Three-dimensional finite element model construction and biomechanical analysis of customized titanium alloy lunate prosthesis / 中国修复重建外科杂志

OBJECTIVE@#To design customized titanium alloy lunate prosthesis, construct three-dimensional finite element model of wrist joint before and after replacement by finite element analysis, and observe the biomechanical changes of wrist joint after replacement, providing biomechanical basis for clinical application of prosthesis.@*METHODS@#One fresh frozen human forearm was collected, and the maximum range of motions in flexion, extension, ulnar deviation, and radialis deviation tested by cortex motion capture system were 48.42°, 38.04°, 35.68°, and 26.41°, respectively. The wrist joint data was obtained by CT scan and imported into Mimics21.0 software and Magics21.0 software to construct a wrist joint three-dimensional model and design customized titanium alloy lunate prosthesis. Then Geomagic Studio 2017 software and Solidworks 2017 software were used to construct the three-dimensional finite element models of a normal wrist joint (normal model) and a wrist joint with lunate prosthesis after replacement (replacement model). The stress distribution and deformation of the wrist joint before and after replacement were analyzed for flexion at and 15°, 30°, 48.42°, extension at 15°, 30°, and 38.04°, ulnar deviation at 10°, 20°, and 35.68°, and radial deviation at 5°, 15°, and 26.41° by the ANSYS 17.0 finite element analysis software. And the stress distribution of lunate bone and lunate prosthesis were also observed.@*RESULTS@#The three-dimensional finite element models of wrist joint before and after replacement were successfully constructed. At different range of motion of flexion, extension, ulnar deviation, and radial deviation, there were some differences in the number of nodes and units in the grid models. In the four directions of flexion, extension, ulnar deviation, and radial deviation, the maximum deformation of wrist joint in normal model and replacement model occurred in the radial side, and the values increased gradually with the increase of the range of motion. The maximum stress of the wrist joint increased gradually with the increase of the range of motion, and at maximum range of motion, the stress was concentrated on the proximal radius, showing an overall trend of moving from the radial wrist to the proximal radius. The maximum stress of normal lunate bone increased gradually with the increase of range of motion in different directions, and the stress position also changed. The maximum stress of lunate prosthesis was concentrated on the ulnar side of the prosthesis, which increased gradually with the increase of the range of motion in flexion, and decreased gradually with the increase of the range of motion in extension, ulnar deviation, and radialis deviation. The stress on prosthesis increased significantly when compared with that on normal lunate bone.@*CONCLUSION@#The customized titanium alloy lunate prosthesis does not change the wrist joint load transfer mode, which provided data support for the clinical application of the prosthesis.

Targeted muscle reinnervation: a surgical technique of human-machine interface for intelligent prosthesis / 中国修复重建外科杂志

OBJECTIVE@#To review targeted muscle reinnervation (TMR) surgery for the construction of intelligent prosthetic human-machine interface, thus providing a new clinical intervention paradigm for the functional reconstruction of residual limbs in amputees.@*METHODS@#Extensively consulted relevant literature domestically and abroad and systematically expounded the surgical requirements of intelligent prosthetics, TMR operation plan, target population, prognosis, as well as the development and future of TMR.@*RESULTS@#TMR facilitates intuitive control of intelligent prostheses in amputees by reconstructing the "brain-spinal cord-peripheral nerve-skeletal muscle" neurotransmission pathway and increasing the surface electromyographic signals required for pattern recognition. TMR surgery for different purposes is suitable for different target populations.@*CONCLUSION@#TMR surgery has been certified abroad as a transformative technology for improving prosthetic manipulation, and is expected to become a new clinical paradigm for 2 million amputees in China.

Mid-term effectiveness of hip preservation in the reconstruction of ultrashort bone segments in the proximal femur with three-dimensional printed customized cementless intercalary endoprosthesis with an intra-neck curved stem / 中国修复重建外科杂志

