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1.
1病例简介患者男,67岁,主因"右髋疼痛,活动受限20余年,加重1年"入院。入院查体:患者持拐行走,右下肢不能负重,右髋固定屈曲30°外旋20°畸形,有10°主动屈曲活动度,内收外展内旋外旋活动度均为零,活动痛明显,可见脊柱下腰段后凸畸形,脊柱各节段均无活动度。Thomas征(+),右侧髂腰肌股四头肌肌力4级,余髋关节肌群因髋关节活动受限无法准确检查。 相似文献
2.
目的:采用基于惯性传感器的运动捕捉系统分析脑性瘫痪(简称脑瘫)患儿和正常儿童以自然步速在日常生活环境中行走时的步态特征。方法:2021年6—12月,在广州市妇女儿童医疗中心康复科招募20例6—12岁脑瘫患儿,面向社会招募同龄20例正常儿童。采集所有儿童的年龄及性别等基本资料后,利用基于惯性传感器的运动捕捉系统采集并分析其以自然步速在日常生活环境中(医院走廊,连续两次行走20m)行走时的步态时空、运动学参数和腰部活动角度。结果:与正常儿童相比,脑瘫患儿的步行周期变长(P<0.05),支撑相在整个周期的占比增大,摆动相的占比减少(P<0.05);跨步长变短,步频加快(P<0.05);髋屈曲、伸展角度受限,髋内旋角度增大,膝屈曲、踝跖屈角度受限,腰后伸、侧屈及右旋转角度增大(P<0.05)。结论:脑瘫患儿的步行周期、支撑相、跨步长、步频、下肢及腰部关节活动度有明显异常。基于惯性传感器的运动捕捉系统可有效识别脑瘫患儿在日常生活环境中行走时的步态特征。 相似文献
3.
摘要
目的:分析所设计的下肢康复机器人腰部机构能否满足脑卒中患者的康复需求,并根据分析结果对机构进行优化。
方法:对腰部机构进行运动学建模和正逆解计算,在此基础上,根据患者在行走康复训练中腰胯部的运动学特点,利用MATLAB软件对机构进行运动学仿真,并分析仿真结果,以此来判断所设计的机构能否满足脑卒中患者在康复训练时的需求。
结果:滑块机构可以实现患者在行走康复训练过程中腰部的上下起伏运动,两个平行四边形机构和两个转动副共同作用可以完全实现患者腰部的左右摆动,转动副和末端的两个球面副可以实现患者腰部的三个旋转自由度。
结论:康复机器人腰部机构能够满足患者在行走康复训练时腰部的运动需求。 相似文献
4.
脊柱骨折是临床上常见的骨折,约占全身骨折的5%~6%,以胸腰段多见,屈曲型损伤居多[1],一般脊柱骨折后8周内禁止下床活动[2],排便要在床上进行。护理人员协助患者排便时,不可直接抬臀放置便盆,以避免脊柱前屈加重损伤。放置便盆时需2~3人进行,将胸腰段与臀部同时抬起,在放置便盆同时在腰部垫枕,或帮助患者侧 相似文献
5.
背景:目前国内外尚未成功建立双足直立的灵长类的特发性脊柱侧凸实验动物模型。随着计算机和影像学的飞速发展,现在可以做到通过计算机软件来虚拟人类特发性脊柱侧凸模型,并进行相关的生物力学分析,为临床手术操作提供指导。目的:利用有限元模型验证PUMCⅡd2型特发性脊柱侧凸脊柱融合治疗的最佳融合节段。设计、时间及地点:对比观察,于2007-05/2008-05在北京协和医院骨科完成。对象:PUMCⅡd2脊柱侧凸女性患者1例,为双弯畸形。方法:利用PUMCⅡd2型特发性脊柱侧凸有限元模型(T5-S),分别模拟上胸弯融合、下腰弯融合和双弯融合方式,在侧弯凹侧端椎椎弓根内分别赋予50,100,150N载荷,比较上弯端椎T5和下弯端椎T11在矢状面向上的位移(Z轴正值为矢状面向上的位移,负值为矢状面向下的位移)以及二者之间的差值,以T5位移代表双弯矫形效果,以T11位移代表下腰弯矫形效果,二者差值(T5-T11)代表上胸弯矫形效果。主要观察指标:不同融合节段、不同矫形力下的T5和T11位移。结果:对于PUMCⅡd2型侧弯,T5在Z轴的位移:双弯矫型较单纯上弯或者下弯矫形融合位移大(P〈0.01)。T5~T11位移差:双弯矫形﹥单纯上胸弯矫形﹥单纯下腰弯矫形(P〈0.01)。T11在Z轴的位移:双弯矫形﹥单纯下腰弯矫形﹥单纯上胸弯矫形(P〈0.01)。结论:对于PUMCⅡd2型侧弯,双弯矫型内固定较单纯上弯或者下弯矫形融合内固定效果好;3种载荷对于上胸弯的矫正效果:双弯矫形〉单纯上胸弯矫形﹥单纯下腰弯矫形;3种载荷对于下腰弯的矫正效果:双弯矫形〉单纯下腰弯矫形〉单纯上胸弯矫形。三维有限元分析法可以作为一种有效的方法应用于脊柱侧弯畸形矫正的生物力学分析,为临床开创了一种虚拟、无创的验证方式,可以优化手术方案。 相似文献
6.
背景:目前国内外尚未成功建立双足直立的灵长类的特发性脊柱侧凸实验动物模型.随着计算机和影像学的飞速发展,现在可以做到通过计算机软件来虚拟人类特发性脊柱侧凸模型,并进行相关的生物力学分析,为临床手术操作提供指导.目的:利用有限元模型验证PUMC Ⅱd_2型特发性脊柱侧凸脊柱融合治疗的最佳融合节段.设计、时间及地点:对比观察,于2007-05/2008-05在北京协和医院骨科完成.对象:PUMCⅡd_2脊柱侧凸女性患者1例,为双弯畸形.方法:利用PUMC Ⅱd_2型特发性脊柱侧凸有限元模型(T_5-S),分别模拟上胸弯融合、下腰弯融合和双弯融合方式,在侧弯凹侧端椎椎弓根内分别赋予50,100,150 N载荷,比较上弯端椎T_5和下弯端椎T_(11)在矢状面向上的位移(Z轴正值为矢状面向上的位移,负值为矢状面向下的位移)以及二者之间的差值,以T5位移代表双弯矫形效果,以T_(11)位移代表下腰弯矫形效果,二者差值(T_5~T_(11))代表上胸弯矫形效果.主要观察指标:不同融合节段、不同矫形力下的T_5和T_(11)位移.结果:对于PUMCⅡd_2型侧弯,T_5在Z轴的位移:双弯矫型较单纯上弯或者下弯矫形融合位移大(P<0.01).T_5~T_(11)位移差:双弯矫形>单纯上胸弯矫形>单纯下腰弯矫形(P<0.01).T_(11)在Z轴的位移:双弯矫形>单纯下腰弯矫形>单纯上胸弯矫形(P<0.01).结论:对于PUMCⅡd_2型侧弯,双弯矫型内固定较单纯上弯或者下弯矫形融合内固定效果好;3种载荷对于上胸弯的矫正效果:双弯矫形>单纯上胸弯矫形>单纯下腰弯矫形;3种载荷对于下腰弯的矫正效果:双弯矫形>单纯下腰弯矫形>单纯上胸弯矫形.三维有限元分析法可以作为一种有效的方法应用于脊柱侧弯畸形矫正的生物力学分析,为临床开创了一种虚拟、无创的验证方式,可以优化手术方案. 相似文献
7.
目的 评价不同经后路内固定方法治疗胸腰段脊柱骨折伴脊髓损伤的疗效。方法 回顾性分析 96例经后路长、短节段内固定治疗胸腰段脊柱骨折伴脊髓损伤患者术后神经功能恢复程度、骨折复位愈合效果和并发症的发生情况。结果 短节段组在神经功能恢复程度上与长节段组无显著差异 (P >0 .0 5 ) ,但短节段组的脊柱后凸术后矫正丢失角度明显 <长节段组 ,而且并发症少。结论 后路短节段内固定治疗胸腰段脊柱骨折伴脊髓损伤的效果明显优于后路长节段内固定 相似文献
8.
