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1.
Bone Joint J ; 102-B(2): 155-161, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32009440

RESUMO

AIMS: Complex displaced osteoporotic acetabular fractures in the elderly are associated with high levels of morbidity and mortality. Surgical options include either open reduction and internal fixation alone, or combined with total hip arthroplasty (THA). There remains a cohort of severely comorbid patients who are deemed unfit for extensive surgical reconstruction and are treated conservatively. We describe the results of a coned hemipelvis reconstruction and THA inserted via a posterior approach to the hip as the primary treatment for this severely high-risk cohort. METHODS: We have prospectively monitored a series of 22 cases (21 patients) with a mean follow-up of 32 months (13 to 59). RESULTS: The mean patient age was 79 years (67 to 87), and the mean ASA score was 3.3 (3 to 5). Three patients had high-energy injuries and 18 had low-energy injuries. All cases were associated fractures (Letournel classification: anterior column posterior hemitransverse, n = 13; associated both column, n = 6; transverse posterior wall, n = 3) with medialization of the femoral head. Mean operative time was 93 minutes (61 to 135). There have been no revisions to date. Of the 21 patients, 20 were full weight-bearing on day 1 postoperatively. Mean length of hospital stay was 12 days (5 to 27). Preoperative mobility status was maintained in 13 patients. At one year, mean Merle d'Aubigné score was 13.1 (10 to 18), mean Oxford Hip Score was 38.5 (24 to 44), mean EuroQol five-dimension five-level (EQ-5D-5L) health score was 68 (30 to 92), and mean EQ-5D-5L index score was 0.68 (0.335 to 0.837); data from 14 patients. Mortality was 9.5% (2/21) at one year. There have been no thromboembolic events, deep infections, or revisions. CONCLUSION: The coned hemipelvis reconstruction bypasses the fracture, creating an immediately stable construct that allows immediate full weight-bearing. The posterior approach minimizes the operative time and physiological insult in this vulnerable patient population. Early results suggest this to be a safe addition to current surgical options, targeted at the most medically frail elderly patient with a complex displaced acetabular fracture. Cite this article: Bone Joint J 2020;102-B(2):155-161.


Assuntos
Acetábulo/cirurgia , Fraturas Ósseas/cirurgia , Idoso Fragilizado , Fraturas por Osteoporose/cirurgia , Ossos Pélvicos/cirurgia , Acetábulo/lesões , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/métodos , Comores , Feminino , Fixação Interna de Fraturas/métodos , Humanos , Masculino , Procedimentos Cirúrgicos Reconstrutivos/métodos , Suporte de Carga
2.
Medicine (Baltimore) ; 99(2): e18202, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914013

RESUMO

To observe thoracolumbar segmental mobility using kinetic magnetic resonance imaging (kMRI) in patients with minimal thoracolumbar spondylosis and establish normal values for translational and angular segmental motion as well as the relative contribution of each segment to total thoracolumbar segmental motion in order to obtain a more complete understanding of this segmental motion in healthy and pathological conditions.Mid-sagittal images obtained by weight-bearing, multi-position kMRI in patients with symptomatic low back pain or radiculopathy were reviewed. The translational motion and angular variation of each segment from T10-L2 were calculated using MRAnalyzer Automated software. Only patients with a Pfirrmann grade of I or II, indicating minimal disc disease, for all thoracolumbar discs from T10-T11 to L1-L2 were included for further analysis.The mean translational motion measurements for each level of the lumbar spine were 1.15 mm at T10-T11, 1.20 mm at T11-T12, 1.23 mm at T12-L1, and 1.34 mm at L1-L2 (P < .05 for L1-L2 vs T10-T11). The mean angular motion measurements at each level were 3.26° at T10-T11, 3.92° at T11-T12, 4.95° at T12-L1, and 6.85° at L1-L2. The L1-L2 segment had significantly more angular motion than all other levels (P < .05). The mean percentage contribution of each level to the total angular mobility of the thoracolumbar spine was highest at L1-L2 (36.1%) and least at T10-T11 (17.1%; P < .01).Segmental motion was greatest in the proximal lumbar levels, and angular motion showed a gradually increasing trend from T10 to L2.


