Effect of a Double Helical Spring Decompression Structure Backpack on the Lumbar Spine Biomechanics of School-Age Children: A Finite Element Study
Keywords:
Backpack; double helical spring decompression structure; pressure distribution; finite element; intervertebral disc
Abstract
Background: A children’s backpack is one of the important school supplies for school-age children. Long-term excessive weight can cause spinal deformity that cannot be reversed. This study compared a double helical spring decompression structure backpack (DHSB) with a traditional backpack (TB) to explore the optimization of decompression devices on upper body pressure. The finite element (FE) method was then used to explore the simulation of lumbar stress with different backpacks, in order to prove that DHSB can reduce the influence of backpack weight on lumbar vertebrae, avoid the occurrence of muscle discomfort and spinal deformity in children; Methods: 18 male children subjects (age: 12.5 ± 0.6 years; height: 145.5 ± 1.9 cm; bodyweight: 40.8 ± 3.1 kg) ran with DHSB and TB at a speed of 3.3 ± 0.2 m/s. Flexible pressure sensors were used to measure the pressure on the shoulder, back, and waist during running. The pressure data was then inputted into the FE model to simulate the effect of carrying different backpacks on the stress of the lumbar intervertebral disc (IVD); Result: There was a significant difference in shoulder and waist peak pressure between the DHSB and TB during the running posture. At a speed of 3.3 ± 0.2 m/s, the peak pressure of the shoulder and waist decreased. After finite element analysis, it was found that carrying DHSB on the back could effectively reduce the intervertebral disc pressure between L4-5 and L5-S1 by 27.9% and 34.1%, respectively; Conclusion: DHSB can effectively reduce the pressure on the shoulder and waist when children are running and can reduce the influence of backpacks on children’s posture to a certain extent. By finite element analysis, it is found that carrying DHSB can effectively reduce the stress of the lumbar intervertebral disc, and the damage to lumbar vertebrae is lower than with a TB.
References
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4 Calvo-Muñoz, I., Kovacs, F. M., Roqué, M., Seco-Calvo, J. (2020). The association between the weight of schoolbags and low back pain among schoolchildren: A systematic review, meta-analysis and individual patient data meta-analysis. European Journal of Pain, 24(1), 91–109. https://doi.org/10.1002/ejp.1471
5. Mackie, H. W., Stevenson, J. M., Reid, S. A., Legg, S. J. (2005). The effect of simulated school load carriage configurations on shoulder strap tension forces and shoulder interface pressure. Applied Ergonomics, 36(2),199–206. https://doi.org/10.1016/j.apergo.2004.10.007
6. Mackenzie, W. G., Sampath, J. S., