Virtual power based algorithm for decoupling large motions from infinitesimal strains: application to shoulder joint biomechanics

New trends of numerical models of human joints require more and more computation of both large amplitude joint motions and fine bone stress distribution. Together, these problems are difficult to solve and very CPU time consuming. The goal of this study is to develop a new method to diminish the calculation time for this kind of problems which include calculation of large amplitude motions and infinitesimal strains. Based on the Principle of Virtual Power, the present method decouples the problem into two parts. First, rigid body motion is calculated. The bone micro-deformations are then calculated in a second part by using the results of rigid body motions as boundary conditions. A finite element model of the shoulder was used to test this decoupling technique. The model was designed to determine the influence of humeral head shape on stress distribution in the scapula for different physiological motions of the joint. Two versions of the model were developed: a first version completely deformable and a second version based on the developed decoupling method. It was shown that biomechanical variables, as mean pressure and von Mises stress, calculated with the two versions were sensibly the same. On the other hand, CPU time needed for calculating with the new decoupled technique was more than 6 times less than with the completely deformable model.     

Effects of idealized joint geometry on finite element predictions of cartilage contact stresses in the hip

Computational models may have the ability to quantify the relationship between hip morphology, cartilage mechanics and osteoarthritis. Most models have assumed the hip joint to be a perfect ball and socket joint and have neglected deformation at the bone-cartilage interface. The objective of this study was to analyze finite element (FE) models of hip cartilage mechanics with varying degrees of simplified geometry and a model with a rigid bone material assumption to elucidate the effects on predictions of cartilage stress. A previously validated subject-specific FE model of a cadaveric hip joint was used as the basis for the models. Geometry for the bone-cartilage interface was either: (1) subject-specific (i.e. irregular), (2) spherical, or (3) a rotational conchoid. Cartilage was assigned either a varying (irregular) or constant thickness (smoothed). Loading conditions simulated walking, stair-climbing and descending stairs. FE predictions of contact stress for the simplified models were compared with predictions from the subject-specific model. Both spheres and conchoids provided a good approximation of native hip joint geometry (average fitting error ～0.5 mm). However, models with spherical/conchoid bone geometry and smoothed articulating cartilage surfaces grossly underestimated peak and average contact pressures (50% and 25% lower, respectively) and overestimated contact area when compared to the subject-specific FE model. Models incorporating subject-specific bone geometry with smoothed articulating cartilage also underestimated pressures and predicted evenly distributed patterns of contact. The model with rigid bones predicted much higher pressures than the subject-specific model with deformable bones. The results demonstrate that simplifications to the geometry of the bone-cartilage interface, cartilage surface and bone material properties can have a dramatic effect on the predicted magnitude and distribution of cartilage contact pressures in the hip joint.     

Comparison of deformable and elastic foundation finite element simulations for predicting knee replacement mechanics

Rigid body total knee replacement (TKR) models with tibiofemoral contact based on elastic foundation (EF) theory utilize simple contact pressure-surface overclosure relationships to estimate joint mechanics, and require significantly less computational time than corresponding deformable finite element (FE) methods. However, potential differences in predicted kinematics between these representations are currently not well understood, and it is unclear if the estimates of contact area and pressure are acceptable. Therefore, the objectives of the current study were to develop rigid EF and deformable FE models of tibiofemoral contact, and to compare predicted kinematics and contact mechanics from both representations during gait loading conditions with three different implant designs. Linear and nonlinear contact pressure-surface overclosure relationships based on polyethylene material properties were developed using EF theory. All other variables being equal, rigid body FE models accurately estimated kinematics predicted by fully deformable FE models and required only 2% of the analysis time. As expected, the linear EF contact model sufficiently approximated trends for peak contact pressures, but overestimated the deformable results by up to 30%. The nonlinear EF contact model more accurately reproduced trends and magnitudes of the deformable analysis, with maximum differences of approximately 15% at the peak pressures during the gait cycle. All contact area predictions agreed in trend and magnitude. Using rigid models, edge-loading conditions resulted in substantial overestimation of peak pressure. Optimal nonlinear EF contact relationships were developed for specific TKR designs for use in parametric or repetitive analyses where computational time is paramount. The explicit FE analysis method utilized here provides a unique approach in that both rigid and deformable analyses can be run from the same input file, thus enabling simple selection of the most appropriate representation for the analysis of interest.     