摘要
目的:观察肌筋膜放松训练对正常人腰部神经肌肉功能的影响,为肌筋膜放松训练的临床应用提供依据。
方法:试验采用随机双盲设计,共23例男性健康受试者,随机分为空白组(7例)、安慰剂组(8例)、试验组(8例)。试验组进行腰部的肌筋膜放松训练,安慰剂组给予模拟电刺激,空白组不做任何干预。每位受试者在干预后即刻(0 min)、10 min、20 min进行躯干的屈曲-伸展测试,并同时采集L3、L5水平左右双侧竖脊肌和多裂肌的表面肌电信号(surface electromyography, sEMG)以及躯干和骨盆在矢状面上的运动加速度信号。计算并分析三组的腰椎屈曲关节活动度、竖脊肌和多裂肌在屈曲—放松现象中肌电静息开始(EMG-off)和终止(EMG-on)时的腰椎角度,以及屈曲—放松比(flexion-relaxation ratio, FRR)。
结果:空白组、安慰剂组、试验组的腰椎关节活动度、竖脊肌和多裂肌EMG-off、EMG-on时的腰椎角度无显著性差异(P>0.05),在三个不同时间点内试验组的FRR值与空白组和安慰剂组比较,大部分具有显著性差异(P<0.05)。
结论:肌筋膜放松训练后腰部竖脊肌和多裂肌的主动活动功能提高,肌肉激活模式得到改善。放松后不影响腰部的神经肌肉功能,对腰椎稳定性具有强化作用。 相似文献
9.
急性腰扭伤多发生于青壮年 ,常由弯腰提重物时姿势不正确、重心离躯干过远、几人抬重物动作不协调或一人突然失足、腰部活动范围过大造成腰部软组织过度牵拉或撕裂所致[1 ] 。我们采用冷疗和综合疗法治疗 5 4例急性腰扭伤患者 ,取得满意效果 ,报道如下。资料与方法一、临床资料急性腰扭伤患者 86例全部为门诊患者 ,其中男 67例 ,女19例 ;年龄 :17~ 5 4岁 ,平均 41岁 ;病程 :2h~ 3d ;均有明显的腰扭伤史 ;伤后立即出现腰部剧痛 ,腰部有撕裂或折断感 ,坐卧翻身困难 ,由他人扶来门诊 ;体检 :腰部僵硬 ,有明显压痛 ,腰部活动受限 ,腰段脊柱… 相似文献
10.
正脊柱侧凸(Scoliosis)是指脊柱的一个或数个节段向侧方弯曲伴有椎体旋转的三维脊柱畸形~([1])。脊柱侧凸的发病率:女性2%,男性0.5%,其中特发性脊柱侧凸占80%以上,其确切原因尚不清楚。特发性脊柱侧凸按照发病年龄,分为婴儿型(0-3岁);少儿型(3-10岁);青少年型(10岁后)。婴儿型特发性脊柱侧凸是在3岁内发现的一种结构性脊柱畸形,男婴多见,通常侧弯凸向左侧;侧弯多位于胸段和胸腰段;多数侧弯在出生后6 相似文献
11.
OBJECTIVE: To evaluate if patients move their trunk sections differently than normal subjects and to determine if these differences increase when lifting a load. DESIGN: Comparative study using a repeated measures design. BACKGROUND: Many studies demonstrate a modification of the lumbar-pelvic rhythm for chronic low back pain patients but the large variability of the results impair the discrimination power. It was hypothesized that the lifting of a load would magnify the manifestation of lumbar impairments. METHODS: Fifteen chronic low back pain patients and 18 normal subjects performed maximal flexion-extension and lateral bending of the trunk with and without a 12 kg load. The pelvic, lumbar and thoracic motions were measured with a motion analysis system. RESULTS: During flexion-extension tasks, a significant decrease in lumbar flexion and increase in thoracic flexion were observed for the patients. The load effect was significant for all trunk sections but did not allow a better discrimination between groups. CONCLUSIONS: Lifting a 12 kg load during flexion-extension of the trunk did confirm alteration in trunk section coordination but did not help to better discriminate patients from normal subjects. However, it was demonstrated for the first time that chronic low back pain patients compensate for a loss of lumbar flexion by increasing their thoracic flexion. RELEVANCE: The lumbar-pelvic rhythm is routinely used to evaluate low back impairments. The use of kinematic measures enhance the objectivity of the examination but the large variability of the results impair the discrimination power. Lifting a load during such an evaluation might magnify the low back impairments and increase the discrimination power of this measure. 相似文献
12.
