La compression élastique de la jambe est le traitement de référence des pathologies liées à l’insuffisance veineuse. Bien que l’efficacité ne soit plus à prouver, les objectifs thérapeutiques restent non atteints pour certains patients. Un objectif de la compression élastique est la réduction de la pression pariétale des veines afin de rétablir ou d’augmenter le retour du sang vers le cœur par une transmission de pression au travers des tissus mous. Ce mécanisme est complexe et peut être prédit par des modèles éléments finis personnalisés. Pour être personnalisés, ces modèles doivent prendre en compte la géométrie et la carte des propriétés mécaniques du sujet.Dans cette étude, on développe deux méthodologies permettant d’identifier les propriétés mécaniques des tissus mous. Dans un premier temps, on mesure par élastographie ultrasonore par onde de cisaillement la distribution du module élastique au sein des tissus mous superficiels. Dans un deuxième temps, on identifie par une méthode inverse les propriétés mécaniques des tissus mous profonds. Cette méthode associe l’acquisition de données d’un essai expérimental de compression localisée de la jambe à un modèle éléments finis bidimensionnel. Ces deux méthodologies nous permettent d’évaluer l’hétérogénéité des propriétés mécaniques de la peau au fascia cruris et de caractériser le comportement non-linéaire des tissus mous profonds. Enfin, les résultats de ces deux méthodologies sont couplés afin de générer un modèle biomécanique de la jambe sous compression élastique pour prédire la distribution de pression au sein des tissus mous pour quatre sujets sains. / Elastic compression of the leg is a widely used treatment in case of pathologies related to venous insufficiency. Its benefits are not to be proven, but still, for some patients, the therapeutic goal is not reached. One goal of this treatment is to reduce transmural pressure applied to veins in order to restore or increase blood return to the heart by the transmission of the external pressure through soft tissues. This is a complex mechanism that can be predicted by patient-specific finite element models. To be patient-specific, these models must take into account the geometry and the distribution of mechanical properties of each subject.In this study, two methodologies are developed to identify the mechanical properties of soft tissues. First, the elastic modulus distribution inside the superficial soft tissues is measured by shear wave ultrasound elastography. Second, the mechanical properties of deep soft tissues are identified through an inverse method combining the data acquired from an experimental localized compression of the leg to a bi-dimensional finite element model.These two methodologies allow to evaluate the mechanical properties heterogeneity from the skin to the fascia cruris and to characterize the non-linear behaviour of deep soft tissues. Finally, the results from both methodologies are brought together to generate a biomechanical model of the leg under elastic compression to predict pressure distribution inside soft tissues for four healthy subjects.

La compression élastique (CE) est un traitement médical qui est prescrit en cas d'insuffisance veineuse. Récemment, la CE rencontre aussi un certain succès auprès des sportifs pour la récupération. Cependant, malgré l’utilisation de plus en plus massive de la CE, son action biomécanique sur le membre inférieur n'est pas encore bien caractérisée. Pour contribuer à cette caractérisation, un modèle biomécanique 3D des tissus mous de la jambe sous CE a été développé et appliqué à un panel de sujets. Chaque modèle est personnalisé : la géométrie est reconstruite à partir des images tomographiques 3D de la jambe de chaque sujet et les conditions aux limites reproduisent fidèlement la pression localement appliquée par la CE sur la peau. De plus, les propriétés hyper-élastiques des tissus mous sont identifiées pour chaque sujet par recalage du modèle. Une méthode de recalage originale a été spécifiquement développée et mise en œuvre pour cette application : elle consiste à utiliser les images tomographiques 3D de la jambe déformée comme données expérimentales pour le recalage. Finalement, le modèle donne accès au champ de pression transmis par la CE aux tissus mous internes. Les principales conclusions sont que le champ de pression à l'intérieur de la jambe n'est pas transmis uniformément et qu'il y a de fortes variabilités inter-sujets. En outre, le modèle permet d'obtenir des indications sur le confort et l'efficacité de la CE. Il a ainsi été possible de montrer que l'intensité des pressions maximales subies par les tissus mous de la jambe est inversement proportionnelle à l’épaisseur du tissu adipeux. Les principales perspectives du travail concernent la validation clinique de ces conclusions sur un nombre significatif de sujets, puis leur exploitation en vue d’améliorer les traitements. / Elastic compression (EC) is a medical treatment prescribed in case of venous insufficiency. Recently, EC is also employed for recovery after efforts in sports. Nevertheless, despite the more and more common use of EC, its biomechanical action onto the lower limb remain partially unknown . To address this issue, a 3D biomechanical model of the soft tissues of the leg under EC has been developed and applied on a group of subjects. Each model is patient-specific: the geometry is reconstructed from the 3D CT-scan images of each subject’s legs and the boundary conditions are prescribed according to the local pressure applied by the EC onto the skin. Furthermore, the hyper-elastic properties of the soft tissues are identified for each subject using an inverse approach. The inverse approach is original: it consists in using the 3D CT-scan images of the deformed leg as experimental data for calibrating the model. The resulting model provides the pressure fields in the internal soft tissues induced by the EC. The main conclusions are that the pressure is not transmitted evenly and that significant inter-subject variability exists. Moreover, it is shown that the magnitude of the pressure undergone by the soft tissues is inversely proportional to the thickness of adipose tissues. The main perspectives of this work are to validate the conclusions on a significant number of subjects and to continue improving the treatments of venous insufficiency by EC.