Evaluation of a subject-specific finite-element model of the equine metacarpophalangeal joint under physiological load

The equine metacarpophalangeal (MCP) joint is frequently injured, especially by racehorses in training. Most injuries result from repetitive loading of the subchondral bone and articular cartilage rather than from acute events. The likelihood of injury is multi-factorial but the magnitude of mechanical loading and the number of loading cycles are believed to play an important role. Therefore, an important step in understanding injury is to determine the distribution of load across the articular surface during normal locomotion. A subject-specific finite-element model of the MCP joint was developed (including deformable cartilage, elastic ligaments, muscle forces and rigid representations of bone), evaluated against measurements obtained from cadaver experiments, and then loaded using data from gait experiments. The sensitivity of the model to force inputs, cartilage stiffness, and cartilage geometry was studied. The FE model predicted MCP joint torque and sesamoid bone flexion angles within 5% of experimental measurements. Muscle–tendon forces, joint loads and cartilage stresses all increased as locomotion speed increased from walking to trotting and finally cantering. Perturbations to muscle–tendon forces resulted in small changes in articular cartilage stresses, whereas variations in joint torque, cartilage geometry and stiffness produced much larger effects. Non-subject-specific cartilage geometry changed the magnitude and distribution of pressure and the von Mises stress markedly. The mean and peak cartilage stresses generally increased with an increase in cartilage stiffness. Areas of peak stress correlated qualitatively with sites of common injury, suggesting that further modelling work may elucidate the types of loading that precede joint injury and may assist in the development of techniques for injury mitigation.     

Computationally efficient finite element evaluation of natural patellofemoral mechanics

Finite element methods have been applied to evaluate in vivo joint behavior, new devices, and surgical techniques but have typically been applied to a small or single subject cohort. Anatomic variability necessitates the use of many subject-specific models or probabilistic methods in order to adequately evaluate a device or procedure for a population. However, a fully deformable finite element model can be computationally expensive, prohibiting large multisubject or probabilistic analyses. The aim of this study was to develop a group of subject-specific models of the patellofemoral joint and evaluate trade-offs in analysis time and accuracy with fully deformable and rigid body articular cartilage representations. Finite element models of eight subjects were used to tune a pressure-overclosure relationship during a simulated deep flexion cycle. Patellofemoral kinematics and contact mechanics were evaluated and compared between a fully deformable and a rigid body analysis. Additional eight subjects were used to determine the validity of the rigid body pressure-overclosure relationship as a subject-independent parameter. There was good agreement in predicted kinematics and contact mechanics between deformable and rigid analyses for both the tuned and test groups. Root mean square differences in kinematics were less than 0.5 deg and 0.2 mm for both groups throughout flexion. Differences in contact area and peak and average contact pressures averaged 5.4%, 9.6%, and 3.8%, respectively, for the tuned group and 6.9%, 13.1%, and 6.4%, respectively, for the test group, with no significant differences between the two groups. There was a 95% reduction in computational time with the rigid body analysis as compared with the deformable analysis. The tuned pressure-overclosure relationship derived from the patellofemoral analysis was also applied to tibiofemoral (TF) articular cartilage in a group of eight subjects. Differences in contact area and peak and average contact pressures averaged 8.3%, 11.2%, and 5.7% between rigid and deformable analyses in the tibiofemoral joint. As statistical, probabilistic, and optimization techniques can require hundreds to thousands of analyses, a viable platform is crucial to component evaluation or clinical applications. The computationally efficient rigid body platform described in this study may be integrated with statistical and probabilistic methods and has potential clinical application in understanding in vivo joint mechanics on a subject-specific or population basis.     

Effect of image registration on 3D absorbed dose calculations in 177Lu-DOTATOC peptide receptor radionuclide therapy

Peptide receptor radionuclide therapy (PRRT) is an effective MRT (molecular radiotherapy) treatment, which consists of multiple administrations of a radiopharmaceutical labelled with ¹⁷⁷Lu or ⁹⁰Y. Through sequential functional imaging a patient specific 3D dosimetry can be derived. Multiple scans should be previously co-registered to allow accurate absorbed dose calculations. The purpose of this study is to evaluate the impact of image registration algorithms on 3D absorbed dose calculation.A cohort of patients was extracted from the database of a clinical trial in PRRT. They were administered with a single administration of ¹⁷⁷Lu-DOTATOC. All patients underwent 5 SPECT/CT sequential scans at 1 h, 4 h, 24 h, 40 h, 70 h post-injection that were subsequently registered using rigid and deformable algorithms. A similarity index was calculated to compare rigid and deformable registration algorithms. 3D absorbed dose calculation was carried out with the Raydose Monte Carlo code.The similarity analysis demonstrated the superiority of the deformable registrations (p < .001).Average absorbed dose to the kidneys calculated using rigid image registration was consistently lower than the average absorbed dose calculated using the deformable algorithm (90% of cases), with percentage differences in the range [−19; +4]%. Absorbed dose to lesions were also consistently lower (90% of cases) when calculated with rigid image registration with absorbed dose differences in the range [−67.2; 100.7]%. Deformable image registration had a significant role in calculating 3D absorbed dose to organs or lesions with volumes smaller than 100 mL.Image based 3D dosimetry for ¹⁷⁷Lu-DOTATOC PRRT is significantly affected by the type of algorithm used to register sequential SPECT/CT scans.     

A multibody knee model with discrete cartilage prediction of tibio-femoral contact mechanics

Combining musculoskeletal simulations with anatomical joint models capable of predicting cartilage contact mechanics would provide a valuable tool for studying the relationships between muscle force and cartilage loading. As a step towards producing multibody musculoskeletal models that include representation of cartilage tissue mechanics, this research developed a subject-specific multibody knee model that represented the tibia plateau cartilage as discrete rigid bodies that interacted with the femur through deformable contacts. Parameters for the compliant contact law were derived using three methods: (1) simplified Hertzian contact theory, (2) simplified elastic foundation contact theory and (3) parameter optimisation from a finite element (FE) solution. The contact parameters and contact friction were evaluated during a simulated walk in a virtual dynamic knee simulator, and the resulting kinematics were compared with measured in vitro kinematics. The effects on predicted contact pressures and cartilage–bone interface shear forces during the simulated walk were also evaluated. The compliant contact stiffness parameters had a statistically significant effect on predicted contact pressures as well as all tibio-femoral motions except flexion–extension. The contact friction was not statistically significant to contact pressures, but was statistically significant to medial–lateral translation and all rotations except flexion–extension. The magnitude of kinematic differences between model formulations was relatively small, but contact pressure predictions were sensitive to model formulation. The developed multibody knee model was computationally efficient and had a computation time 283 times faster than a FE simulation using the same geometries and boundary conditions.     

The interaction of muscle moment arm,knee laxity,and torque in a multi-scale musculoskeletal model of the lower limb

IntroductionMusculoskeletal modeling allows insight into the interaction of muscle force and knee joint kinematics that cannot be measured in the laboratory. However, musculoskeletal models of the lower extremity commonly use simplified representations of the knee that may limit analyses of the interaction between muscle forces and joint kinematics. The goal of this research was to demonstrate how muscle forces alter knee kinematics and consequently muscle moment arms and joint torque in a musculoskeletal model of the lower limb that includes a deformable representation of the knee.MethodsTwo musculoskeletal models of the lower limb including specimen-specific articular geometries and ligament deformability at the knee were built in a finite element framework and calibrated to match mean isometric torque data collected from 12 healthy subjects. Muscle moment arms were compared between simulations of passive knee flexion and maximum isometric knee extension and flexion. In addition, isometric torque results were compared with predictions using simplified knee models in which the deformability of the knee was removed and the kinematics at the joint were prescribed for all degrees of freedom.ResultsPeak isometric torque estimated with a deformable knee representation occurred between 45° and 60° in extension, and 45° in flexion. The maximum isometric flexion torques generated by the models with deformable ligaments were 14.6% and 17.9% larger than those generated by the models with prescribed kinematics; by contrast, the maximum isometric extension torques generated by the models were similar. The change in hamstrings moment arms during isometric flexion was greater than that of the quadriceps during isometric extension (a mean RMS difference of 9.8 mm compared to 2.9 mm, respectively).DiscussionThe large changes in the moment arms of the hamstrings, when activated in a model with deformable ligaments, resulted in changes to flexion torque. When simulating human motion, the inclusion of a deformable joint in a multi-scale musculoskeletal finite element model of the lower limb may preserve the realistic interaction of muscle force with knee kinematics and torque.     

Rotation-Vibration Coupling in Liquid Water Investigated by Molecular Dynamics Simulation

Abstract

The standard rotation-vibration decoupling approximation for liquid water is tested using a method based on the split of the molecular dipole fluctuation correlation function into pure rotational, pure vibrational and crossed terms. Our results corroborate the total decoupling between vibrational and rotational motions in liquid water at ambient conditions and provide a tool able to test the reliability of this approximation for molecular liquids at different states.     