Assuntos
Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Espondilose/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Adolescente , Adulto , Feminino , Humanos , Degeneração do Disco Intervertebral/classificação , Degeneração do Disco Intervertebral/patologia , Cinética , Dor Lombar/patologia , Vértebras Lombares/patologia , Vértebras Lombares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular/fisiologia , Espondilose/fisiopatologia , Vértebras Torácicas/patologia , Vértebras Torácicas/fisiopatologia , Suporte de Carga , Adulto Jovem
3.
Gait Posture ; 75: 93-97, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31639614

RESUMO

BACKGROUND: Scoliosis is accepted as a 3-dimensional deformity involving axial, sagittal and frontal planes. RESEARCH QUESTION: To evaluate the correlation between baropodometric parameters and coronal balance status for idiopathic scoliosis. METHODS: 44 patients (7 males and 37 females) of Adolescent Idiopathic Scoliosis (AIS) were recruited. All participants should have scoliosis confirmed by a spine X-ray performed less than one month ahead of the baropodometric study. Radiographic studies including Cobb angle, offset between Central Sacral Vertical Line (CSVL) and C7 Vertebra Plumb Line (C7PL) (considered as global coronal balance, GCB), Apical Translation of the major curve (AT, considered as regional coronal balance) as well as Lateral Pelvic Tilt (LPT) were examined. A static baropodometry was performed for each patient. The contact surface and load ratio (to the entire load of both feet) were measured. RESULTS: On both sides, the surface of the forefoot was significantly larger than that of the rearfoot (P < 0.001) and the load ratio of the forefoot was significantly smaller than that of the rearfoot (P < 0.001). On the major curve side, GCB showed a positive correlation with the contact surface of the forefoot (r = 0.36, P = 0.019), as well as the load ratio (r = 0.40, P = 0.008). AT also showed a positive correlation with the load ratio of the forefoot (r = 0.331, P = 0.03) but no correlation with contact surface. SIGNIFICANCE: In scoliosis, coronal balance is correlated to plantar pressure distribution. Apical translation of the major curve and offset between CSVL and C7PL are the best describers of coronal balance.


Assuntos
Pé/fisiopatologia , Marcha/fisiologia , Escoliose/fisiopatologia , Adolescente , Criança , Feminino , Humanos , Masculino , Postura/fisiologia , Pressão , Radiografia , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Suporte de Carga/fisiologia
4.
Gait Posture ; 75: 129-136, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31678694

RESUMO

BACKGROUND: Task-specific loading of the limbs-termed as functional resistance training-is commonly used in gait rehabilitation; however, the biomechanical and neuromuscular effects of various forms of functional resistance training have not been studied systematically. This information is crucial for correctly selecting the appropriate mode of functional resistance training when treating individuals with gait disorders. RESEARCH QUESTION: To comprehensively evaluate the biomechanical (i.e., joint moment and power) and muscle activation changes with different forms of functional resistance training that are commonly used in clinics and research using biomechanical simulation-based analyses. METHODS: We developed simulations of functional resistance training during walking using OpenSim (Gait2354, 23 degrees of freedom and 54 muscles) and custom MATLAB scripts. We investigated five modes of functional resistance training that have been commonly used in clinics or in research: (1) a weight attached at the ankle, (2) an elastic band attached at the ankle, (3) a viscous device attached to the hip and knee, (4) a weight attached at the pelvis, and (5) a constant backwards pulling force at the pelvis. Lower-extremity joint moments and powers were computed using inverse dynamics and muscle activations were estimated using computed muscle control while walking with each device under multiple resistance levels: normal walking with no resistance, and walking with 30, 60, and 90 Newtons of resistance. RESULTS: The results indicate that the way in which resistance is applied during gait training differentially affects the internal joint moments, powers, and muscle activations as well as the joints and phase of the gait cycle where the resistance was experienced. SIGNIFICANCE: The results highlight the importance of understanding the joints and muscles that are targeted by various modes of functional resistance training and carefully choosing the best mode of training that meets the specific therapeutic needs of the patient.


Assuntos
Contração Muscular/fisiologia , Músculo Esquelético/fisiologia , Treinamento de Resistência/métodos , Caminhada/fisiologia , Fenômenos Biomecânicos , Simulação por Computador , Marcha/fisiologia , Humanos , Modelos Anatômicos , Suporte de Carga/fisiologia
5.
Clin Podiatr Med Surg ; 37(1): 23-37, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31735267

RESUMO

Imaging with biomechanical analysis augments the clinical examination and improves outcomes by correlating imaging findings with the examination. Plain film radiographs are the gold standard to assess osseous alignment. The biomechanical examination provides information to formulate an accurate assessment. Weightbearing computed tomography scanning is a potentially valuable for functional information about joint biomechanics. True alignment of the lower extremity can be appreciated on weightbearing computed tomography scanning. Soft tissue structures can be assessed with diagnostic ultrasound examination. Acute and chronic injuries that compromise joint stability can be identified.