OBJECTIVE@#To explore the design points of a three-dimensional (3D) printed customized cementless intercalary endoprosthesis with an intra-neck curved stem and to evaluate the key points and mid-term effectiveness of its application in the reconstruction of ultrashort bone segments in the proximal femur.@*METHODS@#Between October 2015 and January 2021, 17 patients underwent reconstruction with a 3D printed-customized cementless intercalary endoprosthesis with an intra-neck curved stem. There were 11 males and 6 females, the age ranged from 10 to 76 years, with an average of 30.1 years. There were 9 cases of osteosarcoma, 4 cases of Ewing sarcoma, 2 cases of chondrosarcoma, 1 case of liposarcoma, and 1 case of myofibroblastoma. The disease duration was 5-14 months, with an average of 9.5 months. Enneking staging included 16 cases of stage ⅡB and 1 case of stage ⅢB. The distances from the center of the femoral head to the body midline and the acetabular apex were measured preoperatively on X-ray images. Additionally, the distances from the tip of the intra-neck curved stem to the body midline and the acetabular apex were measured at immediate postoperatively and last follow-up. The neck-shaft angle was also measured preoperatively, at immediate postoperatively, and at last follow-up. The status of osseointegration at the bone-prosthesis interface and bone growth into the prosthesis surface were assessed by X-ray films, CT, and Tomosynthesis-Shimadzu metal artefact reduction technology (T-SMART). The survival status of the patients, presence of local recurrence or distant metastasis, and occurrence of postoperative complications were assessed. The recovery of lower limb function was evaluated pre- and post-operatively using the Musculoskeletal Tumor Society (MSTS) scoring system, and pain relief was evaluated using the visual analogue scale (VAS) scores.@*RESULTS@#The patient's femoral resection length was (163.1±57.5) mm, the remaining proximal femoral length was (69.6±9.3) mm, and the percentage of femoral resection length/total femoral length was 38.7%±14.6%. All 17 patients were followed up 25-86 months with an average of 58.1 months. During the follow-up, 1 patient died of lung metastasis at 46 months postoperatively, and the remaining 16 patients survived tumor-free. There was no complication such as periprosthetic infection, delayed incision healing, aseptic loosening, prosthesis fracture, or periprosthetic fracture. No evidence of micromotion or wear around the implanted stem of the prosthesis was detected in X-ray and T-SMART evaluations. There was no significant radiolucent lines, and radiographic evidence of bone ingrowth into the bone-prosthesis interface was observed in all stems. There was no significant difference in the distance from the tip of the curved stem to the body midline and the apex of the acetabulum at immediate postoperatively and last follow-up compared with the distance from the center of the femoral head to the body midline and the apex of the acetabulum before operation, respectively (P>0.05), and there was no significant difference in the above indexes between immediate postoperatively and last follow-up (P>0.05). The differences in the neck-shaft angle at various time points before and after operation were also not significant (P>0.05). At last follow-up, the MSTS score was 26.1±1.2 and the VAS score was 0.1±0.5, which were significantly improved when compared with those before operation [19.4±2.1 and 5.7±1.0, respectively] (t=14.735, P<0.001; t=21.301, P<0.001). At last follow-up, none of the patients walked with the aid of crutches or other walkers.@*CONCLUSION@#The 3D printed customized cementless intercalary endoprosthesis with an intra-neck curved stem is an effective method for reconstructing ultrashort bone segments in the proximal femur following malignant tumor resection. The operation is reliable, the postoperative lower limb function is satisfactory, and the incidence of complications is low.

Research Progress on Sensory Feedback Technology in Prostheses / 中国医疗器械杂志

As an important auxiliary tool for amputees to gain abled limb functions, prosthetic limbs with decoration or feedforward control channel could not meet the needs. In order to enable the prosthesis to deliver the information, includes temperature, pressure, position, shape and so on, a variety of sensory feedback methods have been integrated into the prosthesis. According to the position of the feedback terminal on the human body, the perceptual feedback systems include invasive and noninvasive sensory feedback. This review presents the research progress of these perceptual feedback techniques, and summarizes the problems in the application in artificial limbs. Finally, the development trend of sensory feedback technology in prostheses is prospected.

Exercise training program in children with lower-limb amputation

SUMMARY OBJECTIVE: Few physical exercise programs for children with limb loss have been described in detail recently. We provided information regarding the characteristics and effectiveness of an alternative rehabilitation exercise developed for children with lower-limb amputation. METHODS: An 8-year-old boy with a below-knee amputation and a 9-year-old bilateral amputee girl performed an exercise program of one 2-h session per week for 20 weeks, aimed at developing muscular strength and coordination. Walking ability and walking speed were assessed by using the L-test of functional mobility and 10-m walk test, respectively. Mechanical and neuromuscular muscle function was assessed by using tensiomyography. RESULTS: In case 1, a decrement of 9.5% and 10.5% was found in the L-test (42 s vs. 38 s) and in the 10-m test (19 s vs. 17 s) scores, respectively. In case 2, walking ability remained unchanged (L-test score: 38 s), while a 5.2% reduction in walking speed was observed (10-m test score: 19 s vs. 18 s). No relevant changes were observed in the muscular tone in both cases. CONCLUSIONS: Practitioners should be aware that, contrary to what could be expected, a multidisciplinary training program held once per week for 5 months had a minimal impact on the gait pattern and neuromuscular function of two children with lower-limb amputation.

Design and simulation of dynamic hip prosthesis based on remote motion center mechanism / 生物医学工程学杂志

The rotation center of traditional hip disarticulation prosthesis is often placed in the front and lower part of the socket, which is asymmetric with the rotation center of the healthy hip joint, resulting in poor symmetry between the prosthesis movement and the healthy lower limb movement. Besides, most of the prosthesis are passive joints, which need to rely on the amputee's compensatory hip lifting movement to realize the prosthesis movement, and the same walking movement needs to consume 2-3 times of energy compared with normal people. This paper presents a dynamic hip disarticulation prosthesis (HDPs) based on remote center of mechanism (RCM). Using the double parallelogram design method, taking the minimum size of the mechanism as the objective, the genetic algorithm was used to optimize the size, and the rotation center of the prosthesis was symmetrical with the rotation center of the healthy lower limb. By analyzing the relationship between the torque and angle of hip joint in the process of human walking, the control system mirrored the motion parameters of the lower on the healthy side, and used the parallel drive system to provide assistance for the prosthesis. Based on the established virtual prototype simulation platform of solid works and Adams, the motion simulation of hip disarticulation prosthesis was carried out and the change curve was obtained. Through quantitative comparison with healthy lower limb and traditional prosthesis, the scientificity of the design scheme was analyzed. The results show that the design can achieve the desired effect, and the design scheme is feasible.

