the torsion and bending stiffness were determined from the load-deformation data. Postfixation femora were also subjected to cyclic loading in flexion at three load ranges, and fixation was judged successful if no failure occurred on or before 1,500 cycles of 667 to 2,000 N of a combined compressive force and moment. Anterior-posterior and lateral radiographs of each specimen were taken after fixation in order to evaluate Singh's index of bone density, fracture reduction, implant placement, and cross-sectional diameter of the femoral neck. Bone density was also evaluated by computed tomography (CT) and physical measurement of core samples obtained from the femoral head. The results indicate that there appears to be no justification for the use of more than three pin/screw implants for management of femoral neck fractures. Bone density was found to correlate with fracture stability and may be a useful predictor of fixation success.

The use of laser Doppler flowmetry to evaluate anterior cruciate blood flow.

The purpose of this study was to quantitate the blood flow of the anterior cruciate ligament in vivo. Functional flow was evaluated using laser Doppler flowmetry (LDF), for which the output signal, blood cell flux (BCF), is expressed in terms of volts. Ten patients undergoing routine arthroscopic surgery with clinically intact anterior cruciate ligaments were selected at random for participation in the study. Under arthroscopic visualization, a 2.2-mm probe was placed through a trocar sleeve into the anterior cruciate ligament after the arthroscopic procedure. Pulsatile flow within the ligament was observed in all patients. The mean maximum BCF value ranged from 101 to 274 mV; SD range was +/- 3-9 mV. The mean minimum BCF ranged from 75 to 197 mV; SD range was +/- 0 to 9 mV. Laser Doppler flowmetry offers significant promise as a method for measurement of in vivo anterior cruciate and cruciate substitution blood flow.

Aging, vertebral density, and disc degeneration alter the tensile stress-strain characteristics of the human anterior longitudinal ligament.

The mechanical properties of the human lumbar anterior longitudinal ligament were investigated, and the influence of aging, disc degeneration, and vertebral bone density on these properties was determined. Tensile mechanical properties of the vertebra-anterior longitudinal ligament-vertebra complex were determined for 16 segments from cadavera of individuals who had been 21-79 years old (mean, 52.1 years) at the time of death. Regional strain patterns associated with three sites across the width and three sites along the length of the anterior longitudinal ligament were measured with use of a video-based motion analysis system. In the young, normal anterior longitudinal ligament, the elastic moduli of the insertion and substance regions of the ligament were similar (approximately 500 MPa). During aging (21-79 years), the elastic modulus of the substance region increased 2-fold, whereas the elastic modulus of the insertion decreased 3-fold; this resulted in an approximately 5-fold difference in elastic modulus between these regions in the older spine. The strength of the bone-ligament complex decreased approximately 2-fold (from 29 to 13 MPa) over this same age range. The outer portion of the anterior longitudinal ligament consistently had the highest peak tensile strains (11.8 +/- 2.7%) in all of the specimens examined. Preparations with nondegenerated discs and high bone density were significantly stronger (66%) and failed in the ligament substance; in contrast, segments from older individuals with degenerated discs and lower bone density failed in the ligament insertion regions.

Porous ceramics as bone graft substitutes in long bone defects: a biomechanical, histological, and radiographic analysis.

Three porous ceramic bone graft materials were compared with regard to their ability to heal a 2.5 cm defect created surgically in a bilateral canine radius model. The ceramic materials were analyzed at 12 and 24 weeks after surgery and included tricalcium phosphate, hydroxyapatite, and collagen hydroxyapatite, which contained a mixture of 35% tricalcium phosphate and 65% hydroxyapatite with added collagen. Each material was evaluated alone and with added bone marrow aspirate. All the implants were compared with a graft of autogenous cancellous bone in the contralateral radius. Biomechanical testing and radiographic evaluation revealed that the addition of bone marrow aspirate was essential for tricalcium phosphate and hydroxyapatite to achieve results comparable with those of cancellous bone. Collagen hydroxyapatite performed well without the addition of bone marrow, although the addition of marrow did have a positive effect. Further qualitative radiographic and histological analysis demonstrated that tricalcium phosphate was the only ceramic that showed any sign of degradation at 24 weeks. This observed degradation proved to be an important factor in evaluating radiographs because the radiodensity of collagen hydroxyapatite and hydroxyapatite interfered with the determination of radiographic union. At 24 weeks, tricalcium phosphate with bone marrow was the material that performed most like cancellous bone. In this study, the biomechanical and radiographic parameters of tricalcium phosphate with bone marrow were roughly comparable with those of cancellous bone at 12 and 24 weeks. Tricalcium phosphate was the only implant that showed significant evidence of degradation at 24 weeks by both histological and radiographic evaluations, and this degradation took place only after a degree of mechanical competence necessary for weight-bearing was achieved.