Assuntos
Deformidades do Pé/diagnóstico por imagem , Deformidades do Pé/fisiopatologia , Humanos , Imagem por Ressonância Magnética , Radiografia , Amplitude de Movimento Articular/fisiologia , Ultrassonografia , Suporte de Carga/fisiologia
6.
J Orthop Res ; 38(1): 36-42, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31286548

RESUMO

In tendon, type-I collagen assembles together into fibrils, fibers, and fascicles that exhibit a wavy or crimped pattern that uncrimps with applied tensile loading. This structural property has been observed across multiple tendons throughout aging and may play an important role in tendon viscoelasticity, response to fatigue loading, healing, and development. Previous work has shown that crimp is permanently altered with the application of fatigue loading. This opens the possibility of evaluating tendon crimp as a clinical surrogate of tissue damage. The purpose of this study was to determine how fatigue loading in tendon affects crimp and mechanical properties throughout aging and between tendon types. Mouse patellar tendons (PT) and flexor digitorum longus (FDL) tendons were fatigue loaded while an integrated plane polariscope simultaneously assessed crimp properties at P150 and P570 days of age to model mature and aged tendon phenotypes (N = 10-11/group). Tendon type, fatigue loading, and aging were found to differentially affect tendon mechanical and crimp properties. FDL tendons had higher modulus and hysteresis, whereas the PT showed more laxity and toe region strain throughout aging. Crimp frequency was consistently higher in FDL compared with PT throughout fatigue loading, whereas the crimp amplitude was cycle dependent. This differential response based on tendon type and age further suggests that the FDL and the PT respond differently to fatigue loading and that this response is age-dependent. Together, our findings suggest that the mechanical and structural effects of fatigue loading are specific to tendon type and age in mice. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:36-42, 2020.


Assuntos
Envelhecimento/fisiologia , Ligamento Patelar/fisiologia , Animais , Fenômenos Biomecânicos , Feminino , Técnicas In Vitro , Camundongos Endogâmicos C57BL , Suporte de Carga
7.
J Orthop Res ; 38(1): 173-181, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31692087

RESUMO

Tendon cells exist in a dense extracellular matrix and mechanical loading is important for the strength development of this matrix. We therefore use a three-dimensional (3D) culture system for tendon formation in vitro. The objectives of this study were to elucidate the temporal expression of tendon-related genes during the formation of artificial tendons in vitro and to investigate if early growth response-1 (EGR1), EGR2, FOS, and cyclooxygenase-1 and -2 (PTGS1 and PTGS2) are sensitive to mechanical loading. First, we studied messenger RNA (mRNA) levels of several tendon-related genes during formation of tendon constructs. Second, we studied the mRNA levels of, for example, EGR1 and EGR2 after different degrees of loading; dynamic physiologic-range loading (2.5% strain), dynamic overloading (approximately 10% strain), or tension release. The gene expression for tendon-related genes (i.e., EGR2, MKX, TNMD, COL3A1) increased with time after seeding into this 3D model. EGR1, EGR2, FOS, PTGS1, and PTGS2 did not respond to physiologic-range loading. But overloading (and tension release) lead to elevated levels of EGR1 and EGR2 (p ≤ 0.006). FOS and PTGS2 were increased after overloading (both p < 0.007) but not after tension release (p = 0.06 and 0.08). In conclusion, the expression of tendon-related genes increases during the formation of artificial tendons in vitro, including EGR2. Furthermore, the gene expression of EGR1 and EGR2 in human tendon cells appear to be sensitive to overloading and unloading but did not respond to the single episode of physiologic-range loading. These findings could be helpful for the understanding of tendon tensional homeostasis. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:173-181, 2020.


Assuntos
Proteína 1 de Resposta de Crescimento Precoce/metabolismo , Proteína 2 de Resposta de Crescimento Precoce/metabolismo , Tenócitos/metabolismo , Engenharia Tecidual , Expressão Gênica , Humanos , Cultura Primária de Células , Suporte de Carga
8.
Artigo em Russo | MEDLINE | ID: mdl-31884763

RESUMO

The article considers the statistical justification of the need to minimize the load on the spine of students, both in Russia and in foreign countries and the main directions and multi-aspect regulation of optimizing the load on the spine, since this factor plays a key role in the formation of the health of the whole organism. The movement, correct posture, comfortable clothes and shoes, rationally selected chairs and beds allow you to maintain health of the spine, and the overload, in particular heavy school backpacks have a negative effect on its development and functioning. The issue of the load on the spine of schoolchildren attracts attention of the government, physicians, parents and teachers. The problem really exists and it is not solved yet, despite significant efforts in this direction. The numerous Russian and foreign studies carried out by medical experts, students and teachers confirm the facts of violation of SanPiNs, supporting actuality of research topic. The electronic textbooks can be a key point in solving this problem.