Avaliação da qualidade e do nível de satisfação de atletas amputados transfemorais com suas próteses: um estudo preliminar / Quality and level of satisfaction assessment of amputee athletes with their prosthesis: a preliminary study

O aumento do número de sujeitos amputados protetizados torna necessário o desenvolvimento de dispositivos cada vez mais seguros e funcionais para o uso. Dentre os aspectos envolvidos no desenvolvimento protético, é importante que seja avaliada a percepção do usuário em relação ao dispositivo para detectar problemas e desconfortos que prejudicam o processo de adaptação e rein serção social após a amputação. Objetivo: analisar o nível de satisfação de atletas com amputação transfemoral em relação à suas próteses e seus impactos em sua funcionalidade e qualidade de vida. Mét o do : estudo transversal preliminar realizado com cinco atletas amputados, a coleta de dados foi realizada por meio da aplicação de um formulário de avaliação estruturado e questionário para obtenção das características estruturais e psicológicas dos participantes com amputação e do dispositivo protético utilizado, o nível de associação entre os aspectos avaliados foi medido por meio do coeficiente de correlação de sp earm an . Resultados: após a avaliação dos dados, foi observada correlação positiva forte entre o tempo de amputação e o grau de adaptação protético (p<0.05). Indivíduos mais adaptados ao dispositiv o p ossuem maior satisfação ao uso da prótese nas atividades de vida diária e maiores pontuações no questionário. Foi observada ainda e que a qualidade da prótese impacta o nível de satisfação em relação à adaptação e desenvolvimento das atividades diárias e desportivas. Conclusão: as análises evidenciam a influência do processo de protetização no desempenho esportivo e nas atividades cotidianas executadas pelos sujeit o s amputados, dados que podem contribuir para desenvolvimento tecnológico de dispositivos que interfiram positivamente no desempenho funcional diário e esportivo dessa população...(AU)

Background: the increase of amputated subjects with leg prostheses requires the development of increasingly safe and functional devices, and for this purpose it is necessary t o ev aluate the user's perception regarding his device to detect problems and discomforts that undermine t he so cial reintegration process after the amputation. Purpose: to analyze the satisfaction level o f athletes wit h transfemoral amputation about their prosthesis and its impacts in their functionality and qualit y o f life. Methods: a preliminary cross-sectional study was developed; data collection was performed through t he application of a structured evaluation form and a questionnaire to obtain structural an d p sy ch ological characteristics of five participants with amputation and the prosthetic device used. Correlation coefficients between evaluated aspects were calculated. Results: there was a strong positive correlation bet ween t he time since amputation and prosthetic adaptation (p<0.05). Subjects more adap ted t o t he dev ice h ave greater satisfaction using their prosthesis in activities of daily living and higher scores on quest io nnaire. The present study verified that the quality of the prosthesis influences the level of satisfaction related t o adaptation and development of daily and sports activities. Conclusion: this study correlations sh o ws t he real influence of prosthetization process in sports performance and daily activities executed by am p utee subjects, this data may assist the technological development of devices that contribute t o th e daily and sportive functional performance of this population...(AU)

Funcionalidad de prótesis de mano impresa en 3D en adolescentes con amputación congénita parcial de mano: una serie de casos / 3D-printed hand prostheses function in adolescents with congenital hand amputation: a case series

Resumen: Objetivo: Describir el efecto de la prótesis impresa en 3D Cyborg Beast en la funcionalidad de miembros superiores (MMSS) en adolescentes con amputación congénita parcial de mano. Casos Clínicos: Se seleccionaron 5 pacientes entre 12 y 17 años con amputación congénita parcial de mano en el Instituto Teletón Santiago. Los pacientes fueron entrenados en el uso de la prótesis por 4 sesiones. Se evaluó la función basal (sin prótesis), al mes y los 4 meses de uso de la prótesis con la pauta Bilan 400 points modificada y la percepción de funcionalidad de MMSS sin y con prótesis con la "Upper Extremity Function Index (UEFI)". Al mes y 4 meses de uso, el porcentaje de cambio para funcionalidad de mano fue de -11% y -4% para la extremidad no afectada y de -9% y -2% para la afectada. El porcentaje de cambio para la percepción de funcionalidad de MMSS fue de -62%. Conclusiones: El uso de la prótesis de mano Cyborg Beast no fue una solución funcional para los 5 pacientes incluidos en este estudio. Futuras investigaciones son necesarias para poder mejorar la funcionalidad de estos diseños de prótesis impresa en tecnología 3D.