Motion of groups of atoms in DNA studied by molecular dynamics simulation

The analysis of Molecular Dynamics simulations of two double stranded oligonucleotides is presented in terms of motions of quasi rigid subunits. First, a strategy is presented for grouping atoms submitted to concerted internal motions. The method is based on the analysis of the interatomic distance RMS matrix. It is found that each nucleotide can reasonably be decomposed into 3 or 4 rigid groups of atoms depending on the tolerance of the definition of a rigid body. In the second part, the different kinds of motions of the subunits (deformation, translation and rotation) are studied in terms of correlation using the canonical correlation analysis of data. It is shown that the residual deformation of any subunit does not influence the translational and rotational motions of the others, except perhaps for long time dynamics. Received: 3 October 1997 / Revised version: 22 December 1997 / Accepted: 23 December 1997     

Estimating joint kinematics from skin motion observation: modelling and validation

Modelling of soft tissue motion is required in many areas, such as computer animation, surgical simulation, 3D motion analysis and gait analysis. In this paper, we will focus on the use of modelling of skin deformation during 3D motion analysis. The most frequently used method in 3D human motion analysis involves placing markers on the skin of the analysed segment which is composed of the rigid bone and the surrounding soft tissues. Skin and soft tissue deformations introduce a significant artefact which strongly influences the resulting bone position, orientation and joint kinematics. For this study, we used a statistical solid dynamics approach which is a combination of several previously reported tools: the point cluster technique (PCT) and a Kalman filter which was added to the PCT. The methods were tested and evaluated on controlled human-arm motions, using an optical motion capture system (Vicon^TM).

The addition of a Kalman filter to the PCT for rigid body motion estimation results in a smoother signal that better represents the joint motion. Calculations indicate less signal distortion than when using a digital low-pass filter. Furthermore, adding a Kalman filter to the PCT substantially reduces the dispersion of the maximal and minimal instantaneous frequencies. For controlled human movements, the result indicated that adding a Kalman filter to the PCT produced a more accurate signal. However, it could not be concluded that the proposed Kalman filter is better than a low-pass filter for estimation of the motion. We suggest that implementation of a Kalman filter with a better biomechanical motion model will be more likely to improve the results.     

人工半骨盆假体置换联合腰椎椎弓根螺钉固定术后生物力学的有限元分析

目的:建立人工半骨盆假体置换与联合腰椎椎弓根螺钉固定后的三维有限元模型,评价腰骶段生物力学改变后半骨盆假体力学结构的特点。方法:采用CT薄层扫描采集原始数据,分别建立正常骨盆、半骨盆假体置换术后以及半骨盆假体置换联合腰椎椎弓根螺钉固定术后骨盆的三维有限元模型,分别在第4腰椎上终板平面施以500 N的垂直纵向载荷,分析不同骨盆模型的应力分布特点。结果:与正常骨盆有限元模型相比,半骨盆假体置换术后健侧骨盆应力分布以骶髂关节、髋臼窝及耻骨为主,置换侧半骨盆假体以耻骨连接棒、髋臼杯及髂骨座为主,最大应力出现在耻骨连接棒,应力峰值为65.62 MPa。联合腰椎椎弓根螺钉固定后健侧应力相对减小,置换侧髂骨固定座与骶骨固定处应力相对减小,应力分布以腰椎椎弓根钉棒、耻骨连接棒及髋臼杯为主,最大应力出现在椎弓根螺钉,应力峰值为107 MPa。结论:半骨盆假体置换联合腰椎椎弓根螺钉固定后钉棒分担了半骨盆置换后健侧骨盆及置换侧髂骨固定座与骶骨固定处附近的部分应力,缓解应力集中现象,降低术后骨盆破坏风险,一定程度上增加了半骨盆置换后骨盆的稳定性。     

