Dimeo Andrew J, Lalush David S, Grant Edward, Morcuende Jose A
Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC, USA.
J Pediatr Orthop. 2012 Oct-Nov;32(7):e47-52. doi: 10.1097/BPO.0b013e3182571656.
Congenital talipes equinovarus (clubfoot) is a complex deformity of the lower extremity and foot occurring in 1/1000 live births. Regardless of treatment, whether conservative or surgical, clubfoot has a stubborn tendency to relapse, thus requiring postcorrection bracing. However, to date, there are no investigations specifically focused on clubfoot bracing from a bioengineering perspective. This study applied engineering principles to clubfoot bracing through construction of a surrogate biomodel. The surrogate was developed to represent an average 5-year-old human subject capable of biomechanical characteristics including joint articulation and kinematics. The components include skeleton, articulating joints, muscle-tendon systems, and ligaments. A protocol was developed to measure muscle-tendon tension in resting and braced positions of the surrogate. Measurement error ranged from 1% to 6% and was considered variance due to brace and investigator. In conclusion, this study shows that surrogate biomodeling is an accurate and repeatable method to investigate clubfoot bracing. The methodology is an effective means to evaluate wide ranging brace options and can be used to assist in future brace development and the tuning of brace parameters. Such patient-specific brace tuning may also lead to advanced braces that increase compliance.
先天性马蹄内翻足（畸形足）是一种发生于千分之一活产儿中的下肢和足部的复杂畸形。无论采用保守治疗还是手术治疗，畸形足都有顽固的复发倾向，因此需要矫正后使用支具。然而，迄今为止，尚无专门从生物工程学角度对畸形足支具进行的研究。本研究通过构建一个替代生物模型，将工程原理应用于畸形足支具。该替代模型被开发用于代表一个具有包括关节活动和运动学在内的生物力学特征的5岁人类受试者平均水平。其组成部分包括骨骼、关节、肌腱系统和韧带。制定了一项方案来测量替代模型在休息和佩戴支具位置时的肌腱张力。测量误差范围为1%至6%，被认为是由支具和研究者导致的差异。总之，本研究表明替代生物建模是一种研究畸形足支具的准确且可重复的方法。该方法是评估各种支具选择的有效手段，可用于协助未来支具的开发和支具参数的调整。这种针对患者的支具调整也可能会带来提高依从性的先进支具。