Abstract: Objective: To describe the effect of the 3D-printed Cyborg Beast prosthesis on upper limbs function in adolescents with congenital hand amputation. Clinical Cases: Five patients aged between 12 and 17 years, with congenital hand amputation were selected. All patients were from the Teletón Institute in Santiago, Chile. The patients were trained for prosthesis use in four sessions. Hand function was evaluated without prosthesis, at 1 and 4 months of use with the modified Bilan 400 points scale, and upper limb function perception was evaluated with the 'Upper Extremity Functional Index (UEFI)'. At 1 month and 4 months of use, the percentage change for hand functionality for the unaffected limbs was between -11% and -4%; and -9% and -2% for the affected limb. The percentage change for the upper limbs perceived function was -62%. Conclusions: The use of the 3D-printed Cyborg Beast prosthesis was not a functional solution for the 5 patients included in this study. Future research is needed to improve the functionality of these types of 3D-printed hand prostheses.

Tradução e adaptação transcultural do Questionnaire de Satisfaction de la Personne Amputée face à sa Prothèse (SAT-PRO) para a língua portuguesa do Brasil / Translation and cultural adaptation of the Questionnaire de Satisfaction de la Personne Amputée face à sa Prothèse (SAT-PRO) to portuguese language in Brazil

A satisfação da pessoa amputada com a sua prótese é fundamental para o sucesso da reabilitação protésica, o que justifica a necessidade de existirem instrumentos para serem utilizados pelos profissionais de saúde. Um dos instrumentos que permite realizar esta avaliação é o questionário SAT-PRO, que foi desenvolvido e aplicado no Canadá, em idosos amputados de membro inferior, mas que no Brasil ainda não está traduzido, adaptado ou validado. Objetivo: Realizar a tradução do SAT-PRO para a língua portuguesa, e apresentar uma versão adaptada culturalmente para ser aplicada em idosos brasileiros. Método: A tradução e adaptação transcultural foi realizada em cinco etapas, seguindo-se de uma sexta etapa em que se verificou a validade de conteúdo e confiabilidade do instrumento. Resultados: Durante o processo de tradução e adaptação encontraram-se algumas ambiguidades que foram colmatadas pela realização de ajustes consensuais ao questionário. O índice de validade de conteúdo dos itens variou entre 0,85 e 1, e o índice de validade da escala foi de 0,98. O valor total do coeficiente alfa de Cronbach foi de 0,89. Conclusão: O processo de tradução e adaptação transcultural do SAT-PRO, revelou que este se encontra adaptado à realidade cultural de idosos brasileiros com amputação de membro inferior, apresentando também boa validade de conteúdo e confiabilidade.

The satisfaction of amputees with their prostheses is essential for the success of prosthetic rehabilitation, which justifies the need for instruments to be used by health professionals. One of the instruments that allows this assessment to be carried out is the SAT-PRO questionnaire, developed and applied in Canada, for elderly amputees of lower limb, nevertheless in Brazil it is not yet translated, adapted or validated. Objective: The aim of this study is to carry out the translation of the SAT-PRO into Portuguese and to present a culturally adapted version to be applied to elderly Brazilians. Method: The translation and adaptation were carried out in five stages, followed by a sixth stage, in which the content validation and reliability was verified. Results: During the translation and adaptation process, some ambiguities were found that were overcome by making consensual adjustments to the questionnaire. The content validity index of the items varied between 0.85 and 1 and the scale validity index was 0.98. The total value of Cronbach's alpha coefficient was 0.89. Conclusion: The process of translation and cross-cultural adaptation of the SAT-PRO revealed that it is adapted to the cultural reality of elderly Brazilians with lower limb amputation, also showing good content validity and reliability.

Sistema de órtesis activa para la capacidad motora del miembro superior de personas con lesiones en el plexo braquial. Reporte de casos / Active orthosis system for the motor capacity of the higher member of persons with injuries in the brachial plexus. Case report

Introducción La órtesis activa es uno de los principales temas de investigación en el campo de la rehabilitación y recuperación motora de una extremidad lesionada. Dentro de las lesiones podemos resaltar la lesión en el plexo braquial el cual genera la pérdida total de la capacidad motora del miembro superior. Materiales y métodos Esta investigación identifica el nivel de discapacidad de esta lesión y busca mejorar la capacidad motora de las personas con lesiones en el plexo braquial mediante el uso de una órtesis. Resultados Se obtuvo una órtesis activa construida con material ABS, impresa por una impresora 3D, con la finalidad de reducir costos y el uso de un sensor muscular EMG MyoWare activado con el musculo del hombro para controlar dos servomotores ubicados en el codo y muñeca. Discusión Se logró mejorar la capacidad motora de dos pacientes que padecen esta lesión logrando realizar flexión de codo, extensión de muñeca y flexión de muñeca con la ayuda de la órtesis construida, así como también se identificaron algunas dificultades que se deben considerar para tener un producto totalmente funcional.

Background Active orthosis is one of the main research topics in rehabilitation field and recovery of an injured limb. Within the injuries we can highlight the injury of brachial plexus generates the total loss of motor capacity of the upper limb. Materials and methods This research identifies the level of disability of this lesion and seeks to improve the motor capacity of people with lesions in the plexus by using an active orthosis. Results We built a printed by a 3D printer with ABS material, and using a MyoWare EMG muscle sensor activated with shoulder muscles to control two servomotors located at elbow and wrist joints. Discussion This work was able to improve the motor skills of two patients suffering from this injury, achieving elbow flexion, wrist extension and wrist flexion with the help of the built-in orthosis, as well as identifying some difficulties that must be considered in order to have a fully functional product.