Acute middle cerebral artery occlusion: experience with volume expansion therapy.

Five consecutive patients with acute neurological deficits after middle cerebral artery (MCA) occlusion were given emergency treatment with colloidal volume expansion. In each case, the diagnosis was confirmed promptly by computed tomography and cerebral angiography. Aggressive volume expansion therapy was started 2 to 18 hours (mean, 11 hr) after the onset of the neurological deficit. The mean colloidal volume used was 920 ml/day for an average of 4 days. During volume expansion, the mean cardiac output increased 57% from 4.6 +/- 0.6 to 7.2 +/- 1.9 litres/min (P less than 0.05). The mean hematocrit decreased 19% from 46 +/- 3% to 37 +/- 4% (P less than 0.01). The mean arterial blood pressure remained stable, and the pulmonary artery wedge pressure was maintained at less than 15 mm Hg. Three patients improved dramatically with volume expansion therapy and have returned to their previous life-styles. Two patients made partial recoveries and manage at home with nursing care. The three patients who improved dramatically were young (aged less than 34) and, when compared to the older patients, they had greater increases in cardiac output (67% vs. 19%). No major complications or deaths were attributed to the volume expansion therapy. We propose that intravascular volume expansion and its concomitant augmentation of the cardiovascular dynamics may be effective in the treatment of acute neurological deficits after acute MCA occlusion.

Loss of cerebral regulation during cardiac output variations in focal cerebral ischemia.

Focal cerebral ischemia was induced in anesthetized macaque monkeys by unilateral middle cerebral artery occlusion. The effect of blood volume expansion by a colloid agent and subsequent exsanguination to baseline cardiac output (CO) on local cerebral blood flow (CBF) was measured by the hydrogen clearance technique in both ischemic and nonischemic brain regions. Cardiac output was increased to maximum levels (159% +/- 92%, mean +/- standard error of the mean) by blood volume expansion with the colloid agent hetastarch, and was then reduced a similar amount (166% +/- 82%) by exsanguination during the ischemic period. Local CBF in ischemic brain regions varied directly with CO, with a correlation coefficient of 0.89 (% change CBF/% change CO), while CBF in nonischemic brain was not affected by upward or downward manipulations of CO. The difference in these responses between ischemic and nonischemic brain was highly significant (p less than 0.001). The results of this study show a profound loss of regulatory control in ischemic brain in response to alterations in CO, thereby suggesting that blood volume variations may cause significant changes in the intensity of ischemia. It is proposed that CO monitoring and manipulation may be vital for optimum care of patients with acute cerebral ischemia.

Sudden deterioration and death in patients with benign tumors of the third ventricle area.

Although sudden deterioration and death is a widely recognized complication in patients with benign tumors of the third ventricle area, the exact incidence of this dreaded occurrence is unknown and the reports in the literature on the subject are largely anecdotal. Neither risk factors nor the etiology of the sudden death have been analyzed. The vast majority of these benign tumors are colloid cysts, and the presence and degree of ventricular dilatation and herniation associated with these tumors as cited in the reports are quite variable. The authors report a case of sudden death in a 27-year-old woman with a subependymoma of the left lateral and third ventricles. A review of the literature is included in an attempt to discern identifiable risk factors for sudden death in patients with tumors of the third ventricle area. Since this potential complication is known to exist in patients with otherwise benign tumors amenable to surgical resection, the authors recommend either prompt removal of the tumor on discovery or close monitoring of the patient if surgery is to be delayed.

Colloidal volume expansion during acute cerebral ischaemia: assessed by local cerebral blood flow and computerized power ratio index.