Assuntos
Instituições Acadêmicas , Coluna Vertebral , Estudantes , Criança , Humanos , Postura , Federação Russa , Suporte de Carga
9.
Medicine (Baltimore) ; 98(52): e18439, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876724

RESUMO

BACKGROUND: Our previous three-dimensional finite element analysis found that posterior cruciate ligament (PCL) reconstruction in the modified tibial tunneling placement (MTT, 10 mm inferior and 5 mm lateral to the PCL anatomical insertion) could reduce the peak stress of the graft and may reduce the killer turn. The purpose of the current study was to compare the biomechanical results between MTT and traditional tibial tunneling technique (TTT, PCL anatomical insertion) during transtibial PCL reconstruction. METHODS: Fifty-six 3D-printed tibia models and fresh mature porcine flexor digitorum tendons were studied. The PCL reconstruction specimens were randomly divided into TTT group and MTT group based on tibial tunnel placement. A 50 to 300 N cyclic loading was applied using a material testing system. Each specimen completed 2000 cycles at a rate of 200 mm/min and a loading frequency of 80 cycles/min. Load-displacement curves, failure mode, and graft displacement were recorded. Mean maximum contact pressure was measured using a pressure-sensitive film. After cyclic loading test, the surviving grafts were randomly assigned to load-to-failure group or Scanning Electron Microscopy (SEM) group. Ultimate failure load and the appearance of graft abrasion were recorded and analyzed. RESULT: During the cyclic loading test, 3 samples in the TTT group, and 2 in the MTT group were excluded because of the graft pullout during the test. Mean maximum contact pressure of killer turn was 9.30 ±â€Š0.29 MPa in the TTT group and 7.27 ±â€Š0.25 MPa in MTT group (P < .05). Mean graft displacement was 4.54 ±â€Š0.23 mm in the TTT group and 3.37 ±â€Š3.56 mm in the MTT group (P < .05). Maximum failure load was 1886.0 ±â€Š41.83 N in the TTT group and 2019.30 ±â€Š20.10 N in the MTT group (P < .05). The SEM analysis showed heavy abrasion and fiber discontinuity in graft in the TTT group, while it showed slight abrasion and fiber arrangement disorders in the MTT group. CONCLUSIONS: The MTT PCL reconstruction significantly reduced stress concentration and graft abrasion as compared with the TTT PCL reconstruction, and it may be a better choice for the reduction of "killer Turn" effect during transtibial PCL construction.


Assuntos
Ligamento Cruzado Posterior/transplante , Procedimentos Cirúrgicos Reconstrutivos/métodos , Fenômenos Biomecânicos , Humanos , Microscopia Eletrônica de Varredura , Modelos Anatômicos , Ligamento Cruzado Posterior/cirurgia , Suporte de Carga
10.
Dent Mater J ; 38(6): 1002-1011, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31666485

RESUMO

This study evaluated the effect of material type, thickness and composite-composite interfacial adhesion on the load-bearing capacity of the bilayered composite structures. Bilayered cylindrical specimens (diameter=7 mm, height=5 mm) were prepared having three surface-layer thicknesses (1, 1.5, 2 mm) of Gænial Posterior to overlay base-composites [everX Posterior or Smart Dentin Replacement (SDR)]. Adhesion between surface and base composite-layers was based on an O2-inhibited layer for optimal-adhesion (OA) or polished surface for deteriorated-adhesion (DA). Specimens (n=10) were light-cured before static-loading with a steel-ball until fracture. Stress distribution in the same designs of mechanical test was calculated by finite element analysis (FEA). Static-loading demonstrated that in both base materials, thickness and adhesion had an effect on load-bearing capacity (p<0.05). FEA showed less strain distribution for everX groups than SDR.With OA, everX Posterior demonstrated higher load-bearing capacity even with thin surface-composite layer. DA made the load-bearing capacity more sensitive to surface-layer thickness.


