基于气动肌腱混合驱动上肢康复装置的开发与研制

目的:设计一款基于气动肌腱混合驱动的上肢康复装置。该装置一方面可增加康复训练装置的柔顺性,降低使用者在康复训练中被造成二次伤害的可能性,另一方面兼顾到对肩关节大范围高效率康复治疗的追求。方法:首先根据人因工程学确定上肢各关节运动角度范围,通过D-H法对其进行正向运动学求解得到外骨骼末端运动轨迹。然后,进行动力学建模与分析,求出各个关节驱动所需扭矩。最后设计合理的控制系统,对装置各个关节运动进行数学模型建立并进行Matlab/Simulink仿真验证控制系统的合理性。结果:得到基于气动肌腱混合驱动的上肢康复装置的末端运动轨迹、关节运动角度和驱动扭矩并设计其控制系统。结论:研究结果对基于气动肌腱混合驱动的上肢康复装置控制系统的上下位机程序编写提供良好的参考依据,并对上肢康复训练器械的开发具有指导意义。     

壤塘县50岁以上成人大骨节病患者日常生活能力的影响因素分析

目的分析影响壤塘县50岁以上的成人大骨节病患者日常生活能力受限的主要因素,便于研究制定综合防治措施。方法由大骨节病课题组相关骨外科,风湿免疫科,地方病专家设计壤塘县大骨节病患者上肢功能调查表,纳入壤塘县50岁以上大骨节病患者127例,现场完成病史采集、查体及评分。根据其上肢日常生活能力评分进行分组,与病程、上肢大关节受累数目之间进行相关性统计分析,各组之间大骨节病分度例数分布进行统计学分析。结果日常生活能力受限比例最高的是便后拭净112例(88.2%),其次做糌粑104例(81.9%);上肢关节活动受限比例最高的是伸肘121例(95.3%),其次是屈肘118例(92.91%);其上肢日常生活能力评分与病程及上肢大关节受累数目呈正相关(P<0.05),各分组之间的大骨节病分度例数分布无明显统计学差异(P>0.05)。结论大骨节病病程与上肢大关节受累数目是壤塘县50岁以上成人大骨节病患者上肢日常生活能力受限的主要因素;伸屈肘障碍是影响其上肢日常生活能力的重要原因。     

可穿戴上肢康复机器人的设计及其运动仿真和动力学分析

目的针对目前台式上肢康复机器人体积庞大、不便移动的缺点,设计了一款新型的可穿戴式上肢康复机器人,并通过对其运动特性的分析和关节力矩的计算,验证设计的合理性。方法首先,根据模块化设计原理,进行总体结构设计;然后,利用SOILDWORKS进行三维建模,并运用SOILDWORKS Motion对机器人肘关节屈曲/伸展运动、肩关节屈曲/伸展运动、肩肘关节联动运动进行运动仿真;最后,基于拉格朗日方法建立系统的动力学方程,并应用MATLAB软件计算得到机械臂关节力矩的变化曲线。结果仿真结果证实了肩关节、肘关节、腕关节运动仿真曲线平滑,动力学分析证实关节力矩变化曲线平滑且最大关节力矩均小于电机经减速后输出的额定转矩。结论该可穿戴式上肢康复机器人设计合理,为后续上肢康复机器人的研究奠定了理论基础。     

MPU6050在评定人体上肢关节角度中的应用

该文开发了一套上肢康复评定仪器,用于评定肘关节及肩关节的关节活动度。该仪器包括下位机硬件和上位机评定软件,通过MPU6050传感器采集关节运动的加速度和角速度信号,并将数据经蓝牙串口传输至上位机评定软件。该仪器实现了实时评定上肢关节的运动参数,并能动态显示上肢关节运动状态。对仪器进行可靠性测试,组内相关系数均大于0.6,说明该仪器具有良好的可靠性,能准确地输出患者关节运动角度,对临床上制定合理的康复训练计划有重要意义。     