Introduction: Though xenogeneic acellular scaffolds are frequently used for surgical reconstruction, knowledge of their mechanical properties is lacking. This study compared the mechanical, histological and ultrastructural properties of various native and acellular specimens. Materials and methods: Porcine esophagi, ureters and skin were tested mechanically in a native or acellular condition, focusing on the elastic modulus, ultimate tensile stress and maximum strain. The testing protocol for soft tissues was standardized, including the adaption of the tissue’s water content and partial plastination to minimize material slippage as well as templates for normed sample dimensions and precise cross-section measurements. The native and acellular tissues were compared at the microscopic and ultrastructural level with a focus on type I collagens. Results: Increased elastic modulus and ultimate tensile stress values were quantified in acellular esophagi and ureters compared to the native condition. In contrast, these values were strongly decreased in the skin after acellularization. Acellularization-related decreases in maximum strain were found in all tissues. Type I collagens were well-preserved in these samples; however, clotting and a loss of cross-linking type I collagens was observed ultrastructurally. Elastins and fibronectins were preserved in the esophagi and ureters. A loss of the epidermal layer and decreased fibronectin content was present in the skin. Discussion: Acellularization induces changes in the tensile properties of soft tissues. Some of these changes appear to be organ specific. Loss of cross-linking type I collagen may indicate increased mechanical strength due to decreasing transverse forces acting upon the scaffolds, whereas fibronectin loss may be related to decreased load-bearing capacity. Potentially, the alterations in tissue mechanics are linked to organ function and to the interplay of cells and the extracellular matrix, which is different in hollow organs when compared to skin.

Total hip replacement is one of the most common surgeries in orthopedics. Complete hip replacement can be addressed with several different types of surgical approaches. In this work we deal mainly with the anterior and anterolateral approach. The theoretical part of this work summarizes the basic knowledge about the anatomy, kinesiology of the hip joint and the prearthrotic causes leading to complete hip replacement. Furthermore, the types of surgical approaches, types of total endoprostheses are mentioned and the knowledge about soft tissue healing and early postoperative rehabilitation is summarized. The aim of this work is to determine whether rehabilitation will be faster in the first days after surgery in patients operated by the anterior approach, depending on the gentle approach and respect for anatomical structures, compared to the anterolateral approach. We present a group of 24 patients, 12 of whom underwent anterior approach and 12 anterolateral approach. In the practical part we evaluate and compare early postoperative rehabilitation in both approaches. The parameters we evaluate are the muscular strength of abduction, flexion and extension in the hip joint. Furthermore, the passive and active range of motion in the hip joint during abduction, flexion and extension. We also evaluate...

