© [2015] American Physical Therapy Association. / 京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第19641号 / 人健博第33号 / 新制||人健||3(附属図書館) / 32677 / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 市橋 則明, 教授 山田 重人, 教授 妻木 範行 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

Musculoskeletal computational modeling is a versatile and effective tool which may be used to study joint mechanics, examine muscle and ligament function, and simulate surgical reconstructive procedures. While injury to the elbow joint can be significantly debilitating, questions still remain regarding its normal, pathologic, and repaired behavior. Biomechanical models of the elbow have been developed, but all have assumed fixed joint axes of rotation and ignored the effects of ligaments. Therefore, the objective of this thesis was to develop and validate a computational model of the elbow joint whereby joint kinematics are dictated by three-dimensional bony geometry contact, ligamentous constraints, and muscle loading.Accurate three-dimensional bone geometry was generated by acquiring CT scans, segmenting the images to isolate skeletal features, and fitting surfaces to the segmented data. Ligaments were modeled as tension-only linear springs, and muscle were represented as force vectors with discrete attachment points. Bone contact was modeled by a routine which applied a normal force at points of penetration, with a force magnitude being a function of penetration depth. A rigid body dynamics simulator was used to predict the model's behavior under particular external loading conditions.The computational model was validated by simulating past experimental investigations and comparing results. Passive flexion-extension range of motion predicted by the model correlated exceptionally well with reported values. Bony and ligamentous structures responsible for enforcing motion limits also agreed with past observations. The model's varus stability as a function of elbow flexion and coronoid process resection was also investigated. The trends predicted by the model matched those of the associated cadaver study.This thesis successfully developed an accurate musculoskeletal computational model of the elbow joint complex. While the model may now be used in a predictive manner, further refinements may expand its applicability. These include accounting for the interference between soft tissue and bone, and representing the dynamic behavior of muscles.

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The use of computational modeling is an effective and inexpensive way to predict the response of complex systems to various perturbations. However, not until the early 1990s had this technology been used to predict the behavior of physiological systems, specifically the human skeletal system. To that end, a computational model of the human elbow joint was developed using computed topography (CT) scans of cadaveric donor tissue, as well as the commercially available software package SolidWorks™. The kinematic function of the joint model was then defined through 3D reconstructions of the osteoarticular surfaces and various soft-tissue constraints. The model was validated against cadaveric experiments performed by Hull et al and Fern et al that measured the significance of coronoid process fractures, lateral ulnar collateral ligament ruptures, and radial head resection in elbow joint resistance to varus displacement of the forearm. Kinematic simulations showed that the computational model was able to mimic the physiological movements of the joint throughout various ranges of motion including flexion/extension and pronation/supination. Quantitatively, the model was able to accurately reproduce the trends, as well as the magnitudes, of varus resistance observed in the cadaveric specimens. Additionally, magnitudes of ligament tension and joint contact force predicted by the model were able to further elucidate the complex soft-tissue and osseous contributions to varus elbow stability.

The topic of this diploma thesis is "Influence of footwear on foot deformities in women - the role of nurses in prevention". The theoretical part is devoted to the foot anatomy, it describes the issue of heels on the foot and represents the Giraffe certification. The practical part of the qualitative research shows the role of nurses in preventing foot deformities for patients. This thesis has two goals. To find out what footwear affects the deformities of the legs in women and to find out what role the nurse plays in preventing this issue. The research questions are 1. What is the importance of wearing high-heeled shoes for women and how will this be reflected later? 2. What role do nurses attribute to the prevention in this issue? Data collection was collected by semi-structured interviews with nurses in the orthopaedic ward and orthopaedic clinics. The research sample consists of 20 respondents, the choice was deliberate and formed by snowball sampling. In February 2019, data was collected, which was subsequently terminated at the moment of theoretical saturation. The interview covered themes: wearing high-heeled shoes, leg deformities caused by high-heeled shoes, nurse-led prevention and education. The results show that only a fraction of nurses adhere to the role of a nurse who helps patients prevent leg deformities. The rest of the nurses leave prevention and education to doctors. This diploma thesis presents as a work output a poster, which can be an information material for nurses from the orthopaedic clinics and beds. The output of the thesis is an educational poster that will reflect the entire nursing issue in prevention (the role of a nurse, the deformity of the feet caused by high-heeled shoes, etc.).

Title Atypical Pronation of the Sub-Talar Joint: Its Implications on the Lower Limb Background Atypical pronation of the sub-talar joint, or overpronation of the foot, as it is more commonly known, is a current subtopic in foot and lower limb-related biomechanical issues. Typical pronation is a tri-planar movement that involves eversion of the hindfoot, combined with abduction and dorsiflexion of the forefoot. Atypical pronation is recognized when this motion is excessive, and may be determined by the extent and duration to which this occurs according to the rhythmic timing during the gait pattern. It is a mechanical problem of the foot that primarily results from a subluxation or shift of the sub-talar joint and bones of the mid- and hind-foot. As a common finding in the general population, especially in those with flexible flat feet, atypical pronation may result chronically in a displacement of the bones and joints of the lower limb. Research has stated that excessive pronation of the ankle-foot complex may cause change in position of certain bones in the lower limb. This is believed to occur through an interaction between foot and pelvis through a kinetic chain mechanism. Furthermore, it has been stated that atypical pronation may affect weight transfer of the lower limb during gait that may...