Experiencias del uso de ortoprótesis de mano impresa en 3D (Cyborg Beast) en adolescentes con amputación congénita de mano y sus cuidadores principales: un estudio de casos / Experiences of the use of 3D printed hand ortoprosthesis (Cyborg Beast) in adolescents with congenital hand amputation and their main caregivers: a study of cases

OBJETIVO: Describir la experiencia del uso de la ortoprótesis de mano impresa en 3D Cyborg Beast, en adolescentes usuarios de Teletón Santiago con amputación congénita de mano y sus cuidadores principales, que participaron en un estudio de casos para evaluar la funcionalidad de la mano proté sica. CASO CLÍNICO: Investigación de estudio de casos de tipo descriptivo, mediante entrevistas semi- estructuradas a cinco adolescentes con amputación congénita de mano y a sus cuidadores principales, las cuales fueron transcritas y analizadas mediante codificación abierta. Los participantes visualizan la ortoprótesis como una oportunidad para ellos asociándola a la normalidad. Asimismo, identificaron características positivas y negativas, enfatizando en estas últimas. Además, describieron efectos positivos y negativos producidos al utilizar la prótesis, destacando que el uso de la prótesis les permite ha blar sobre su condición. Finalmente, se presentan propuestas de mejora para la prótesis, definiéndose que se debe corregir el prototipo y cambiar la edad de la población objetivo. CONCLUSIONES: El estudio se configura como pionero al investigar un tema poco explorado, permitiendo entregar información respecto de la experiencia subjetiva de adolescentes que utilizan una ortoprótesis que actualmente tiene gran importancia mediática. Los participantes del estudio relataron dificultades para usar la ortoprótesis de mano, ya sea por aspectos de materialidad y diseño. La ortoprótesis no cumplió las expectativas de uso y estética.

OBJECTIVE: To describe the experience of using the 3D-printed prosthetic hand Cyborg Beast in ado lescents of Teletón Santiago with congenital hand amputation and their main caregivers who partici pated in a case study to evaluate the functionality of the prosthetic hand. CLINICAL CASE: Qualitative and descriptive research of case studies using semi-structured interviews with five adolescents with congenital hand amputation and their main caregivers. The information was transcribed and ana lyzed through open coding. Participants visualize the prosthesis as an opportunity for them by asso ciating it with normality. They also identify positive and negative characteristics, emphasizing in the latter. In addition, they described positive and negative effects produced when using the prosthesis, highlighting that the use of the prosthesis allows them to talk about their condition. Finally, im provement proposals for the prosthesis are presented, defining that the prototype must be corrected and change the age of the target population. CONCLUSIONS: The study is the first to investigate a little explored topic, allowing to provide information regarding the subjective experience of adolescents who use a prosthesis that currently has great media importance. The study participants reported dif ficulties in using the hand prosthesis, either due to materiality and design aspects. The prosthesis did not meet the expectations of use and esthetic.

Impacto funcional y psicosocial del uso de prótesis de bajo costo en impresión 3D en amputado unilateral de antebrazo: estudio de un caso / Functional and psychosocial impact of the use of low cost 3D prosthesis in a subject with unilateral forearm amputation: case report

Introducción: Los pacientes que presentan una amputación a nivel transradial cuentan con oferta reducida de dispositivos protésicos (gancho y mano cosmética). Postulamos que disponer de nuevos sistemas protésicos 3D de bajo costo y la experiencia de su uso, permitirá aumentar las opciones para mejorar funcionalidad, actividad y participación. Objetivo: Evaluar el impacto funcional y psicosocial del uso de mano protésica manufacturada con impresión 3D. Método: Se seleccionó un paciente Teletón con amputación transradial de antebrazo izquierdo nivel tercio medio, 15 años de edad, con consentimiento informado. Se tomó molde en yeso y confeccionó prótesis 3D fabricada en acrilonitrilo butadieno estireno (ABS) y ácido poli-láctico (PLA); el pulgar tiene dos articulaciones y los demás dedos tres articulaciones. La prótesis la constituyen también el antebrazo y muñeca. El usuario recibió cuatro sesiones de entrenamiento con la prótesis en el lapso de un mes. Las evaluaciones con pauta de funcionalidad de mano Bilan 400 points modificada, índice funcional de las extremidades superiores (UEFI) y escala del impacto psicosocial de la asistencia tecnológica (PIADS), se aplicaron previo al ingreso, a tres y once meses de seguimiento. Resultados: La funcionalidad de mano mostró un incremento de alrededor de 30% con ambos instrumentos. En medición PIADS, competencia, autoestima y adaptabilidad, variaron de ningún efecto de la asistencia tecnológica, hasta el máximo de 3 puntos para adaptabilidad en el seguimiento a 11 meses. Conclusión: Este estudio de caso destaca potenciales beneficios del uso de prótesis de extremidad superior en el desempeño funcional y calidad de vida.