新型腰椎后路动态稳定系统的三维有限元分析

目的对新型腰椎后路动态稳定系统进行三维有限元分析,研究其在稳定节段及邻近节段的生物力学影响,为下腰痛的脊柱内植物的设计和应用提供参考。方法基于正常腰椎有限元模型,构建腰椎不稳损伤模型,即腰椎切除腰4和腰5之间的双侧小关节、腰4椎板下1/2、后纵韧带,形成脊柱失稳模型,分别在失稳模型上进行坚强内固定系统和后路动态稳定系统,比较两种术式对手术节段和临近阶段的活动度、各个节段的弯曲刚度、椎间盘应力水平、前纵韧带应力水平及小关节韧带拉力的变化情况。结果对内固定桥接节段(腰4/腰5)应用新型腰椎后路动态稳定系统和坚强内固定系统后,在屈伸、侧屈、轴向旋转方向上的活动度均明显减小,但坚强固定后活动度减小更明显,应用动态稳定系统活动度更接近于正常腰椎节段;腰4/腰5椎间盘最大应力均减小,但坚强固定后活动度减小更明显,应用动态稳定系统活动度更接近于正常腰椎节段;对邻近节段(腰3/腰4、腰5/S1)应用新型腰椎后路动态稳定系统和坚强内固定系统后,在屈伸、侧屈、轴向旋转方向上的活动度均有所增大,但坚强固定后活动度增加更明显,应用动态稳定系统邻近节段活动度更接近于正常腰椎节段;邻近节段椎间盘最大应力均增大,但坚强固定后增大更明显,应用动态稳定系统更接近于正常腰椎节段;应用腰椎内固定后,邻近节段的小关节应力峰值增大,并且应用腰椎坚强内固定模型的小关节应力增大更多;应用腰椎动态固定的模型邻近关节应力峰值更加接近完整腰椎模型。结论新型腰椎后路动态稳定系统对比坚强内固定系统能够使失稳节段的活动更加接近于正常,减小邻近节段的活动度增加,减小邻近节段椎间盘及小关节压力,说明新型腰椎动态稳定系统达到设计要求。     

动态关节松动术 Mulligan 在腰椎小关节紊乱患者康复治疗中的应用

目的:探讨动态关节松动术Mulligan在腰椎小关节紊乱患者康复治疗中的应用.方法:选取我院2020年4月至2020年12月间收治的82例腰椎小关节紊乱患者,根据随机抛硬币法分为观察组与对照组(n=41).对照组患者接受常规治疗,观察组接受动态关节松动术Mulligan治疗.分别于治疗前及治疗后8 w采用视觉模拟评分法(Visual analogue scale,VAS)以及日本骨科协会评分(Japanese Orthopaedic Association scores,JOA)评估患者疼痛程度及关节功能的变化;同时采用酶偶联法检测血清肌酸激酶(Creatine kinase,CK)和乳酸脱氢酶(Lactate dehydrogenase,LDH)水平.结果:观察组治疗后VAS评分、CK、LDH水平均明显低于对照组(P<0.05),JOA评分明显高于对照组(P<0.05).结论:动态关节松动术Mulligan可减轻腰椎小关节紊乱患者疼痛,改善功能障碍情况,促进恢复.     

经皮内固定治疗陈旧性肩锁关节全脱位生物力学分析

肩锁关节是上肢与躯干的唯一骨性关节,肱骨承载的应力大部分要通过肩胛骨与锁骨传到躯干骨。所以,肩锁关节不仅是个很重要的力的传递关节,而且也是上肢活动力的一个支撑点。如果肩锁关节脱位得不到良好的复位,将限制锁骨和肩胛骨的运动,直接影响到上肢的功能。因此,保证肩锁关节的良好复位与固定就显得尤为重要。经皮内固定治疗陈旧性肩锁关节全脱位的治疗方法,是依据肩锁关节的生物力学原理,吸取了闭合疗法和手术疗法的双重优点,具有损伤小,痛苦少,固定牢靠及可进行早期功能锻炼的特点,达到了韧带修复与功能恢复并进的目的．对…     