Impact responses of the flexed human knee using a deformable impact interface

Blunt impact trauma to the patellofemoral joint during car accidents, sporting activities, and falls can produce a range of injuries to the knee joint, including gross bone fracture, soft tissue injury, and/or microinjuries to bone and soft tissue. Currently, the only well-established knee injury criterion applies to knee impacts suffered during car accidents. This criterion is based solely on the peak impact load delivered to seated cadavers having a single knee flexion angle. More recent studies, however, suggest that the injury potential, its location, and the characteristics of the damage are also a function of knee flexion angle and the stiffness of the impacting structure. For example, at low flexion angles, fractures of the distal patella are common with a rigid impact interface, while at high flexion angles splitting of the femoral condyles is more evident. Low stiffness impact surfaces have been previously shown to distribute impact loads over the anterior surface of the patella to help mitigate gross and microscopic injuries in the 90 deg flexed knee. The objective of the current study was to determine if a deformable impact interface would just as effectively mitigate gross and microscopic injuries to the knee at various flexion angles. Paired experiments were conducted on contralateral knees of 18 human cadavers at three flexion angles (60, 90, 120 deg). One knee was subjected to a fracture level impact experiment with a rigid impactor, and the opposite knee was impacted with a deformable interface (3.3 MPa crush strength honeycomb material) to the same load. This (deformable) impact interface was effective at mitigating gross bone fractures at approximately 5 kN at all flexion angles, but the frequency of split fracture of the femoral condyles may not have been significantly reduced at 120 deg flexion. On the other hand, this deformable interface was not effective in mitigating microscopic injuries observed for all knee flexion angles. These new data, in concert with the existing literature, suggest the chosen impact interface was not optimal for knee injury protection in that fracture and other minor injuries were still produced. For example, in 18 cadavers a total of 20 gross fractures and 20 subfracture injuries were produced with a rigid interface and 5 gross fractures and 21 subfracture injuries with the deformable interface selected for the current study. Additional studies will be needed to optimize the knee impact interface for protection against gross and microscopic injuries to the knee.     

A Finite Element Model of the L5-S1 Functional Spinal Unit: Development and Comparison with Biomechanical Tests In Vitro

The main objective of this work is to develop a three-dimensional finite element model of the L5-S1 segment that is able to simulate its passive mobility measured in vitro . Due to their limited role in segment mobility, an isotropic linear elastic constitutive law was used for cartilage, cancellous and cortical bone. The intervertebral disk ground substance was modeled with a non-linear hyperelastic polynomial law. Fibers of the disk, as well as ligaments, were modeled with piecewise linear springs. Flexion-extension, axial rotation, and lateral bending torques were applied to the model. A comparison with the experimental results obtained on the same segment for these three major motions was conducted. The compliance of the segment subjected to pure torques was found to be similar between numerical and experimental results for all major motions. Coupled motions and translations were also similar, even in their amplitude. For lateral bending, the normal coupled motions originate from the geometry of the disk and not from the facet geometry.     

A theoretical model of the knee and ACL: theory and experimental verification.

A three-dimensional mathematical model of the human knee joint was developed to examine the role of single ligaments, such as an anterior cruciate ligament (ACL) graft in ACL reconstruction, on joint motion and tissue forces. The model is linear and valid for small motions about an equilibrium position. The knee joint is modeled as two rigid bodies (the femur and the tibia) interconnected by deformable structures, including the ACL or ACL graft, the cartilage layer, and the remainder of the knee tissues (modeled as a single element). The model was demonstrated for the equilibrium condition of the knee in extension with an anterior tibial force, causing anterior drawer and hyperextension. The knee stiffness matrix for this condition was measured for a human right knee in vitro. Predicted model response was compared with experimental observations. Qualitative agreement was found between model and experiment, validating the model and its assumptions. The model was then used to predict the change in graft and cartilage forces and joint motion of the knee due to an increment of load in the normal joint both after ACL removal and with various altered states simulating ACL reconstructions. Results illustrate the interdependence between loads in the ACL graft, other knee structures, and contact force. Stiffer grafts and smaller maximum unloaded length of the ligament lead to higher graft and contact forces. Changes in cartilage stiffness alter load sharing between ACL graft and other joint tissues.     

'Equivalent geometry' of the knee and the prediction of tensions along the cruciates: an experimental study

In this paper we introduce the concept of the functional (or equivalent) geometry of the knee, which is an attempt to reduce the natural knee with its complex geometry, frictional resistance and deformable cartilage into a two-dimensional joint comprising rigid femur and tibia in frictionless contact. An apparatus and method are described to measure the slope of the tangent to the surfaces of the 'equivalent' bones at their 'point' of contact. An antero posterior force of +/-300-500 N and axial compressive load of twice body weight were applied on cadaveric knee joints. The corresponding displacement of the tibia in the saggital plane was measured firstly with both cruciates intact and then when each was severed in turn. From the data obtained both the slope of the tangent mentioned above and the tensions developed along the cruciates under the influence of the forces applied were calculated. The results showed that the functional geometry of the knee in the saggital plane can be represented by a convex femur and a concave tibia. The tensions along the cruciates calculated on the basis of the experimental measurements were nearly always lower than the antero posterior force applied, and although this corroborated the trend demonstrated in a previous theoretical analysis, they were lower still. The reason for this may be the deformation of the cartilage under load, thus modifying the geometry of contact resulting in a more concave tibia of the 'equivalent' knee joint, than that of the rigid model used in the theoretical analysis.     