Introduction: The range of prosthetic devices (hooks and cosmetic hands) is limited for transradial amputation patients. Having new low-cost 3D prosthetic systems available, as well as experience on how to use them, will increase the options for better functionality, activity and participation. Objective: To assess functional and psychosocial impact of the use of 3D printed prosthetic hand. Method: A 15 year-old Teleton patient was selected with a middle third transradial amputation of the left forearm; informed consent was obtained. A plaster mold was taken and a 3D prosthesis was made using acrylonitrile butadiene styrene (ABS) and polylactic acid (PLA); the thumb had two articulations and the other fingers had three articulations. The prosthesis comprised also forearm and wrist. The user attended four prosthetic training sessions in a month. Modified Bilan 400 points scale for hand functionality, upper extremity functional index (UEFI) and the psychosocial impact of assistive devices scale (PIADS) were applied before admittance, and then at three and eleven months of follow up. Results: Hand functionality showed an increase of approximately 30% with both measuring instruments. In case of PIADS, competence, self-esteem and adaptability varied, from no effect of technology assistance, to the maximum of 3 points in adaptability at the eleven-month follow up. Conclusion: This case study highlights potential benefits of using upper limb 3D prosthesis on daily functional performance and quality of life.

Dolor fantasma en niños y jóvenes amputados congénitos: prevalencia y características clínicas / Phantom pain in children and youth with congenital amputations: prevalence and clinical characteristics

Introducción: El dolor es una patología discapacitante, que en niños está siendo abordada en los últimos tiempos, siendo el dolor fantasma en amputados congénitos una complicación impensada hace algunos años, considerando teorías que describían que carecían de la madurez biológica suficiente para experimentarlo. Actualmente, existe literatura que reconoce una prevalencia de dolor fantasma de 3,7 a 20% en la población de amputados congénitos. Objetivo general: Evaluar población de amputados congénitos del Instituto Teletón Santiago para determinar incidencia, prevalencia lápsica y características clínicas del dolor fantasma. Pacientes y Métodos: Estudio descriptivo de prevalencia, con revisión de ficha clínica para registro de variables demográficas y clínicas, y aplicación de encuesta telefónica al total de pacientes que asintieran y contaran con el consentimiento de sus padres. Se incluyó a todos los pacientes de 10 o más años; se excluyó a los con hipoacusia asociada o con imposibilidad administrativa para contactarlos. Resultados: 57 pacientes, edad promedio 18,6 años, 59,6% con deficiencia longitudinal. Ningún paciente presentó dolor fantasma en el último mes en la población estudiada. La prevalecia lápsica fue de 7,0%. Un 24,6% refirió además presentar sensación fantasma alguna vez en su vida y un 5,3% haber presentado dolor en el último año. Conclusión: Existe dolor fantasma en la población de pacientes amputados congénitos en los rangos de prevalencia encontrados en la literatura internacional contribuyendo a la evidencia existente. Este es el primer estudio en nuestro país que evalúa dolor en deficiencias congénitas y constituye una línea de base para estudios adicionales.

Introduction: Pain is a crippling pathology, which has been addressed in children only in recent times, and phantom pain in congenital amputees was a complication unthought to exist some years ago, considering theories that described that they lacked biological maturity enough to experience it. Currently, there is literature that recognizes a prevalence of phantom pain of 3.7 to 20% in congenital amputees. Overall objective: To evaluate the in vivo amputee population of Instituto Teletón Santiago, to determine incidence, lapses prevalence and clinical characteristics of phantom pain in these patients. Patients and Methods: A prevalence descriptive study was carried out, with a review of the clinical files to register demographic and clinical variables and application of a telephone survey to the total number of Instituto Teletón Santiago patients who agreed to participate and had the consent of their parents. We included all patients aged 10 years and over; excluding those with associated hearing loss, or inability to contact for administrative reasons. Results: 57 patients, mean age 18,6 years, 59,6% with longitudinal deficiency. No patient refered phantom pain during de last month in the study population. The lapsic prevalence was 7,0%. 24,6% of the population studied reported phantom feeling at som time in their lives and 5,3% had phantom pain during the last year. Conclusion: There is phantom pain in the population of congenital amputees in the prevalence ranges found in the international literature contributing to the existing evidence. This is the first study in our country that evaluates pain in congenital deficiencies and constitutes a baseline for additional studies.

Avaliação fisioterapêutica em criança com malformação congênita de membro inferior: um relato de caso / Physiotherapy evaluation in children with congenital malformation of lower members: a case study

Este trabalho teve como objetivo realizar uma avaliação fisioterapêutica em um voluntário com malformação congênita do membro inferior direito, a fim de conhecer seus aspectos motores e funcionais, devido ao fato de ser um caso peculiar com incidência de 1 a cada 100.000 nascidos vivos. Tratou-se de um relato de caso, realizado na clínica escola de fisioterapia de uma universidade do interior do Estado de São Paulo. Os procedimentos consistiram em: anamnese, exame físico, escalas e instrumentos de avaliação do controle, índice de Barthel modificado, plataforma de força e avaliação postural. Pode-se observar através da avaliação fisioterapêutica alterações posturais relevantes com assimetrias entre os hemicorpos, déficit de equilíbrio e diminuição de força muscular no membro inferior direito, o que acarreta uma alteração biomecânica importante no participante avaliado. Essas informações coletadas durante as avaliações são essenciais para conhecer as alterações físicas decorrentes da malformação congênita para promover um melhor direcionamento em seu tratamento.