Objective. The purpose of this study was to determine the importance of model and cardan angle sequence for calculating thorax kinematics. Background. Patients with myelomeningocele often show a significant lateral bending and large trunk rotation over the gait cycle. The temporal pattern and magnitudes of these rotations are important for clinical decision-making. Two common thorax models and two orders of rotation in calculating the thoracic kinematics are compared. Methods. Thoracic kinematics in eight myelomeningocele patients were studied retrospectively. Four markers were placed on the trunk in addition to the lower limb markers. Each child walked at a self-selected speed over the walkway in bare feet. The spatial position and orientation of each segment were computed from the marker position at 2% of the gait cycle. Cardan angles for two thorax models were calculated using two different orders of rotation with respect to both the laboratory and the pelvic reference systems. Results. The results showed that differences between models in the coronal and transverse planes were greater than in the sagittal plane. The changes in the modelling technique yielded the greatest differences when comparing between models. Conclusions. Clinical significant differences were found between changes in different thorax models and between the sequences of rotation for subjects with pathological thoracic motion. This clearly indicates that existing thorax models based on indirect marker placement may give misleading kinematic measurements. Different rotation sequences also lead to different results and an analysis of these suggests that the conventional sequence (flexion, lateral bending, axial rotation), is preferable for the thorax. Relevance Accurate measurement of thoracic motion will enhance our understanding of both the pathological and compensatory mechanism in the gait pattern of children with myelomeningocele. Furthermore, the current investigation on thorax kinematics will lead to calculation of the motion of the center of mass and future methodology to calculate thoracic kinetics. 相似文献
13.
[Purpose] The purpose of this study was to compare the lumbar flexion angle and
electromyography (EMG) measurements of trunk muscle activity in individuals with and
without limited hip flexion range of motion (ROM) during visual display terminal (VDT)
work with cross-legged sitting. [Subjects] The 15 participants included a control group
with sufficient hip flexion ROM (n = 7) and an experimental group with limited hip flexion
ROM (n = 8). [Methods] All subjects performed VDT work with cross-legged sitting. The
lumbar flexion angle was measured using a three-dimensional motion capture system, and the
trunk muscle activity was recorded using a surface EMG system during VDT work with
cross-legged sitting. The differences in trunk flexion angle and trunk muscle activity
between the two groups were analyzed using independent t-tests. [Results] The lumbar
flexion angle was significantly greater in the experimental group than the control group,
although trunk muscle activity did not differ between the two groups. [Conclusion] These
findings suggest that limited hip flexion leads to greater lumbar flexion during
cross-legged sitting.Key words: Cross-legged sitting, Electromyography, Lumbar flexion 相似文献
14.
BackgroundIn case of people suffering from chronic low back pain, specific movements of the hip, pelvis, and trunk are associated with pain. Comparing range of motion measurements for multiple planes and from different segments and lines in reference to those of healthy individuals seems interesting but present interpretations challenge in relation to important number of variables and correlation with clinical data. MethodsThe proposed index is based on using principal component analysis to quantify differences in trunk mobility between patients with chronic low back pain and a control group. Kinematic data were recorded for the cervical and thoracic vertebrae, the lumbar spine, and the pelvic and scapular belts during repeated trials (hip flexion and extension, hip bending, and trunk twists). Angular motion values were calculated. Principal component analysis was used to convert 10 discrete variables (kinematical data) extracted from control data into 10 independent variables. FindingsThe proposed index comprises the sum of the variables. Initial demonstration of its clinical utility and statistical tests of this index validity were revealed. It establishes correlations between the psychosocial impact of chronic low back pain, trunk mobility (as summarized by the index) and the positive effects of functional restoration program. InterpretationThis index let to assess the absolute potential benefits of rehabilitation in term of kinematic motion. Functional restoration program promotes the physical functioning of patients by increasing their range of motion. This index uses kinematic motion to assess the potential benefits of such rehabilitation program. 相似文献
15.