Assuntos
Resinas Compostas , Teste de Materiais , Suporte de Carga
11.
Bone Joint J ; 101-B(11): 1459-1463, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31674236

RESUMO

AIMS: Rotational acetabular osteotomy (RAO) is an effective joint-preserving surgical treatment for acetabular dysplasia. The purpose of this study was to investigate changes in muscle strength, gait speed, and clinical outcome in the operated hip after RAO over a one-year period using a standard protocol for rehabilitation. PATIENTS AND METHODS: A total of 57 patients underwent RAO for acetabular dysplasia. Changes in muscle strength of the operated hip, 10 m gait speed, Japanese Orthopaedic Association (JOA) hip score, and factors correlated with hip muscle strength after RAO were retrospectively analyzed. RESULTS: Three months postoperatively, the strength of the operated hip in flexion and abduction and gait speed had decreased from their preoperative levels. After six months, the strength of flexion and abduction had recovered to their preoperative level, as had gait speed. At one-year follow-up, significant improvements were seen in the strength of hip abduction and gait speed, but muscle strength in hip flexion remained at the preoperative level. The mean JOA score for hip function was 91.4 (51 to 100)) at one-year follow-up. Body mass index (BMI) showed a negative correlation with both strength of hip flexion (r = -0.4203) and abduction (r = -0.4589) one year after RAO. Although weak negative correlations were detected between strength of hip flexion one year after surgery and age (r = -0.2755) and centre-edge (CE) angle (r = -0.2989), no correlation was found between the strength of abduction and age and radiological evaluations of CE angle and acetabular roof obliquity (ARO). CONCLUSION: Hip muscle strength and gait speed had recovered to their preoperative levels six months after RAO. The clinical outcome at one year was excellent, although the strength of hip flexion did not improve to the same degree as that of hip abduction and gait speed. A higher BMI may result in poorer recovery of hip muscle strength after RAO. Radiologically, acetabular coverage did not affect the recovery of hip muscle strength at one year's follow-up. A more intensive rehabilitation programme may improve this. Cite this article: Bone Joint J 2019;101-B:1459-1463.


Assuntos
Acetábulo/cirurgia , Luxação do Quadril/fisiopatologia , Força Muscular/fisiologia , Músculo Esquelético/fisiologia , Osteotomia/métodos , Adulto , Feminino , Marcha/fisiologia , Luxação do Quadril/cirurgia , Articulação do Quadril/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia/reabilitação , Cuidados Pós-Operatórios/métodos , Estudos Retrospectivos , Resultado do Tratamento , Velocidade de Caminhada/fisiologia , Suporte de Carga/fisiologia , Adulto Jovem
12.
Medicine (Baltimore) ; 98(46): e18018, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725676

RESUMO

BACKGROUND: Cavus foot is a deformity represented by an increased and rigid medial longitudinal arch, and it is often associated with persistent pain and gait disturbances. None of the conservative conventional treatments for cavus foot have shown conclusive evidence of effectiveness, and so further is research needed to understand how to manage this condition better. This study aimed to assess the immediate and short-term radiological changes after combining static stretching and transcutaneous electrical stimulation of the plantar fascia in adults with idiopathic cavus foot. METHODS: A randomized, single-blinded clinical trial was conducted. Sixty-eight participants with idiopathic cavus foot, as determined by an internal Moreau-Costa-Bertani angle (MCBA) less than 125° in a lateral weight-bearing foot radiograph, were equally distributed into a neuromuscular stretching group (NSG) or a control group (no intervention). The NSG underwent a single session, combining transcutaneous electrical nerve stimulation with static stretching of the plantar fascia. Primary measurements of 3 angles were taken using a lateral weight-bearing foot radiograph: the internal MCBA; the calcaneal pitch angle (CPA); and the first metatarsal declination angle (FMDA). Outcomes were collected at baseline, immediately postintervention, and 1 week after intervention. RESULTS: Analysis of variance revealed a significant group effect for all angles (all, P < .05). NSG participants showed a significant increase in the internal MCBA (P = .03), and a significant decrease in the CPA (P = .01) and FMDA (P = .04) from baseline to immediately postintervention. These changes remained statistically significant 1 week after the intervention (all, P < .05). CONCLUSION: The combination of static stretching and transcutaneous electrical stimulation of the plantar fascia, compared with no treatment, achieved immediate and short-term changes in the internal MCBA, the CPA, and the FMDA, which resulted in flattening the medial longitudinal plantar arch in adults with idiopathic cavus foot.


Assuntos
Exercícios de Alongamento Muscular/métodos , Pé Cavo/terapia , Estimulação Elétrica Nervosa Transcutânea/métodos , Adulto , Terapia Combinada , Fáscia/fisiopatologia , Feminino , Humanos , Masculino , Método Simples-Cego , Pé Cavo/diagnóstico por imagem , Suporte de Carga , Adulto Jovem
13.
Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi ; 37(10): 746-751, 2019 Oct 20.
Artigo em Chinês | MEDLINE | ID: mdl-31726504