A physiotherapy evaluation has been undertaken with a voluntary subject with congenital malformation of the right lower limber to understand motor and functional aspects of the issue. The fact has an occurrence of 1/100000 live births. The case study has been undertaken in a physiotherapy school at a university clinical in the interior of the state of São Paulo, Brazil. Procedures included anamnesis, physical examination, scales and instruments for control assessment, modified Barthel Index, force platform and posture evaluation. Physiotherapeutic evaluation revealed significant posture changes with asymmetry between the hemibodies, deficit in equilibrium and lessening of muscular force in the right lower member, with subsequent important biomechanical changes in the patient. Information collected during evaluations is essential to understand the physical alternations due to congenital malformation for better results through treatment.

Study on gait symmetry based on simulation and evaluation system of prosthesis gait / 生物医学工程学杂志

A software and hardware platform for gait simulation and system evaluation for lower limb intelligent prosthesis is proposed and designed, in order that the wearable symmetry effect of the intelligent knee prosthesis can be quantitatively analyzed by machine test instead of human wear test. The whole-body three-dimensional gait and motion analysis system instrument, a device to collect gait data such as joint angle and stride of adults, was used for extracting simulated gait characteristic curve. Then, the gait curve was fitted based on the corresponding joint to verify the feasibility of the test platform in the experiment. Finally, the developed artificial knee prosthesis was worn on the prosthetic evaluation system to quantitatively analyze the gait symmetry effect. The results showed that there was no significant difference in gait symmetry between the developed knee joints at different speeds, which could reach more than 88%. The simulation and evaluation of the prosthetic gait have good effects on the functional simulation and evaluation of the lower limb intelligent prosthesis.

Research progress on perception and feedback technology in artificial prosthesis / 生物医学工程学杂志

Artificial prosthesis is an important tool to help amputees to gain or partially obtain abled human limb functions. Compared with traditional prosthesis which is only for decoration or merely has feedforward control channel, the perception and feedback function of prosthesis is an important guarantee for its normal use and self-safety. And this includes the information of position, force, texture, roughness, temperature and so on. This paper mainly summarizes the development and current status of artificial prostheses in the field of perception and feedback technology in recent years, which is derived from two aspects: the recognition way of perception signals and the feedback way of perception signals. Among the part of recognition way of perception signals, the current commonly adopted sensors related to perception information acquisition and their application status in prosthesis are overviewed. Additionally, from the aspects of force feedback stimulation, invasive/non-invasive electrical stimulation, and vibration stimulation, the feedback methods of perception signals are summarized and analyzed. Finally, some problems existing in the perception and feedback technology of artificial prosthesis are proposed, and their development trends are also prospected.

Qualidade de vida de protetizados de membro inferior / Quality of life of lower limb prosthetized subjects

Introdução: Atualmente nota-se muitas pessoas com algum tipo deficiência, sendo a física a segunda maior causa com 1,3% dos acometidos por acidentes que podem levar a amputações. O Instituto Nacional do Seguro Social (INSS) reabilita profissionalmente os beneficiários incapacitados para a sua atividade profissional em decorrência de doença ou acidente e portadores de deficiência, com finalidade de promoção dos meios para a sua reinserção no mercado de trabalho e sociedade. Para entender a qualidade de vida dessa população e partindo da definição da OMS sobre qualidade de vida entende-se que a amputação influencia nos aspectos físico, psicológico, cultural e social. Objetivo: Este estudo teve como objetivo avaliar a qualidade de vida de amputados protetizados de membro inferior segurados do Instituto Nacional do Serviço Social (INSS) a partir das dificuldades apresentadas da rotina de vida diária. Método: Aplicação do protocolo de avaliação da qualidade de vida em amputados (Prostthesis Evalution Questionnaire"(PEQ). Foram avaliados 13 sujeitos homens, jovens adultos com idade média de 39 anos, etiologia mais evidente foi acidente de trabalho, nível de amputação transfemoral (59%) e incidência do lado direito. Resultados e Discussão: Foi possível verificar boa qualidade dessa clientela, com maioria dos resultados dos grupos do questionário com média acima do mínimo (5,0), porém apresentam dificuldades quanto à realização das atividades de vida diária, justificadas pelo fato da instituição somente ter como objetivo a volta ao trabalho. Conclusão: Por meio de uma somatória de resultados apresentados pelos participantes da pesquisa foi possível evidenciar que a população amputada protetizada do INSS- Bauru possui qualidade de vida classificada média dentro do padrão (média do score 5,0) avaliada nessa população.