Estimating joint kinematics from skin motion observation: modelling and validation

Modelling of soft tissue motion is required in many areas, such as computer animation, surgical simulation, 3D motion analysis and gait analysis. In this paper, we will focus on the use of modelling of skin deformation during 3D motion analysis. The most frequently used method in 3D human motion analysis involves placing markers on the skin of the analysed segment which is composed of the rigid bone and the surrounding soft tissues. Skin and soft tissue deformations introduce a significant artefact which strongly influences the resulting bone position, orientation and joint kinematics. For this study, we used a statistical solid dynamics approach which is a combination of several previously reported tools: the point cluster technique (PCT) and a Kalman filter which was added to the PCT. The methods were tested and evaluated on controlled human-arm motions, using an optical motion capture system (Vicon(TM)). The addition of a Kalman filter to the PCT for rigid body motion estimation results in a smoother signal that better represents the joint motion. Calculations indicate less signal distortion than when using a digital low-pass filter. Furthermore, adding a Kalman filter to the PCT substantially reduces the dispersion of the maximal and minimal instantaneous frequencies. For controlled human movements, the result indicated that adding a Kalman filter to the PCT produced a more accurate signal. However, it could not be concluded that the proposed Kalman filter is better than a low-pass filter for estimation of the motion. We suggest that implementation of a Kalman filter with a better biomechanical motion model will be more likely to improve the results.     

Kinetics of gene expression and bone remodelling in the clinical phase of collagen-induced arthritis

IntroductionPathological bone changes differ considerably between inflammatory arthritic diseases and most studies have focused on bone erosion. Collagen-induced arthritis (CIA) is a model for rheumatoid arthritis, which, in addition to bone erosion, demonstrates bone formation at the time of clinical manifestations. The objective of this study was to use this model to characterise the histological and molecular changes in bone remodelling, and relate these to the clinical disease development.MethodsA histological and gene expression profiling time-course study on bone remodelling in CIA was linked to onset of clinical symptoms. Global gene expression was studied with a gene chip array system.ResultsThe main histopathological changes in bone structure and inflammation occurred during the first two weeks following the onset of clinical symptoms in the joint. Hereafter, the inflammation declined and remodelling of formed bone dominated.Global gene expression profiling showed simultaneous upregulation of genes related to bone changes and inflammation in week 0 to 2 after onset of clinical disease. Furthermore, we observed time-dependent expression of genes involved in early and late osteoblast differentiation and function, which mirrored the histopathological bone changes. The differentially expressed genes belong to the bone morphogenetic pathway (BMP) and, in addition, include the osteoblast markers integrin-binding sialoprotein (Ibsp), bone gamma-carboxyglutamate protein (Bglap1), and secreted phosphoprotein 1 (Spp1). Pregnancy-associated protein A (Pappa) and periostin (Postn), differentially expressed in the early disease phase, are proposed to participate in bone formation, and we suggest that they play a role in early bone formation in the CIA model. Comparison to human genome-wide association studies (GWAS) revealed differential expression of several genes associated with human arthritis.ConclusionsIn the CIA model, bone formation in the joint starts shortly after onset of clinical symptoms, which results in bony fusion within one to two weeks. This makes it a candidate model for investigating the relationship between inflammation and bone formation in inflammatory arthritis.

Electronic supplementary material

The online version of this article (doi:10.1186/s13075-015-0531-7) contains supplementary material, which is available to authorized users.     

腰椎弹性固定进展研究

对于腰椎退变和不稳的治疗,传统方法是采用后路减压、椎弓根螺钉固定同时行植骨术(僵硬固定)。然而,僵硬固定存在加速周围椎体的退变等缺点。因而,人们逐步把目光投向腰椎弹性固定。最近几年,腰椎弹性固定因具有利于应力分散,防止周围节段退行性变,降低应力遮挡等优点,越来越多地被用于临床。大多数临床资料显示相较于传统坚强固定,弹性固定疗效相当,而固定节段骨萎缩、骨质疏松以及邻近节段退变的发生率显著降低,更利于脊柱生理特性。该文就腰椎弹性固定的发展过程、各种类型弹性固定的工作原理以及临床效果等作一综述。