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Die Magnetresonanzelastographie (MRE) stellt ein nichtinvasives Verfahren dar, welches die Bestimmung der in vivo Scherelastizität weicher Gewebe ermöglicht. Im Rahmen diese Arbeit wurden Methoden zur Bestimmung isotroper und anisotroper Scherelastizitäten anhand von MRE Wellenbildern entwickelt und evaluiert. Alle in dieser Arbeit vorgestellten Methoden basieren auf planarer MRE, d.h. auf der Aufnahme einer einzelnen Auslenkungskomponente innerhalb der Bildschicht. Dadurch wird die MRE erheblich beschleunigt. Allerdings stellen sich dadurch auch besondere Anforderungen an die Datenauswertung zur Bestimmung aussagekräftiger elastischer Kenngrößen. Anhand von planaren MRE-Experimenten an Gewebephantomen und menschlicher Skelettmuskulatur sowie mittels numerischer Simulation wird gezeigt, dass bei Beachtung weniger experimenteller Randbedingungen und einer darauf abgestimmten Datenauswertung, korrekte Elastizitäten ermittelt werden können. Ein besonderer Schwerpunkt der Arbeit liegt in der Analyse experimenteller Einflüsse wie Bildrauschen und -auflösung auf die ermittelten elastischen Kenngrößen. Des Weiteren werden Methoden zur Bestimmung anisotroper Elastizitäten sowie zur Analyse von Streueffekten im MRE-Wellenbild vorgestellt. Die behandelten Einflüsse auf die Amplituden und Wellenlängen im MRE-Bild, werden vergleichend diskutiert und zusammengefasst, um ein einfaches Verfahrensprotokoll zur Analyse experimenteller in vivo MRE-Daten zu entwickeln. Alle in dieser Arbeit verwendeten Methoden und Programme sind im Anhang zusammengefasst und auf Anforderung erhältlich. / Magnetic resonance elastography (MRE) is a noninvasive method that allows the determination of in vivo shear elasticity of soft tissues. In this thesis methods for the determination of isotropic and anisotropic shear elasticities from MRE wave data were developed and evaluated. All methods presented in this work are based on planar MRE, i.e. they are based on the measurement of a single displacement component in the image plane. This way measurement time in MRE is greatly reduced. However, this imposes specific requirements on data evaluation in order to determine significant elastic constants. On the basis of planar MRE experiments on tissue mimicking gels, human skeletal muscle and numerical simulations it is demonstrated that correct shear elasticities can be determined, taking into account a small set of experimental boundary conditions as well as the employment of complementary data evaluation strategies. This thesis is particularly focussed on the analysis of noise and image resolution on the determined elastic constants. Moreover, methods for determining anisotropic elasticity and analyzing shear wave scattering effects on MRE wave data are introduced. The investigated influences on wave amplitudes and wave lengths are compared and discussed to develop a simple measurement protocol for the evaluation of in vivo MRE data. All methods employed in this work are summarized in the appendix along with the corresponding computer code, which is available on demand.

Made available in DSpace on 2016-08-03T16:31:07Z (GMT). No. of bitstreams: 1 JULIANA.pdf: 859794 bytes, checksum: 36f08ac0fd837829cfaaed65ef62f644 (MD5) Previous issue date: 2007-03-20 / The purpose of this study was applies Cephalometric soft tissue analysis proposed by ARNETT et al. in Brazilian youths, determining their medium values and comparing with the authors. The sample was compounded by 60 subjects, being 24 males and 36 females. All of them were Brazilians, leukoderms with natural normal occlusion, presenting four out of the six keys to ANDREWS s occlusion. The natural head position and the true vertical line were used at the moment of the lateral cephalograms and the profile photographs take, these made up the methodology for the study. The Cephalometric soft tissue analysis was performed evaluating the dentoskeletal factors, soft tissue structures, facial lengths, true vertical line projections and the harmony intramandibular, intrajaw and total face. The results demonstrated that the medium values of the studied sample presented differences in relation to the normative values of ARNETT et al. in most of the variables. As facial height when compared, they allowed to conclude that the Americans present larger facial height, straighter facial profile and more prominent nose than the Brazilians, so much in the masculine sex as in the feminine. The masculine sex presents facial height and thickness of the larger soft fabrics than the feminine sex, however, upper lip and inferior less protruded in relation to true vertical line. / Este estudo teve como objetivo aplicar e avaliar a Análise Cefalométrica do Tecido Mole proposta por ARNETT et al. em jovens brasileiros, determinando seus valores médios e comparando com os dos autores. A amostra compôs-se de 60 indivíduos, sendo 24 do sexo masculino e 36 do sexo feminino. Todos brasileiros, leucodermas e portadores de oclusão normal natural, apresentando um mínimo de quatro das seis chaves de oclusão de ANDREWS. A utilização da posição natural da cabeça e da linha vertical verdadeira no momento da obtenção das telerradiografias compuseram a metodologia do trabalho. Avaliaram-se os fatores dentários e os esqueléticos, as espessuras do tecido mole, os comprimentos faciais, as projeções do tecido mole em relação à Linha Vertical Verdadeira e a harmonia intramandibular, a intermaxilar e a facial total. Os resultados demonstraram que os valores médios da amostra estudada apresentaram diferenças em relação aos valores normativos de ARNETT et al. na maioria das variáveis e quando comparados entre si, verificou-se que os americanos apresentaram altura facial maior, perfil facial mais reto e nariz mais proeminente que os brasileiros, tanto para o sexo masculino como para o feminino. O sexo masculino apresentou altura facial e espessura dos tecidos moles maior que o sexo feminino, porem, lábios superior e inferior menos protruídos em relação à Linha Vertical Verdadeira. A

This thesis deals with problems of biomechanics of soft tissues, namely of stress-strain analysis of abdominal aortic aneurysm (AAA). The introduction describes briefly the possibility of aneurysm occurrence with a focus on an aneurysm in the abdominal aorta.