RESUMO

Objective: To investigate the influence of different variable combinations of the carrying system on gait and muscle fatigue during weight-bearing walking on both shoulders and back, and to optimize daily carrying experience. Methods: From September to December, 2018, 6 male college students were selected as subjects; the electromyographic signal of the anterior tibial muscle and plantar pressure were measured during weight-bearing walking under six different variable combinations of the carrying system (with the three variables of gravity center, single or double shoulders, and waist cushion), and a subjective evaluation test was performed for the degree of fatigue. The electromyographic data and plantar pressure data were processed and compared to evaluate behavior and fatigue. Results: Different variable combinations of the carrying system had significant influence on the degree of fatigue and gait (P<0.05). Both subjective and objective analyses found that the carrying system with different heights of gravity center and single-or double-shoulder carrying mode had great influence on human fatigue and walking gait, while the hardness of waist cushion had little influence. Compared with the other groups, the group with a high gravity center, a double-shoulder carrying mode, and a soft waist cushion had a significantly smaller slope of average electromyographic amplitude, a significantly larger slope of median frequency, and a significantly lower degree of plantar pressure curve disorder. Conclusion: The carrying system with a relatively high gravity center, a double-shoulder carrying mode, and a soft waist cushion can significantly relieve fatigue, with low influence on walking gait.


Assuntos
Marcha , Fadiga Muscular , Caminhada , Suporte de Carga , Humanos , Masculino
14.
Rev Prat ; 69(6): 616-619, 2019 Jun.
Artigo em Francês | MEDLINE | ID: mdl-31626416

RESUMO

The off-loading of diabetic foot ulcers is the most urgent and theoretically the easiest treatment to implement. Its effectiveness has been proven for decades by randomized controlled studies on neuropathic ulcers that heal with a cast in an average of 6 weeks with a high level of evidence. Total contact casts are not widely used throughout the world, although it is the standard treatment. Off-loading shoes are certainly effective but only if they are worn. It is the prescriber's challenge to obtain maximum compliance that makes it possible to avoid infections and secondary amputations that are totally avoidable most of the time and only related to the delay in optimal care, of which off loading is the essential part.


Assuntos
Pé Diabético , Suporte de Carga/fisiologia , Cicatrização , Amputação , Moldes Cirúrgicos , Pé Diabético/prevenção & controle , Pé Diabético/terapia , Humanos , Pressão , Sapatos
15.
J Pediatr Orthop ; 39(10): 527-533, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31599864

RESUMO

BACKGROUND: Individuals with clubfoot, treated in infancy with either the Ponseti method or comprehensive clubfoot release, often encounter pain as adults. Multiple studies have characterized residual deformity after Ponseti or surgical correction using physical exam, radiographs and pedobarography; however, the relationship between residual foot deformity and pain is not well defined. The purpose of the current study was 2-fold: (1) to evaluate the relationship between foot morphology and pain for young adults treated as infants for idiopathic clubfoot and (2) to describe and compare pedobarographic measures and outcome measures of pain and morphology among surgically treated, Ponseti treated, and typically developing feet. METHODS: We performed a case-control study of individuals treated for clubfoot at 2 separate institutions with either the Ponseti method or comprehensive clubfoot release between 1983 and 1987. All subjects (24 treated with comprehensive clubfoot release, 18 with Ponseti method, and 48 controls) were evaluated using the International Clubfoot Study Group (ICFSG) morphology scoring, dynamic pedobarography, and foot function index surveys. During pedobarography, we collected the subarch angle and arch index as well as the center of pressure progression (COPP) on all subjects. RESULTS: Foot morphology (ICFSG) scores were highly correlated with foot function index pain scores (r=0.43; P<0.001), although the difference in pain scores between the surgical and Ponseti group did not reach significance. The surgical group exhibited greater subarch angle and arch indexes than the Ponseti group, demonstrating a significant difference in morphology, a flatter foot. Finally, we found more abnormalities in foot progression, decreased COPP in the forefoot and increased COPP in the midfoot and hindfoot, in the surgical group compared with controls. CONCLUSIONS: Measures of foot morphology were correlated with pain among all treated for clubfoot. Compared with Ponseti method, comprehensive surgical release lead to greater long-term foot deformity, flatter feet and greater hindfoot loading time. LEVEL OF EVIDENCE: Level III-Therapeutic.


