A numerical analysis of the effects of the lower-limb prosthetic socket on muscle atrophy of the residual limb_Journal of Biomedical Engineering

Authors：

WANG Zhenze ^1,2,3 , XU Zhi ^4,5 , YAN Fei ^4,5 , CHU Zhaowei ^1,2,3 ,  JIANG Wentao ⁴ , FAN Yubo ^1,2,3

1. National Research Center for Rehabilitation Technical Aids, Beijing 100176, P.R.China;
2. Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, Beijing 100176, P.R.China;
3. Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, Beijing 100176, P.R.China;
4. Laboratory of Biomechanical Engineering, Sichuan University, Chengdu 610065, P.R.China;
5. Department of Biomedical Engineering, Hong Kong Polytechnic University, Hong Kong 999077, P.R.China;

Corresponding author：

JIANG Wentao, Email: scubme@aliyun.com

Keywords：

socket; residual limb; muscle atrophy; finite element model; vessel

DOI：

10.7507/1001-5515.201803060

Video：

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Muscle atrophy of the residual limb after lower-limb amputation is a disadvantage of amputees' rehabilitation. To investigate the biomechanics mechanism of muscle atrophy of the residual limb, we built a finite element model of a residual limb including muscle, skeletons and main vessels based on magnetic resonance images of a trans-femoral amputee, and studied the biomechanics effects of the socket of the lower-limb prosthesis on the soft tissue and vessels in the residual limb. It was found that the descending branch of the lateral femoral circumflex artery suffered the most serious constriction due to the extrusion, while that of the deep femoral artery was comparatively light. Besides, the degree of the constriction of the descending branch of the lateral femoral circumflex vein, femoral vein and deep femoral vein decreased in turn, and that of the great saphenous vein was serious. The stress-strain in the anterior femoral muscle group were highest, while the stress concentration of the inferior muscle group was observed at the end of the thighbone, and other biomechanical indicators at the inferior region were also high. This study validated that the extrusion of the socket on the vessels could cause muscle atrophy to some degree, and provided theoretical references for learning the mechanism of muscle atrophy in residual limb and its effective preventive measures.

Citation： WANG Zhenze, XU Zhi, YAN Fei, CHU Zhaowei, JIANG Wentao, FAN Yubo. A numerical analysis of the effects of the lower-limb prosthetic socket on muscle atrophy of the residual limb. Journal of Biomedical Engineering, 2018, 35(6): 887-891, 899. doi: 10.7507/1001-5515.201803060 Copy

