Bug-free prostheses: Reducing infection risk and improving reliability

在这项可行性研究中，我们建议研究假体的机械和生物学性能耦合的关键控制，目的是建立一个独特的跨学科研究团队，以设计新型抗菌衬里材料和假体界面系统。在英国，大约有62，000名截肢者，保守估计，世界上有超过1000万人患有肢体缺失。因此，开发功能性、舒适、廉价和安全的假肢具有遍及发达世界和其他地区的社会和经济影响。假体失效的一个主要原因是接受腔的细菌污染，在发达国家，高达50%的患者发生这种情况。假肢接受腔紧贴残肢以提供两个主要功能：（1）将通过与环境相互作用产生的力传递到残肢上的坚固界面，以及（2）用于替换缺失的身体部分的部件的附接点。通过假体和肢体之间的这种紧密连接，产生了一个封闭的环境，为细菌生长提供了理想的条件。细菌不仅会产生难闻的气味，还会导致感染，最终导致整个假肢系统的崩溃。即使使用者保持假肢接受腔的清洁，在假肢接受腔的使用寿命（最长3年）内，细菌也不可避免地会定居下来。皮肤问题很常见，对下肢假肢使用者的研究表明，34%至50%的患者会出现皮肤问题。感染会对假体的使用产生重大的负面影响，因此对使用者的生活质量非常有害。可行性研究将开始，以收集皮肤上和内衬内存在的微生物种群的数据。将利用分子技术对微生物DNA进行测序，以确定存在的物种，并对可能在群落功能中发挥关键作用的基因进行编目。将使用电子显微镜对内衬上的微生物种群结构进行成像。一旦这些数据可用，我们将开始开发假体界面的多学科模型。这种模型的开发是由跨学科团队提供的广泛的专业知识成为可能：我们将开发概念和数学模型，描述现有的接口和新的内衬材料和假体接口系统的建议。

In this feasibility study, we propose to investigate key controls on the coupled mechanical and biological performance of prostheses with the aim of building a unique cross-disciplinary research team to design novel antimicrobial lining materials and prosthetic interface systems. In the UK there are approximately 62,000 amputees and conservative estimates suggest that there are more than 10 million people in the world who live with limb loss. Thus, developing functional, comfortable, cheap and safe prosthetic limbs has social and economic impacts that spread through the developed world and beyond. A major cause of prostheses failure is bacterial fouling of the socket, which occurs in up to 50% of patients in the developed world. A prosthetic socket envelops the residual limb snugly to provide two main functions: (1) a solid interface to transmit forces created through the interaction with the environment onto the residual limb and (2) an attachment point for the components replacing the missing body parts. Through this tight connection between the prosthesis and the limb, a closed environment is generated that provides ideal conditions for bacterial growth. Bacteria not only cause unpleasant odour but also lead to infection and ultimately a breakdown of the whole prosthetic system. Even if a user keeps a prosthetic socket meticulously clean, it is inevitable that over the lifetime of a prosthetic socket (max 3 years) bacteria will settle. Skin problems are frequent and studies on lower limb prosthetics users have shown they occur in 34% to 50% of patients. Infections can have a major negative impact on the use of the prosthesis and hence are highly detrimental to the users' quality of life.The feasibility study will begin to collect data on the microbial populations present on the skin and within the liner. Molecular techniques will be used to sequence microbial DNA to determine the species present and catalogue the genes which may play key roles in community function. Electron microscopy will be used to image the structure of the microbial populations living upon the liner. Once these data are available, we will begin to develop multidisciplinary models of the prosthetic interface. This model development is made possible by the wide range of expertise provided by the cross-disciplinary team: we will develop both conceptual and mathematical models that describe existing interfaces and proposals for new lining materials and prosthetic interface systems.