Introduction: Nowadays, there are a large number of people with some type of disability, with physics being the second largest cause with 1.3% of those affected by accidents that can lead to amputations. The National Institute of Social Security (INSS) professionally rehabilitates beneficiaries who are incapacitated for their professional activity as a result of illness or accident and with disabilities, with the purpose of promoting the means for their reintegration into the labor market and society. To understand the quality of life of this population and starting from the definition of the WHO on quality of life is understood that the amputation influences in the physical, psychological, cultural and social aspects. Objective: The objective of this study was to evaluate the quality of life of the protected socially assisted amputees of the National Institute of Social Work (INSS), based on the difficulties presented in the daily life routine. Methods: It was used the Quality of life assessment protocol (Prosthetics Evaluation Questionnaire - PEQ). A total of 13 male subjects, young adults with a mean age of 39 years, the most evident etiology was work accident, transfemoral amputation level (59%) and right-side incidence. Results and Discussion: It was possible to verify good quality of this clientele, with most of the results of the groups of the questionnaire with a mean above the minimum (5.0), but they present difficulties regarding the accomplishment of daily life activities, justified by the fact that the institution only aims to return to work. Conclusion: Through a sum of results presented by the research participants, it was possible to show that the prosthetized amputated population of the INSS-Bauru has quality of life, classified as average within the standard (average score 5.0) as evaluated in this population.

Traitement par fixateur externe des fractures ouvertes des membres type III de Gustilo-Anderson

Introduction : Les fractures ouvertes des membres type III de Gustilo et Anderson relèvent d'un traumatisme à haute énergie. Ces fractures sont stabilisées par un fixateur externe. Le but de cette étude rétrospective était de préciser les caractéristiques épidémio-cliniques des patients et d'évaluer les résultats du traitement. Patients et Méthodes : Cette étude était basée sur 20 patients totalisant 20 fractures ouvertes des membres traitées par fixateur externe entre janvier 2015 et décembre 2017. L'évaluation des résultats tenait compte de la consolidation, le résultat fonctionnel et les complications. Résultats : Il y avait 15 hommes et cinq femmes avec un âge moyen de 26 ans. Le délai moyen de prise en charge était de 21 heures. Les lésions siégeaient au membre inférieur (n=17) et au membre supérieur (n=3). Selon la classification de Gustilo et Anderson les fractures étaient de type IIIa (n= 11), type IIIb (n= 8) et type IIIc(n=1). Il a été réalisé des greffes de peau (n=16) et des lambeaux n=3). Les types de fixateur étaient le Fixateur Externe du Service de Santé des Armées (n=7), le Hoffman (n=7), et l'Orthofix (n=6). La cicatrisation des plaies a été obtenue dans un délai moyen de 31 jours. La consolidation était acquise chez 17 patients dans un délai moyen de 9 mois. Après un recul moyen de 9 mois, le résultat fonctionnel a été jugé excellent (n= 12), bon (n= 5) et mauvais (n=3). Les complications étaient l'infection postopératoire (n=12), le cal vicieux (n= 4), et la pseudarthrose (n=2). Conclusion : Le fixateur externe a été utilisé comme moyen de contention. La cicatrisation dirigée associée à une greffe cutanée a été réalisée dans la majorité des cas. La consolidation a été acquise chez 17 patients avec des résultats fonctionnels excellents et bons

Squamous Cell Carcinoma Arising in an Amputation Stump / 대한피부과학회지

Amputation of the lower extremities followed by the use of an artificial leg is very common. However, malignancy arising in an amputation stump is an extremely rare event. In this report, we describe a case of squamous cell carcinoma arising in the amputation stump of a 56-year-old Korean man. To the best of our knowledge, similar cases have not been previously reported in Korea.

Clinical outcomes of a low-cost single-channel myoelectric-interface three-dimensional hand prosthesis

BACKGROUND: Prosthetic hands with a myoelectric interface have recently received interest within the broader category of hand prostheses, but their high cost is a major barrier to use. Modern three-dimensional (3D) printing technology has enabled more widespread development and cost-effectiveness in the field of prostheses. The objective of the present study was to evaluate the clinical impact of a low-cost 3D-printed myoelectric-interface prosthetic hand on patients' daily life. METHODS: A prospective review of all upper-arm transradial amputation amputees who used 3D-printed myoelectric interface prostheses (Mark V) between January 2016 and August 2017 was conducted. The functional outcomes of prosthesis usage over a 3-month follow-up period were measured using a validated method (Orthotics Prosthetics User Survey–Upper Extremity Functional Status [OPUS-UEFS]). In addition, the correlation between the length of the amputated radius and changes in OPUS-UEFS scores was analyzed. RESULTS: Ten patients were included in the study. After use of the 3D-printed myoelectric single electromyography channel prosthesis for 3 months, the average OPUS-UEFS score significantly increased from 45.50 to 60.10. The Spearman correlation coefficient (r) of the correlation between radius length and OPUS-UEFS at the 3rd month of prosthetic use was 0.815. CONCLUSIONS: This low-cost 3D-printed myoelectric-interface prosthetic hand with a single reliable myoelectrical signal shows the potential to positively impact amputees' quality of life through daily usage. The emergence of a low-cost 3D-printed myoelectric prosthesis could lead to new market trends, with such a device gaining popularity via reduced production costs and increased market demand.