1.	Fraisse N, Martinet N, Kpadonou T G, et al. Muscles of the below-knee amputees. Ann Readapt Med Phys, 2008, 51(3): 218-227.
2.	Schmalz T, Blumentritt S, Reimers C D. Selective thigh muscle atrophy in trans-tibial amputees: an ultrasonographic study. Archives of Orthopaedic and Trauma Surgery, 2001, 121(6): 307-312.
3.	Sanders J E, Harrison D S, Allyn K J, et al. Clinical utility of in-socket residual limb volume change measurement: case study results. Prosthet Orthot Int, 2009, 33(4): 378-390.
4.	Aagaard P, Suetta C, Caserotti P, et al. Role of the nervous system in sarcopenia and muscle atrophy with aging: strength training as a countermeasure. Scand J Med Sci Sports, 2010, 20(1): 49-64.
5.	Bongers K S, Fox D K, Ebert S M, et al. Skeletal muscle denervation causes skeletal muscle atrophy through a pathway that involves both Gadd45a and HDAC4. Am J Physiol Endocrinol Metab, 2013, 305(7): E907-E915.
6.	Dirks M L, Wall B T, Snijders T, et al. Neuromuscular electrical stimulation prevents muscle disuse atrophy during leg immobilization in humans. Acta Physiol (Oxf), 2014, 210(3): 628-641.
7.	Guillot M, Charles A L, Chamaraux-Tran T N, et al. Oxidative stress precedes skeletal muscle mitochondrial dysfunction during experimental aortic cross-clamping but is not associated with early lung, heart, brain, liver, or kidney mitochondrial impairment. J Vasc Surg, 2014, 60(4): 1043-51.e5.
8.	邢国刚, 樊小力, 宋新爱, 等. 废用性肌肉萎缩的研究. 国外医学•物理医学与康复分册, 2000, 20(4): 145-150.
9.	Glass D J. Skeletal muscle hypertrophy and atrophy signaling pathways. Int J Biochem Cell Biol, 2005, 37(10): 1974-1984.
10.	Caron M A, Thériault M È, Paré M , et al. Hypoxia alters contractile protein homeostasis in L6 myotubes. FEBS Lett, 2009, 583(9): 1528-1534.
11.	Jia Xiaohong, Zhang Ming, Lee W C C. Load transfer mechanics between trans-tibial prosthetic socket and residual limb-dynamic effects. J Biomech, 2004, 37(9): 1371-1377.
12.	Lee W C C, Zhang Ming, Jia Xiaohong, et al. Finite element modeling of the contact interface between trans-tibial residual limb and prosthetic socket. Med Eng Phys, 2004, 26(8): 655-662.
13.	Portnoy S, Yizhar Z, Shabshin N, et al. Internal mechanical conditions in the soft tissues of a residual limb of a trans-tibial amputee. J Biomech, 2008, 41(9): 1897-1909.
14.	Zhang M, Mak A F T, Roberts V C. Finite element modelling of a residual lower-limb in a prosthetic socket: a survey of the development in the first decade. Med Eng Phys, 1998, 20(5): 360-373.
15.	Yan F, Jiang W, Dong W, et al. Blood flow and oxygen transport in the descending branch of lateral femoral circumflex arteries after transfemoral amputation: a numerical study. J Med Biol Eng, 2017, 37(1): 63-73.
16.	Dong Ruiqi, Li Xiaolong, Yan Fei, et al. The spatial structure changes of thigh arterial trees after transfemoral amputation: case studies. J Med Imaging Health Inf, 2016, 6(3): 688-692.
17.	李小龙, 晏菲, 董瑞琪, 等. 一种表征残肢血管结构变形的参数方法. 医用生物力学, 2016, 31(1): 19-23.
18.	Kirkendall W M, Burton A C, Epstein F H, et al. Recommendations for human blood pressure determination by sphygmomanometers. Circulation, 1967, 36(6): 980-988.
19.	朱大年, 郑黎明. 人体解剖生理学. 上海: 复旦大学出版社, 2002.
20.	Lee W C C, Frossard L A, Hagberg K, et al. Kinetics of transfemoral amputees with osseointegrated fixation performing common activities of daily living. Clin Biomech (Bristol, Avon), 2007, 22(6): 665-673.
21.	Wyllie A H. Apoptosis: cell death in tissue regulation. J Pathol, 1987, 153(4): 313-316.
22.	Sanders J E, Daly C H. Normal and shear stresses on a residual limb in a prosthetic socket during ambulation: comparison of finite element results with experimental measurements. J Rehabil Res Dev, 1993, 30(2): 191-204.

