Li Lunjian, Liu Xuanchi, Patel Minoo, Zhang Lihai
Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria, Australia.
Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria, Australia.
J Biomech. 2025 Jan;179:112458. doi: 10.1016/j.jbiomech.2024.112458. Epub 2024 Dec 5.
With the internal volar locking plate (VLP) technique emerging as a preferred surgical approach, early post-surgery therapeutic exercises have shown promise in promoting wrist functionality after distal radial fractures (DRFs). The biomechanical microenvironment, particularly the role of biomechanical stimuli, plays a crucial role in guiding stem tissue formation at the fracture site. However, much less is known about how various hand exercises interact with the microenvironment and influence fracture healing outcomes. This study employed the Leap Motion Controller for markerless hand motion capture and utilised an enhanced OpenSim hand model to simulate these motions. An advanced DRF healing model, integrating angiogenesis and the mechano-regulated maturation of callus tissue, was applied to simulate the MSCs differentiation and predict the healing outcomes. The effects of various rehabilitation exercises on DRFs' healing outcomes were systematically analysed. The results showed rehabilitation exercises, such as wrist extension/flexion and ulnar deviation, generally had a higher contact force on the distal radius compared with the slack state. Also, the relationship between contact force and muscle activations was not always linear, reflecting the intricate dynamics of the kinematic system. Exercise could induce changes in the bony bridge and cartilage formation, while angiogenesis remained unaffected. In the initial weeks, gripping exercises proved most beneficial, but as time progressed, extension and flexion exercises became more advantageous. The study highlights the importance of tailoring rehabilitation exercises to the dynamic healing process of DRFs. As the healing trajectory progresses, the therapeutic efficacy of specific exercises evolves, necessitating adaptive and patient-specific rehabilitation programs.
随着掌侧锁定钢板（VLP）技术成为一种首选的手术方法，术后早期治疗性锻炼在促进桡骨远端骨折（DRF）后的腕部功能恢复方面显示出了前景。生物力学微环境，特别是生物力学刺激的作用，在引导骨折部位的干组织形成中起着关键作用。然而，对于各种手部锻炼如何与微环境相互作用并影响骨折愈合结果，人们了解得要少得多。本研究采用Leap Motion控制器进行无标记手部运动捕捉，并利用增强的OpenSim手部模型来模拟这些运动。应用一个先进的DRF愈合模型，该模型整合了血管生成和骨痂组织的机械调节成熟过程，以模拟间充质干细胞的分化并预测愈合结果。系统分析了各种康复锻炼对DRF愈合结果的影响。结果表明，与松弛状态相比，腕部伸展/屈曲和尺偏等康复锻炼通常在桡骨远端产生更高的接触力。此外，接触力与肌肉激活之间的关系并不总是线性的，这反映了运动系统的复杂动态。锻炼可诱导骨桥和软骨形成的变化，而血管生成不受影响。在最初几周，抓握锻炼被证明最有益，但随着时间的推移，伸展和屈曲锻炼变得更具优势。该研究强调了根据DRF的动态愈合过程调整康复锻炼的重要性。随着愈合轨迹的进展，特定锻炼的治疗效果会发生变化，因此需要适应性强且针对患者的康复计划。