背景:近年来随着对脊柱生物力学研究的深入,人工椎间盘被认为是治疗腰椎退行性变较理想的方法,但目前对人工腰椎间盘的生物力学研究还非常有限.目的:建立腰椎运动节段人工椎间盘置换的三维有限元模型并进行生物力学分析,观察人工椎间盘置换对腰椎小关节应力的影响.方法:在已建立的正常腰椎运动节段三维有限元模型的基础上去除L4~5椎间盘、上下终板的有限元单元,加入SB-Chaite Ⅲ型人工椎间盘的有限元模型,保留L4~5椎间隙的纤维环及相关韧带,形成L4~5运动节段人工椎间盘置换的三维有限元模型.对三维有限元模型在垂直压缩、前屈、后伸、侧弯等不同载荷下进行生物力学分析,记录小关节的应力,并与正常运动节段三维有限元模型相应部位的应力进行对比.结果与结论:生物力学分析结果显示,人工椎间盘置换后:①垂直压缩时上下椎体、双侧小关节内应力与正常节段相比差异无显著性意义(P > 0.01).②前屈、后伸时上下椎体前、后方及双侧小关节内应力与正常节段相比差异无显著性意义(P > 0.01).③侧弯时上下椎体左右两侧及双侧小关节内应力与正常节段相比差异无显著性意义(P > 0.01).提示人工腰椎间盘置换后小关节应力可保持在正常运动节段的水平,人工腰椎间盘置换可以达到腰椎生物力学性能重建的目的. 相似文献
16.
BackgroundElectromyography-assisted (EMG-assisted) biomechanical models are used to characterize the muscle and joint reaction forces in the lumbar region. However, during a full-range trunk flexion, there is a transition of extension moment from the trunk extensor muscles to the passive tissues of the low back, indicating that the empirical EMG data used to drive these EMG-assisted models becomes less correlated with the extensor moment. The objectives of this study were to establish the trunk flexion angles at which the passive tissues generate substantial trunk extension moment and to document how these angles change with asymmetry. MethodsParticipants performed controlled trunk flexion–extension motions in three asymmetric postures. The trunk kinematics data and the electromyographic activity from L3- and L4-level paraspinals and rectus abdominis were captured. The time-dependent net internal active moment (from an EMG-assisted model) and the net external moment were calculated. The trunk and lumbar angles at which the net internal active moment was less than 70% of the external moment were found. FindingsThe trunk flexion angle at which the net internal moment reaches the stated criteria varied as a function of asymmetry of trunk flexion motion with the sagittally symmetric case providing the deepest flexion angle of 38° (asymmetry 15°: 33°; asymmetry 30°: 26°). InterpretationThese results indicate that EMG-assisted biomechanical models need to consider the role of passive tissues at trunk flexion angles significantly less than previously thought and these flexion angles vary as a function of the asymmetry and direction of motion. 相似文献
17.
BACKGROUND: A new on-body personal lift augmentation device was developed to support the back muscles during the repetitive lifting task. METHODS: Nine male subjects participated in the study. Three Fastrak units were used to record positions and rotations of the segments. Trunk muscle normalized and integrated electromyography of the left and right thoracic erector spinae, lumbar erector spinae, external obliques, and rectus abdominis, as well as the kinematic variables of peak lumbar angle, peak pelvis angle, peak trunk acceleration, peak load acceleration were compared in symmetrical lifting for three different loads (5 kg, 15 kg, 25 kg) with three different styles (stooped, squat, free) under two conditions of with and without personal lift assist device. FINDINGS: The lift assist device significantly reduced the required muscular effort of the lumbar (p = 0.001) and thoracic erector spinae with no significant differences in the level of abdominal muscle activity. The amount of integrated electromyography reduction ranged from 14.4% to 27.6% for the lumbar and thoracic erector spinae respectively. Simple measures of trunk posture and accelerations confirmed that there were no differences in lifting technique that would cause the integrated electromyography activity to be reduced. No major kinematic differences were found when the lift assist device was worn indicating that it did not alter these specific technique variables. INTERPRETATION: The lift assist device did reduce the required muscular effort of the lumbar and thoracic erector spinae without adversely affecting the level of abdominal muscle activity. This reduction may help reduce the risk of recurring back injuries or assist in the return to work phase, especially in repetitive tasks. 相似文献
18.