寰枢关节后路动态固定的生物力学研究

目的探讨动态固定(转动钉、滑动钉)对寰枢关节稳定性的影响。方法用6具新鲜成人枕骨(Oc)～颈椎(C4)节段进行测试,分别模拟完整状态、损伤状态、坚强固定、转动钉固定、滑动钉固定。采用重复测量的实验设计,在完整、损伤和不同固定状态下,通过脊柱试验机对标本分别施加1.5 N·m前屈/后伸、左/右侧弯和左/右轴向旋转纯力偶矩。三维运动系统测量寰枢椎运动,分析比较固定节段角度的运动范围(range of motion,ROM)和中性区(neutral zone,NZ)。结果损伤状态下,寰枢关节ROM在前屈、后伸、侧弯和旋转方向上均显著增加,产生了寰枢关节不稳。在前屈、后伸、侧弯和旋转方向上,坚强固定和动态固定后ROM均显著减小。与坚强固定比较,动态固定仅在侧弯方向上ROM较大。动态固定显著减小了在屈伸、侧弯和旋转方向上的NZ,且与坚强固定之间的差异无显著性。结论寰枢关节动态固定后,在前屈、后伸和旋转方向上的稳定性与坚强固定相当,但在侧弯方向上较弱。动态固定能够维持寰枢关节的相对稳定。     

西安秦始皇兵俑耳廓造型的解剖学考察

目的通过对秦兵俑耳廓造型解剖学考察,为进一步探索秦代在体质观测、科学应用与艺术表达能力诸方面提供人类学基础。方法采用现场观测与望远摄影观测,主要对西安临潼秦俑博物馆1号坑215例兵俑耳廓的16项解剖学标志结构的造型表达,开展了非测量性考察。结果发现能准确或接近正常位置形态的耳廓造型可达138例,占64%;解剖学标志结构造型表达频数为2663,占77.4%;准确表达10项以上结构的有138侧俑耳,占64%;经分析具有统计学意义。结论考察表明,秦兵俑耳廓造型及解剖学结构的表达基本准确,说明2000多年前秦兵俑的创作者已能充分掌握丰富的体质人类学解剖知识和具备相当娴熟的艺术造型的应用能力。     

抓举过程中运动员的上肢运动学分析

人体运动过程中,身体各部位的加速度、角加速度等运动学参数对计算关节力、关节力矩及肌肉力等动力学参数起着至关重要的作用.文章通过分析人体运动过程中关节坐标系相对世界坐标系的瞬时位置关系,以及各时刻关节坐标系空间位置关系,提出了基于关节坐标系的人体运动学参数计算方法.然后,以运动员抓举杠铃过程中的上肢运动为例,利用运动捕捉系统进行数据采集,计算出前臂在运动过程中的质心平移加速度和角加速度.结果 表明,前臂质心总的平移加速度主要由竖直方向的分量构成,而角加速度主要在改变杠铃轨迹过程中产生.     

HOW DIFFERENT VARIABLES AFFECT THE ACCURACY OF HAND- TIMING

To analyze the process of hand- timing and the resulting data collected from the hand - timing computer system（ HTCS）, in cluding the timing operator＇ s reaction times of starting and stopping the watch, the results from the timing, the simulated electronic timing, the major factor that affects the time - keeper＇s accuracy of time - keeping were studied,i, e. the stability of the time - keeper＇s reaction time,rather than the time - keeper＇ s reation time. The leading cause that inflicts error between the hand - time - keeping and the electrionic time - keeping consists in the pitfall that the time - keeper makes a wrong judgment in stopping the watch. The analytical results provide theoretic gist for the selection and training of time - keeping operators.     

Relationship between the dynamic range of cochlear nerve fibres and their spontaneous activity

Summary The dynamic ranges of cochlear nerve fibres in cats were determined automatically and were related to the fibres' rates of spontaneous activity, in both pooled data and data from individual cochlear nerves. The dynamic range represents the range of levels of a tone at the characteristic frequency of the fibre evoking mean discharge rates between spontaneous and saturated activity.In common with the findings of other investigators, the distribution of spontaneous discharge rates was bimodal. The total population could be divided into two sub-populations with spontaneous discharge rates above and below 15 spikes/s, respectively.The mean dynamic range of fibres having spontaneous discharge rates in excess of 15 spikes/s, was 41 dB (±0.65 S.E.); that for fibres with rates below 15 spikes/s was 50 dB (±1.2 S.E.). While the distributions of dynamic ranges of the two populations overlapped, they were significantly different, and dynamic ranges in excess of 60 dB were only found in substantial numbers (23%) in the population having low spontanous discharge rates. Some of these were not saturated at the highest stimulus levels used.     