Assuntos
Moldes Cirúrgicos , Pé Torto Equinovaro/patologia , Pé Torto Equinovaro/terapia , Dor Musculoesquelética/etiologia , Procedimentos Ortopédicos , Adulto , Estudos de Casos e Controles , Pré-Escolar , Pé Torto Equinovaro/complicações , Feminino , Seguimentos , Pé/fisiopatologia , Humanos , Lactente , Recém-Nascido , Masculino , Pressão , Fatores de Tempo , Resultado do Tratamento , Suporte de Carga , Adulto Jovem
16.
Bone Joint J ; 101-B(10): 1256-1262, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31564155

RESUMO

AIMS: Postoperative rehabilitation regimens following ankle arthrodesis vary considerably. A systematic review was conducted to determine the evidence for weightbearing recommendations following ankle arthrodesis, and to compare outcomes between different regimens. PATIENTS AND METHODS: MEDLINE, Web of Science, Embase, and Scopus databases were searched for studies reporting outcomes following ankle arthrodesis, in which standardized postoperative rehabilitation regimens were employed. Eligible studies were grouped according to duration of postoperative nonweightbearing: zero to one weeks (group A), two to three weeks (group B), four to five weeks (group C), or six weeks or more (group D). Outcome data were pooled and compared between groups. Outcomes analyzed included union rates, time to union, clinical scores, and complication rates. RESULTS: A total of 60 studies (2426 ankles) were included. Mean union rates for groups A to D were 93.2%, 95.5%, 93.0%, and 93.0%, respectively. Mean time to union was 10.4 weeks, 14.5 weeks, 12.4 weeks, and 14.4 weeks for groups A to D, respectively. Mean complication rates were 22.3%, 23.0%, 27.1%, and 28.7% for groups A to D, respectively. Reporting of outcome scores was insufficient to conduct meaningful analysis. CONCLUSION: Outcomes following ankle arthrodesis appear to be similar regardless of the duration of postoperative nonweightbearing, although the existing literature is insufficient to make definitive conclusions. Cite this article: Bone Joint J 2019;101-B:1256-1262.


Assuntos
Articulação do Tornozelo/cirurgia , Artrodese/métodos , Medição da Dor , Cuidados Pós-Operatórios/métodos , Suporte de Carga/fisiologia , Fatores Etários , Idoso , Articulação do Tornozelo/fisiopatologia , Artrodese/reabilitação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular/fisiologia , Recuperação de Função Fisiológica , Medição de Risco , Fatores Sexuais
17.
J Appl Biomech ; 35(5): 320-326, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31541067

RESUMO

The authors tested 4 young healthy subjects walking with a powered knee exoskeleton to determine if it could reduce the metabolic cost of locomotion. Subjects walked with a backpack loaded and unloaded, on a treadmill with inclinations of 0° and 15°, and outdoors with varied natural terrain. Participants walked at a self-selected speed (average 1.0 m/s) for all conditions, except incline treadmill walking (average 0.5 m/s). The authors hypothesized that the knee exoskeleton would reduce the metabolic cost of walking uphill and with a load compared with walking without the exoskeleton. The knee exoskeleton reduced metabolic cost by 4.2% in the 15° incline with the backpack load. All other conditions had an increase in metabolic cost when using the knee exoskeleton compared with not using the exoskeleton. There was more variation in metabolic cost over the outdoor walking course with the knee exoskeleton than without it. Our findings indicate that powered assistance at the knee is more likely to decrease the metabolic cost of walking in uphill conditions and during loaded walking rather than in level conditions without a backpack load. Differences in positive mechanical work demand at the knee for varying conditions may explain the differences in metabolic benefit from the exoskeleton.


Assuntos
Metabolismo Energético , Exoesqueleto Energizado , Joelho , Músculo Esquelético/metabolismo , Caminhada/fisiologia , Adulto , Teste de Esforço , Humanos , Masculino , Consumo de Oxigênio , Suporte de Carga
18.
Gait Posture ; 74: 212-217, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31561119

RESUMO

BACKGROUND: A growing body of literature supports the promising effect of real-time feedback to re-train runners. However, no studies have comprehensively assessed the effects of foots trike and cadence modification using different forms of real-time feedback provided via wearable devices. RESEARCH QUESTION: The purpose of the present study was to determine if a change could be made in foot strike pattern and plantar loads using real-time visual, auditory and combined feedback provided using wearable devices. METHODS: Visual, auditory and combined feedback were provided using wearable devices as fifteen recreational runners ran on a treadmill at self-selected speed and increased cadence. Plantar loads and location of initial contact were measured with a flexible insole system. Repeated measures ANOVAs with Bonferroni adjusted pair-wise comparisons were used to assess statistical significance. RESULTS AND SIGNIFICANCE: A significant effect of condition was noted on location of center of pressure (p < 0.01). Bonferroni-adjusted post-hoc comparisons showed that feedback conditions differed from baseline as well as the new cadence conditions, however did not differ from each other. A significant interaction effect (region x feedback) was found for plantar loads (maximum force P < 0.001). Significant effects of feedback were noted at the heel (P < 0.001), medial midfoot (P < 0.001), lateral midfoot (P < 0.001), medial forefoot (P = 0.003), central forefoot (P = 0.003), and great toe (P = 0.004) but not at the lateral forefoot (P = 0.6) or lateral toes (P = 0.507). SIGNIFICANCE: The unique findings of our study showed that an anterior shift of the center of pressure, particularly when foot strike modification was combined with 10% increased cadence. We found lower heel and midfoot loads along with higher forefoot and great toe loads when foot strike modification using real-time feedback was combined with increased cadence. Our findings also suggest that auditory feedback might be more effective than visual feedback in foot-strike modification.