This thesis deals with problems of biomechanics of soft tissues, namely of stress-strain analysis of abdominal aortic aneurysm (AAA). The introduction describes briefly the possibility of aneurysm occurrence with a focus on an aneurysm in the abdominal aorta.

<div>The mechanical behaviors of different kinds of biological tissues, including muscle tissues, cortical bones, cancellous bones and skulls, were studied under various loading conditions to investigate their strain-rate sensitivities and loading-direction dependencies. Specifically, the compressive mechanical behaviors of porcine muscle were studied at quasi-static (<1/s) and intermediate (1/s─10^2/s) strain rates. Both the compressive and tensile mechanical behaviors of human muscle were investigated at quasi-static and intermediate strain rates. The effect of strain-rate and loading-direction on the compressive mechanical behaviors of human frontal skulls, with its entire sandwich structure intact, were also studied at quasi-static, intermediate and high (10^2/s─10^3/s) strain rates. The fracture behaviors of porcine cortical bone and cancellous bone were investigated at both quasi-static (0.01mm/s) and dynamic (~6.1 m/s) loading rates, with the entire failure process visualized, in real-time, using the phase contrast imaging technique. Research effort was also focused on studying the dynamic fracture behaviors, in terms of fracture initiation toughness and crack-growth resistance curve (R-curve), of porcine cortical bone in three loading directions: in-plane transverse, out-of-plane transverse and in-plane longitudinal. A hydraulic material testing system (MTS) was used to load all the biological tissues at quasi-static and intermediate loading rates. Experiments at high loading rates were performed on regular or modified Kolsky bars. Tomography of bone specimens was also performed to help understand their microstructures and obtain the basic material properties before mechanical characterizations. Experimental results found that both porcine muscle and human muscle exhibited non-linear and strain-rate dependent mechanical behaviors in the range from quasi-static (10^(-2)/s─1/s) to intermediate (1/s─10^2/s) loading rates. The porcine muscle showed no significant difference in the stress-strain curve between the along-fiber and transverse-to-fiber orientation, while it was found the human muscle was stiffer and stronger along fiber direction in tension than transverse-to fiber direction in compression. The human frontal skulls exhibited a highly loading-direction dependent mechanical behavior: higher ultimate strength, with an increasing ratio of 2, and higher elastic modulus, with an increasing ratio of 3, were found in tangential loading direction when compared with those in the radial direction. A transition from quasi-ductile to brittle compressive mechanical behaviors of human frontal skulls was also observed as loading rate increased from quasi-static to dynamic, as the elastic modulus was increased by factors of 4 and 2.5 in the radial and tangential loading directions, respectively. Experimental results also suggested that the strength in the radial direction was mainly depended on the diploë porosity while the diploë layer ratio played the predominant role in the tangential direction. For the fracture behaviors of bones, straight-through crack paths were observed in both the in-plane longitudinal cortical bone specimens and cancellous bone specimens, while the cracks were highly tortuous in the in-plane transverse cortical bone specimens. Although the extent of toughening mechanisms at dynamic loading rate was comparatively diminished, crack deflections and twists at osteon cement lines were still observed in the transversely oriented cortical bone specimens at not only quasi-static loading rate but also dynamic loading rate. The locations of fracture initiations were found statistical independent on the bone type, while the propagation direction of incipient crack was significantly dependent on the loading direction in cortical bone and largely varied among different types of bones (cortical bone and cancellous bone). In addition, the crack propagation velocities were dependent on crack extension over the entire crack path for all the three loading directions while the initial velocity for in-plane direction was lower than the other two directions. Both the cortical bone and cancellous bone exhibited higher fracture initiation toughness and steeper R-curves at the quasi-static loading rate than the dynamic loading rate. For cortical bone at a dynamic loading rate (5.4 m/s), the R-curves were steepest, and the crack surfaces were most tortuous in the in-plane transverse direction while highly smooth crack paths and slowly growing R-curves were found in the in-plane longitudinal direction, suggesting an overall transition from brittle to ductile-like fracture behaviors as the osteon orientation varies from in-plane longitudinal to out-of-plane transverse, and to in-plane transverse eventually.</div>