BackgroundAlthough gait analysis has been previously conducted for lumbar spinal stenosis patients, the vertebral segmental movements, such as of the thoracic and lumbar regions, and whether the spinal movement during gait changes after decompression surgery remain unclear. MethodsTen patients with lumbar spinal stenosis and 10 healthy controls participated. Clinical outcomes were assessed using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire and Visual Analogue Scale. Spinal kinematic data of the participants during gait were acquired using a three-dimensional motion analysis system. The trunk (whole spine), thoracic, and lumbar flexion and pelvic tilting values were calculated. Spinal kinematic data and clinical outcomes were collected preoperatively and 1 month postoperatively for the patients. FindingsCompared to that observed preoperatively, the clinical outcomes significantly improved at 1 month postoperatively. In the standing position, the preoperative lumbar extension of the patients was significantly smaller than that of the controls. Moreover, during gait, the lumbar flexion relative to the standing position of the patients was smaller than that of the controls preoperatively, and increased at 1 month postoperatively. The sum of the thoracic and lumbar flexion values during gait negatively correlated with the score for leg pain. InterpretationThe epidural pressure of lumbar spinal stenosis patients is known to be higher than that of normal subjects during gait, and to decrease during walking with lumbar flexion. Preoperatively, smaller thoracic and lumbar flexion movements during gait relative to the standing position cannot decrease epidural pressure; as a result, severe leg pain might be induced. 相似文献
19.
目的 评价腰椎后路Ray-TFC的即时稳定性。方法采用国人成年男性新鲜脊柱标本进行离体生物力学实验,以中性区(NZ)和运动范围(ROM)为观测指标,通过生物力学实验机测定单纯Ray-TFC植入后腰椎运动节段的三维稳定性。结果 单纯Ray-TFC植入后,NZ在前屈、后伸和侧弯时明显减小,但ROM在后伸和旋转时明显增大。结论 后路Ray-TFC植入可使腰椎运动节段的即时稳定性在除旋转的所有方向上显提高,其对腰椎运动节段稳定性的影响在国人与西方人之间无显差异。 相似文献
20.
OBJECTIVE: Main purpose of this study was to develop a biomechanical model for the analysis of sit-to-stand movement in normal and obese subjects. DESIGN: A biomechanical model describing sit-to-stand was developed using kinetic and kinematic experimental data. Trunk flexion, feet movement, knee and hip joint torques were assumed as sensible indexes to discriminate between normal and obese subjects. BACKGROUND: Sit-to-stand is a functional task that may become difficult for certain patients. The analysis of its execution provides useful biomechanical information on the motor ability of selected subjects. METHODS: Sit-to-stand was recorded using an optoelectronic system and a force platform in 40 obese patients and 10 normal subjects. A biomechanical model was developed using inverse dynamics equations. RESULTS: Kinematic and kinetic indexes evidenced differences in motion strategy between normal and obese subjects. Obese subjects rise from the chair limiting trunk flexion (mean value: 73.1 degrees ) and moving their feet backwards from initial position (mean deviation: 50 mm). Normal subjects, instead, show a higher trunk flexion (mean value: 49.2 degrees, a lower angular value between trunk and the horizontal means increased flexion) and fixed feet position (mean deviation: 5 mm). As for kinetics, obese patients show knee joint torque higher than hip torque (maximum knee torque: 0.75 Nm/kg; maximum hip torque: 0.59 Nm/kg), while normal subjects show opposite behaviour (maximum knee torque: 0.38 Nm/kg; maximum hip torque: 0.98 Nm/kg). RELEVANCE: We found differences in motion strategy between normal and obese subjects performing sit-to-stand movement, which may be used to plan and evaluate rehabilitative treatments. 相似文献
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