猴对不同冲击力的动态响应特性

６只猴在活体，麻醉状态下承受１－５０ｇ连续１６次垂直冲击实验，测试了冲击台，座椅，猴的头，胸，腹等部位的加速度值，其中３只猴还接受手术埋藏传感器以测量下腰椎，肝和胃的数据，根据身体不同部位响应的峰值相对于座椅峰加速度的相关关系，所得到的方程表明猴对冲击的响应特性可看作拟线性系统。     

可控微管道结构支架构造及旋转式动态培养研究

骨组织工程中。支架的构造。尤其是支架内部微管结构的构造。是一项十分关键的技术。利用光固化快速成形间接构造方法。制备尺寸适合。空间走向、分支、相互连通性完全可控的微管道结构支架。光学显微镜下观察表明：所构造微管道尺寸均在200-600μm，其空间走向、分支与设计结构一致。微管道之间完全相互连通。将所构造支架复合成骨细胞之后。分别置入6孔培养板和自行研制的旋转式三维动态培养系统。进行体外培养。用扫描电镜观察细胞在其表面和内部微管道的生长情况。结果表明：三维动态培养条件下。支架表面的细胞分布更加均匀，微管道内部也有少量细胞长入。     

Airway abnormalities in very early treated infantile‐onset Pompe disease: A large‐scale survey by flexible bronchoscopy

Early enzyme replacement therapy (ERT) improve long‐term outcomes in patients with infantile‐onset Pompe disease (IOPD). Our cohort of patients with IOPD at Taipei Veterans General Hospital (TVGH) joined Taiwan Pompe newborn screening program from 2008, testing more than one million newborns until 2018. By 2010, we had established rapid diagnostic strategies. Now, the average age of ERT initiation starts at an average age of <10 days‐old, the earliest group in the world. However, they still presented some airway problems. We present a retrospective study focused on airway abnormalities in these patients along 8 years of observation. Fifteen patients with IOPD, who received very early treatment at a mean age of 8.94 ± 3.75 days, underwent flexible bronchoscopy (FB) for dynamic assessment of the whole airway. Long‐term clinical outcomes and relevant symptoms of the upper airway were assessed. All patients in the study had varying degrees of severity of upper airway abnormalities and speech disorders. The three oldest children (Age 94, 93, and 88 months, respectively) had poor movement of the vocal cords with reduced abduction and adduction and had silent aspiration of saliva through the glottis during respiration. This is the largest cohort study presented to date about airway abnormalities in very early treated patients with IOPD patients by FB. Despite very early treatment, we observed upper airway abnormalities in these IOPD patients. In IOPD, upper airway abnormalities seem inevitable over time. We suggest early and continuous monitoring for all IOPD patients, even with early and regular treatment.     

Experimental muscle pain results in reorganization of coordination among trapezius muscle subdivisions during repetitive shoulder flexion

The aim of the study was to examine the effect of experimental unilateral upper trapezius muscle pain on the relative activation of trapezius muscle subdivisions bilaterally during repetitive movement of the upper limb. Surface EMG signals were detected from nine healthy subjects from the upper, middle and lower divisions of trapezius during a repetitive bilateral shoulder flexion task. Measurements were performed before and after injection of 0.5 ml hypertonic (pain condition) and isotonic (control) saline into the upper division of the right trapezius muscle in two experimental sessions. On the painful side, upper trapezius showed decreased EMG amplitude (average rectified value, ARV) and lower trapezius increased ARV throughout the entire task following the injection of hypertonic saline (40.0 ± 22.2 vs. 26.0 ± 17.4 μV, and 12.5 ± 7.6 vs. 25.6 ± 14.8 μV, respectively, at the beginning of the contraction). On the side contralateral to pain, greater estimates of ARV were identified for the upper division of trapezius as the task progressed (37.4 ± 20.2 vs. 52.7 ± 28.4 μV, at the end of the contraction). Muscle fiber conduction velocity did not change with pain in all three divisions of the right trapezius muscle. The results suggest that local elicitation of nociceptive afferents in the upper division of the trapezius induces reorganization in the coordinated activity of the three subdivisions of the trapezius in repetitive dynamic tasks.     

