基于有限元的方法,用于确定治疗和预防足跟溃疡的最佳减压设计。

Finite element-based method for determining an optimal offloading design for treating and preventing heel ulcers.

机构信息

Biorobotics and Biomechanics Lab (BRML), Faculty of Mechanical Engineering, Technion-Israel Institute of Technology, 32000, Haifa, Israel.

Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel.

出版信息

Comput Biol Med. 2021 Apr;131:104261. doi: 10.1016/j.compbiomed.2021.104261. Epub 2021 Feb 9.

Abstract

Diabetic heel ulceration, a serious, destructive, and costly complication of diabetes, is often treated by custom-made offloading footwear. One common offloading device is a custom-made insole designed with a hole under the damaged site that is intended to reduce local mechanical loads on the ulcer. However, current devices do not take into account the increasing loads at the wound peripheries, and quantitative assessments and scientific guidelines for the optimal design of the offloading hole are lacking. Here, we develop a novel method to determine the volumetric exposure to mechanical loading of a human heel, at two volume of interests (VOIs) during walking in 150 different finite-element footwear configurations. We defined the two VOIs as (1) the area of the heel soft tissues typically at high risk of ulceration, and (2) the soft tissues surrounding the high risk area. For all model variants, three hole-geometry parameters were defined: (1) radius, (2) radius of curvature (ROC) and (3) depth. We found two combinations of the offloading parameters which minimize heel loads in both VOIs. The first is with a large offloading radius, large ROC and large depth, whereas the second is with a large offloading radius, large depth but relatively small ROC. Our novel practical scientific analysis method, that takes into account the ulcer site as well as the peripheral area, has the potential to optimize development of offloading solutions by streamlining the examination of their biomechanical efficiency, and thus may revolutionize prevention and treatment of diabetic ulcers at any foot location.

摘要

糖尿病性足跟溃疡是糖尿病的一种严重、破坏性且昂贵的并发症,通常采用定制式减压鞋具进行治疗。一种常见的减压装置是一种定制的鞋垫,其在受损部位下方设计有一个孔,旨在减少溃疡处的局部机械负荷。然而,目前的装置没有考虑到伤口周边的负荷增加,也缺乏关于减压孔最佳设计的定量评估和科学指南。在这里,我们开发了一种新方法,用于确定人足跟在行走过程中两个感兴趣区域(VOI)的机械加载体积暴露情况,涉及 150 种不同的有限元鞋具配置。我们将这两个 VOI 定义为:(1) 足跟软组织中通常容易发生溃疡的高风险区域;(2) 高风险区域周围的软组织。对于所有模型变体,我们定义了三个减压孔几何参数:(1) 半径;(2) 曲率半径(ROC);(3) 深度。我们发现了两种可以使两个 VOI 中的足跟负载最小化的减压参数组合。第一种是采用大减压半径、大 ROC 和大深度的组合,第二种是采用大减压半径、大深度但相对较小 ROC 的组合。我们的新实用科学分析方法考虑到了溃疡部位以及周边区域,有可能通过简化对减压解决方案生物力学效率的检查来优化其开发,从而可能彻底改变任何足部位置的糖尿病性溃疡的预防和治疗。

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