Assuntos
Pé/fisiologia , Feedback Formativo , Corrida/fisiologia , Dispositivos Eletrônicos Vestíveis , Suporte de Carga/fisiologia , Adulto , Análise de Variância , Teste de Esforço , Feminino , Calcanhar/fisiologia , Humanos , Masculino , Atividade Motora/fisiologia , Sapatos , Dedos do Pé/fisiologia , Adulto Jovem
19.
Zhongguo Gu Shang ; 32(8): 692-695, 2019 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-31533377

RESUMO

OBJECTIVE: To investigate clinical effect of partly weight-bearing walking and functional exercise immediatly after operation for Achilles tendon rupture(ATR) on function of ankle joint and rate of fragmentation of Achilles tendon, through comparing effect of partly weight-bearing walking and functional exercise immediatly at 2 weeks after operation for Achilles tendon rupture. METHODS: Sixty-four patients with ATR selected from March 2012 to March 2013 were randomly divided into two groups. There were 34 patients in treatment group, including 18 males and 16 females with an average age of 41.4±7.6, they began to do functional exercise and walk on fields with partly weight-bearing at two days after operation; there were 30 patients in control group, including 16 males and 14 females with an average age of 39.9±7.6, and they were immobilized with plaster in plantar flexion at two weeks after operation, and started to do functional exercise and walk on fields with partly weight-bearing at two weeks after operation. Two groups were performed by the same doctor with the same operation. The rate of fragmentation of Achilles tendon, and AOFAS score and complications between two groups were observed and compared. RESULTS: AOFAS score in treatment group at two weeks after operation was 74.3±3.9, which in control group was 71.7±4.2, and had statistical differences between two groups; AOFAS score in treatment group at one year after operation was 93.3±3.9, which in control group was 92.0±4.1, and had no statistical significance. No Achilles tendon fragmentation in treatment group occurred at three years after operation, and 1 patient occurred in control group. Two patients in treatment group occurred complications after operation, and 1 patient occurred in control group, however, there was no statistical significance between two groups. CONCLUSIONS: Functional exercise immediate after operation for Achilles tendon rupture(ATR) patients in the early days, the AOFAS scores is higher than the fixing for two weeks, and does not increase the rate of fragmentation of Achilles tendon and complication after operation, and benefits for function recovery.


Assuntos
Tendão do Calcâneo , Traumatismos dos Tendões , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ruptura , Resultado do Tratamento , Suporte de Carga
20.
Gait Posture ; 74: 154-161, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31525653

RESUMO

BACKGROUND: Abnormal peak plantar pressure in neuropathic diabetic foot during walking activities is well managed through the use of appropriate design and material selection for the fabrication of custom made insoles (CMI). The redistribution of plantar pressure is possible by selecting an appropriate material for the fabrication of CMI. The walking activities may alter the plantar pressure distribution; which may differ while using CMI with different materials. OBJECTIVE: The objective of the study was to evaluate the effectiveness of CMI's materials on plantar pressure distribution during different walking activities, in diabetic feet with neuropathy. METHODS: The study was conducted on sixteen diabetic neuropathic subjects. The subjects were provided with two types of CMI; CMI-A (Plastazote® and microcellular rubber) and CMI-B (Multifoam, Plastazote® and microcellular rubber). Maximum peak plantar pressure and plantar pressure distribution were determined by Pedar-X® sensor insole during level walking, ramp walking and stair walking. RESULTS: The CMI-B lessened the maximum peak plantar pressure from the forefoot throughout the walking activities compared to CMI-A. The contact area was observed as lower using CMI-A compared to CMI-B, while performing walking activities. CONCLUSION: CMI-B, with multifoam as an additional top layer, provided more effective peak plantar pressure reduction at forefoot and it had better plantar pressure distribution compared to CMI-A during level walking and ramp ascending in diabetic foot with neuropathy.


Assuntos
Diabetes Mellitus/fisiopatologia , Pé Diabético/fisiopatologia , Órtoses do Pé , Pé/fisiopatologia , Caminhada/fisiologia , Suporte de Carga/fisiologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pressão , Sapatos
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