Colloidal volume expansion during acute cerebral ischaemia was assessed by local cerebral blood flow (CBF) and the power ratio index (PRI) in 8 anaesthetized Macaque monkeys. Focal cerebral ischaemia was produced by right middle cerebral artery occlusion. The animals were then volume expanded (to maximum cardiac output) with 6% hetastarch and then exsanguinated to baseline cardiac output. During volume expansion, local CBF in the ischaemic hemisphere increased from 25 +/- 12 to 39 +/- 23 cc/100 g/min (p less than 0.01) and during exsanguination decreased to 32 +/- 18 cc/100 g/min. Local CBF did not change significantly in the nonischaemic hemisphere. EEG power data, as assessed by PRI [(delta + theta power/alpha + beta power) x 100] changed significantly during blood volume manipulation. The mean PRI value in the right hemisphere deteriorated by increasing from 65 +/- 22 to 94 +/- 25 (p less than 0.01) following vessel occlusion but improved by decreasing to 81 +/- 23 (p less than 0.05) following volume expansion. Following exsanguination, the PRI value increased to 87 +/- 21. These data demonstrate the benefits of volume expansion during acute cerebral ischaemia. Changes in local CBF were consistently associated with changes in the PRI maps and values.

Blood volume expansion with hetastarch in acute ischaemic stroke: the effects on local cerebral blood flow and computer mapped EEG.

Focal cerebral ischaemia was induced in seven anaesthetized monkeys by unilateral middle cerebral artery (MCA) occlusion. Local cerebral blood flow (CBF) and computer mapped EEG (CME) changes were then studied as blood volume and cardiac output (CO) were varied. CO was increased by colloidal volume expansion and decreased by exsanguination. Local CBF fell to 24 +/- 9% of control values in ischaemic areas following MCA occlusion and increased to 43 +/- 19% of control values (p less than 0.01) when CO was increased by 130 +/- 70% with colloid infusion. Local CBF to nonischaemic regions was not altered significantly by blood volume expansion. Exsanguination led to return of CO to control levels and was associated with reduction of local CBF in ischaemic regions to 24 +/- 12% of control values (p less than 0.05). CME showed bifrontal or ipsilateral slow wave foci (delta) following MCA occlusion. Blood volume expansion brought about a marked reduction of this slow wave activity and exsanguination led to recurrence of the slow wave foci. This data demonstrated that colloidal blood volume expansion induced an increase in local CBF and improved neuroelectric status of ischaemic brain following MCA occlusion. It was also shown that a reduction of blood volume and cardiac output resulted in a reduction in local CBF and a worsening of neuroelectric status in ischaemic areas. This study supports the contention that blood volume and cardiac output maintenance is extremely important in the management of acute ischaemic stroke.

Predicting the compressive mechanical behavior of bone.

The principal objectives of this study were to determine the mathematical dependency of the compressive mechanical properties of human bone on several commonly used measures of bone composition, and to assess variations in this dependency based upon the composition range spanned by the data. Destructive mechanical tests were conducted along the superior-inferior axis of 496 cubic specimens of human trabecular and cortical bone from five male donors (ages 46-84 yr), including specimens from lumbar vertebrae and femoral metaphyses and diaphyses. There was over a 3000-fold variation in strength (S, ultimate stress) and over a 20,000-fold variation in stiffness (E, elastic modulus) over the range of apparent dry density (rho a = 0.05-1.89 g cm-3), apparent ash density (rho alpha = 0.03-1.22 g cm-3) and mineral content (alpha = 17.4-66.2%) examined. Both linear and power models produced very high correlations (R2 > 0.81) between mechanical properties and bone composition, but the linear models resulted in a much greater percent deviation (PD) of the predicted dependent variable with respect to the measured value, in comparison to power models. The best correlations were obtained using rho alpha as the only independent variable: S (MPa) = 117 rho alpha 1.93 +/- 0.04 (R2 = 0.969, PD = 29.9, E (GPa) = 10.5 rho alpha 2.57 +/-0.04 (R2 = 0.965, PD = 46.7). Power models of bone stiffness and strength, incorporating only low density data (rho alpha < 0.2 g cm-3, rho a < 0.3), were characterized by approximately squared exponents and these models underestimated the stiffness (five-fold) and overestimated the strength (two-fold) for higher density data, which were characterized by exponents greater than two. Using a subset of the data based upon an apparent dry density range of 0.22 < rho a < 1.89 g cm-3, it was possible to obtain a mathematical relationship in which bone stiffness and strength were precisely proportional to the cube and square, respectively, of the apparent dry density. These results indicate that the mathematical dependency of bone compressive mechanical properties on composition is closely dependent upon the density and mineral content range examined and, in terms of a single compositional measure, is best predicted by apparent ash density expressed as a power function.

