Evolution of Fatigue Damage in the L5-S1 Intervertebral Disc Resulting from Walking Exposures Among Persons with Lower Limb Loss.
Evolution of Fatigue Damage in the L5-S1 Intervertebral Disc Resulting from Walking Exposures Among Persons with Lower Limb Loss.
复制标题
下肢丧失者步行暴露导致 L5-S1 椎间盘疲劳损伤的演变。
DOI：
10.1007/s10439-020-02481-5
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发表时间：
2020
影响因子：
3.8
通讯作者：
Bazrgari,Babak
中科院分区：
文献类型：
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作者：
Hendershot,BradD;Bazrgari,Babak
使用脊柱运动节段的非线性多轴疲劳模型，计算了52例单侧肢体缺失（26例经胫骨; 26例经股骨）和26例未受伤对照的L5-S1椎间盘内疲劳损伤的风险。计算每个参与者和步行速度的完全损伤时间;通过改变每日步数来确定步行活动的影响。假设各组之间的活动相似（每天10，000步），肢体丧失和无肢体丧失的人之间的失败时间没有差异（分别为50 [23] vs. 46 [24]岁）;行走速度更快与失败时间更短相关。更大的每日步数同样减少了所有组的失败时间。虽然疲劳损伤演变中的这种相似性不一定会低估生物力学因素的作用，但它可能会突出社会心理因素在肢体丧失患者腰痛发展中的重要影响。然而，通过额外的工作来包括行走以外的活动，计算损伤模型可以提供用于评估特定临床干预的预测平台（例如，行为矫正、运动再训练、假肢装置），最终旨在减轻肢体丧失后腰痛的身体风险因素。
The risk of fatigue damage within the L5-S1 spinal disc was calculated for a sample of 52 individuals with unilateral limb loss (26 transtibial; 26 transfemoral) and 26 uninjured controls using a non-linear multi-axial fatigue model of the spine motion segments. Time to complete damage was calculated for each participant and walking pace; the influences of walking activity were determined by varying daily step counts. Assuming similar activity across groups (10,000 steps per day), times to failure were not different between persons with and without limb loss (50 [23] vs. 46 [24] years, respectively); walking faster was associated with shorter times to failure. Greater daily step counts similarly decreased time to failure in all groups. While such a similarity in fatigue damage evolution does not necessarily downplay the role of biomechanical factors, it may highlight the important influences of psychosocial factors in the development of low back pain in persons with limb loss. Nevertheless, with additional work to include activities beyond walking, computational damage models can provide a predictive platform for evaluating specific clinical interventions (e.g., behavior modification, movement retraining, prosthetic devices) that are ultimately intended to mitigate physical risk factors for low back pain following limb loss.