上肢骨折的运动学分析：对康复策略的见解。

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics Pub Date : 2025-02-01 DOI:10.1016/j.clinbiomech.2025.106432

Felipe de Souza Serenza , Marília Manuella Simões Augusto Rizzato , Fernando Vieira , Kevin James McQuade , Anamaria Siriani de Oliveira

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引用次数: 0

摘要

背景：上肢骨折显著改变运动，影响功能和恢复。三维运动分析可以精确地评估这些变化。方法：60例患者分为4组：肩、肘、腕骨折组和对照组。使用DASH问卷进行功能评估，随后使用8台Oqus 300相机和14个反射标记在胸部、肩胛骨、肱骨、前臂和手部进行三维运动学分析。采用肩峰标记簇法对肩胛骨进行精确跟踪。分析的任务包括手放在肩上、手放在背上和手放在脖子上。所有测量的变量都用度数表示。分析的重点是不同任务中每个自由度的最大关节角的差异。使用方差分析评估这些差异，然后使用方差分析和Tukey事后检验（如适用）。结果：在所有任务中，骨折组和对照组之间观察到显著的运动学差异。肩关节骨折患者表现出肱骨屈曲和外展的最大减少。肘关节骨折患者肘关节屈曲受限最多。腕关节骨折患者桡骨/尺侧偏差明显减少。在所有的任务中都观察到这些运动障碍，在手到肩膀的任务中观察到最明显的限制。效应值（η2）表明有临床意义的影响，特别是肩关节运动。解释：这项研究揭示了上肢骨融合术后明显的运动学改变，强调了针对这些特定运动障碍的个性化康复策略的必要性，以优化恢复。

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Kinematic analysis of upper limb fractures: Insights for rehabilitation strategies

Background

Upper limb fractures significantly alter movement, impacting function and recovery. Three-dimensional motion analysis allows precise assessment of these changes.

Methods

Sixty patients were divided into four groups: shoulder, elbow, wrist fractures, and controls. Functional assessment was performed using the DASH questionnaire, followed by three-dimensional kinematic analysis with eight Oqus 300 cameras and 14 reflective markers on the thorax, scapula, humerus, forearm, and hand. The Acromion Marker Cluster method was used for accurate scapular tracking. Tasks analyzed included hand on shoulder, hand on back, and hand on neck. All measured variables are expressed in degrees. The analysis focused on the differences in maximum joint angles for each degree of freedom across the tasks. These differences were assessed using MANOVA, followed by ANOVAs and Tukey's post hoc test when applicable.

Findings

Significant kinematic differences were observed between the fracture groups and the control group across all tasks. Shoulder fracture patients exhibited the greatest reductions in humeral flexion and abduction. Elbow fracture patients showed the most restricted elbow flexion. Wrist fracture patients presented significantly reduced radial/ulnar deviation. These movement impairments were observed across all tasks, with the most pronounced limitations seen in the hand-to-shoulder task. Effect sizes (η²) indicated clinically meaningful impacts, particularly for shoulder and wrist movements.

Interpretation

This study reveals distinct kinematic alterations following upper limb osteosynthesis, emphasizing the need for individualized rehabilitation strategies addressing these specific movement impairments to optimize recovery.

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来源期刊

Clinical Biomechanics 医学-工程：生物医学

CiteScore

3.30

自引率

5.60%

发文量

189

审稿时长

12.3 weeks

期刊介绍： Clinical Biomechanics is an international multidisciplinary journal of biomechanics with a focus on medical and clinical applications of new knowledge in the field. The science of biomechanics helps explain the causes of cell, tissue, organ and body system disorders, and supports clinicians in the diagnosis, prognosis and evaluation of treatment methods and technologies. Clinical Biomechanics aims to strengthen the links between laboratory and clinic by publishing cutting-edge biomechanics research which helps to explain the causes of injury and disease, and which provides evidence contributing to improved clinical management. A rigorous peer review system is employed and every attempt is made to process and publish top-quality papers promptly. Clinical Biomechanics explores all facets of body system, organ, tissue and cell biomechanics, with an emphasis on medical and clinical applications of the basic science aspects. The role of basic science is therefore recognized in a medical or clinical context. The readership of the journal closely reflects its multi-disciplinary contents, being a balance of scientists, engineers and clinicians. The contents are in the form of research papers, brief reports, review papers and correspondence, whilst special interest issues and supplements are published from time to time. Disciplines covered include biomechanics and mechanobiology at all scales, bioengineering and use of tissue engineering and biomaterials for clinical applications, biophysics, as well as biomechanical aspects of medical robotics, ergonomics, physical and occupational therapeutics and rehabilitation.