Regulation of bone stress and strain in the immature and mature rat femur.

Bone in vivo stresses and moments were determined from rosette strain recordings obtained from the mid-diaphysis of growing exercising rats. Two activity groups were examined beginning at 3 weeks of age: 2 min day-1 and 45 min day-1 at 0.2 ms-1 in an exercise wheel. In vitro moment-strain curves were obtained during mechanical calibration tests on intact femora, and area inertial properties were determined from the mid-diaphysis cross-sections. The mechanical calibration and histomorphometry procedures were then used to compute functional stresses and moments based on the in vivo rosette strain recordings. During the period 6-30 weeks of age the rats increased in body weight over threefold, but no significant changes in principal strain and stress magnitude or orientation were found. Peak in vivo compressive and tensile moments increased during growth in proportion to the animal mass squared, but the ratio of these moments to animal body weight times bone length (BWBL) remained constant throughout growth and in the adult. The parameter BWBL appears, therefore, to be a useful predictor of long bone functional strength. Peak torsional moments remained a constant 8.1 +/- 3.0% of the ultimate torsional strength, providing a safety factor of approximately 12. Differences in the in vivo moments between the two activity groups were found, which were due primarily to adaptive, but not significant, changes in bone geometry. These findings support the hypothesis that long bones model and model during growth and altered activity in order to regulate the functional strains at a predefined level.

In vivo strain gage implantation in rats.

A technique for the fabrication of encapsulated micro-miniature rosette strain gages for in vivo implantation is described. The gage units have an overall area of ten square millimeters (2.5 mm X 4.0 mm), and hence can be installed in very small experimental animals, particularly rodents. Using a rat model, strain data for up to 12 days have been obtained and in vitro studies have validified the in vivo strain recordings.

Effects of specimen load-bearing and free surface layers on the compressive mechanical properties of cellular materials.

The influence of load-bearing surface layers on Young's modulus was determined for cancellous bone and polyurethane foam specimens of three different heights cut from each material: 16, 9, and 5 mm for bone specimens (cross-sectional area A = 81 mm2) ranging in density from 0.04 to 0.32 g cm-3; 20, 10, and 5 mm for foam specimens (A = 100 mm2) ranging in density from 0.064 to 0.64 g cm-3. The compressive elastic modulus of the 5 mm bone specimens was significantly smaller (42%) than that of the 16 mm bone specimens. A similar change in elastic modulus was also observed for the foam specimens, but the height effect diminished in a relatively linear manner as the foam density increased. For a height change from 20 to 5 mm, the foam modulus difference ranged from a 41% decrease for the lowest density specimens (p = 0.064 g cm-3) to an insignificant change (< 1.8%) for the highest foam density specimens (p = 0.64 g cm-3). The specimen height effect on elastic modulus was hypothesized to result from a higher deformation (compliance) of the cellular materials in the load-bearing or contacting surface layer than in the bulk. A mathematical formula was derived to predict the variation in measured elastic modulus (E) caused by the contacting surface layer modulus (Ecs) to bulk modulus (Eb) ratio (Y = Ecs/Eb) and contacting surface layer height (hcs) to sample height (h) ratio (t = hcs/h): E/Eb = Y/[Y(1-t)+t]. Predicted differences in the measured modulus associated with graduated specimen heights were verified experimentally by regional strain measurements of the foam and bone samples using an optical microscope. The influence of free-surface layers was also determined for the foam specimens with cross-sectional areas 1.21 and 10 times the load-bearing area of a load platen, but the measured differences were small (< 10%) compared to that of the load-bearing surface layer influence. In future compressive mechanical testing of cellular materials, specimens < 10 mm in height should be avoided, particularly specimens with low bulk density or high porosity.