1. Fraisse N, Martinet N, Kpadonou T G, et al. Muscles of the below-knee amputees. Ann Readapt Med Phys, 2008, 51(3): 218-227.
2. Schmalz T, Blumentritt S, Reimers C D. Selective thigh muscle atrophy in trans-tibial amputees: an ultrasonographic study. Archives of Orthopaedic and Trauma Surgery, 2001, 121(6): 307-312.
3. Sanders J E, Harrison D S, Allyn K J, et al. Clinical utility of in-socket residual limb volume change measurement: case study results. Prosthet Orthot Int, 2009, 33(4): 378-390.
4. Aagaard P, Suetta C, Caserotti P, et al. Role of the nervous system in sarcopenia and muscle atrophy with aging: strength training as a countermeasure. Scand J Med Sci Sports, 2010, 20(1): 49-64.
5. Bongers K S, Fox D K, Ebert S M, et al. Skeletal muscle denervation causes skeletal muscle atrophy through a pathway that involves both Gadd45a and HDAC4. Am J Physiol Endocrinol Metab, 2013, 305(7): E907-E915.
6. Dirks M L, Wall B T, Snijders T, et al. Neuromuscular electrical stimulation prevents muscle disuse atrophy during leg immobilization in humans. Acta Physiol (Oxf), 2014, 210(3): 628-641.
7. Guillot M, Charles A L, Chamaraux-Tran T N, et al. Oxidative stress precedes skeletal muscle mitochondrial dysfunction during experimental aortic cross-clamping but is not associated with early lung, heart, brain, liver, or kidney mitochondrial impairment. J Vasc Surg, 2014, 60(4): 1043-51.e5.
8. 邢国刚, 樊小力, 宋新爱, 等. 废用性肌肉萎缩的研究. 国外医学•物理医学与康复分册, 2000, 20(4): 145-150.
9. Glass D J. Skeletal muscle hypertrophy and atrophy signaling pathways. Int J Biochem Cell Biol, 2005, 37(10): 1974-1984.
10. Caron M A, Thériault M È, Paré M , et al. Hypoxia alters contractile protein homeostasis in L6 myotubes. FEBS Lett, 2009, 583(9): 1528-1534.
11. Jia Xiaohong, Zhang Ming, Lee W C C. Load transfer mechanics between trans-tibial prosthetic socket and residual limb-dynamic effects. J Biomech, 2004, 37(9): 1371-1377.
12. Lee W C C, Zhang Ming, Jia Xiaohong, et al. Finite element modeling of the contact interface between trans-tibial residual limb and prosthetic socket. Med Eng Phys, 2004, 26(8): 655-662.
13. Portnoy S, Yizhar Z, Shabshin N, et al. Internal mechanical conditions in the soft tissues of a residual limb of a trans-tibial amputee. J Biomech, 2008, 41(9): 1897-1909.
14. Zhang M, Mak A F T, Roberts V C. Finite element modelling of a residual lower-limb in a prosthetic socket: a survey of the development in the first decade. Med Eng Phys, 1998, 20(5): 360-373.
15. Yan F, Jiang W, Dong W, et al. Blood flow and oxygen transport in the descending branch of lateral femoral circumflex arteries after transfemoral amputation: a numerical study. J Med Biol Eng, 2017, 37(1): 63-73.
16. Dong Ruiqi, Li Xiaolong, Yan Fei, et al. The spatial structure changes of thigh arterial trees after transfemoral amputation: case studies. J Med Imaging Health Inf, 2016, 6(3): 688-692.
17. 李小龙, 晏菲, 董瑞琪, 等. 一种表征残肢血管结构变形的参数方法. 医用生物力学, 2016, 31(1): 19-23.
18. Kirkendall W M, Burton A C, Epstein F H, et al. Recommendations for human blood pressure determination by sphygmomanometers. Circulation, 1967, 36(6): 980-988.
19. 朱大年, 郑黎明. 人体解剖生理学. 上海: 复旦大学出版社, 2002.
20. Lee W C C, Frossard L A, Hagberg K, et al. Kinetics of transfemoral amputees with osseointegrated fixation performing common activities of daily living. Clin Biomech (Bristol, Avon), 2007, 22(6): 665-673.
21. Wyllie A H. Apoptosis: cell death in tissue regulation. J Pathol, 1987, 153(4): 313-316.
22. Sanders J E, Daly C H. Normal and shear stresses on a residual limb in a prosthetic socket during ambulation: comparison of finite element results with experimental measurements. J Rehabil Res Dev, 1993, 30(2): 191-204.

Journal of Biomedical Engineering

A numerical analysis of the effects of the lower-limb prosthetic socket on muscle atrophy of the residual limb

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