Is the use of vestibular information weighted differently across the initiation of walking?

The purpose of this experiment was to examine vestibular contributions at specific times during the initiation of walking in human subjects. Subjects began walking forward at the sound of an auditory tone, with vision present or occluded. Galvanic vestibular stimulation (GVS) was delivered with the anode electrode on the right or left side at either: (1) onset of the anticipatory postural adjustment (APA), (2) toe-off of the first swing limb (TO) or (3) heel contact of the first swing limb (HC). Ground reaction forces and kinematic data were collected. Upper body (roll angles from head, trunk and pelvis) and lower body (foot placement) data were analysed to determine whether the timing and magnitude of the response to GVS, and therefore the level of vestibular contribution, was modulated at different points during the initiation of gait. With vision present and occluded, the magnitude of the lower body response varied depending on the event in the gait cycle at which the stimulation was delivered. These novel results demonstrate evidence that vestibular weighting during gait initiation is dependent upon the specific gait initiation events. Upper body roll also exhibited magnitude differences between events. However, these changes are proposed to occur due to the transition from a stationary position into a dynamic state, prompting the increased weighting of vestibular information. With vision present no significant changes were seen in the segment roll response. The observations suggest a distinction in vestibular regulation of upper body roll versus foot placement for successful completion of the gait initiation task. Changes in upper body roll are influenced by the dynamic nature of the task, whereas foot placement changes are modulated based on the event during gait initiation at which GVS is delivered.     

Haptic selective attention by foot and by hand

Nonvisual perceptions of a wielded object's spatial properties are based on the quantities expressing the object's mass distribution, quantities that are invariant during the wielding. The mechanoreceptors underlying the kind of haptic perception involved in wielding – referred to as effortful, kinesthetic, or dynamic touch – are those embedded in the muscles, tendons, and ligaments. The present experiment's focus was the selectivity of this muscle-based form of haptic perception. For an occluded rod grasped by the hand at some intermediate position along its length, participants can attend to and report selectively the rod's full length, its partial lengths (fore or aft of the hand), and the position of the grip. The present experiment evaluated whether participants could similarly attend selectively when wielding by foot. For a given rod attached to and wielded by foot or attached to (i.e. grasped) and wielded by hand, participants reported (by magnitude production) the rod's whole length or fractional length leftward of the point of attachment. On measures of mean perceived length, accuracy, and reliability, the degree of differentiation of partial from full extent achieved by means of the foot matched that achieved by means of the hand. Despite their neural, anatomical, and experiential differences, the lower and upper limbs seem to abide by the same principles of selective muscle-based perception and seem to express this perceptual function with equal facility.     

人密质骨动态力学性能及莫电效应

本实验建立起用Ｈｏｐｋｉｎｓｏｎ压杆技术，测量骨动态力学性能及骨应变源电动势的实验方法，对新鲜人股骨密质进行测试。①低应变率下（２ｘ１０－３／ｓ）骨弹性模量值为１３．６ＧＰａ，与高应变率（６ｘ１０２／ｓ）下骨弹性模量值１８．３ＧＰａ之间差别显著，表明骨是一种粘弹性材料。②结合骨断面扫描电镜图象，讨论了静、动载荷下骨创伤发生的机制，证实骨单位粘合线处是密质骨力学性能薄弱点，骨单位断裂前发生骨板相对滑动。③湿骨试件应变源电动势（ＳＧＰｓ）峰值较干骨试件大，且时相滞后于骨应变时相约４４μｓ，干骨试件ＳＧＰｓ无明显滞后。④提出压电效应和流动电动势分别是干、湿骨试件ＳＧＰｓ产生的机制。实验结果为新型骨生物材料研制，临床骨伤病电刺激疗法的应用，以及骨折愈合质量的评价等，提供了理论依据。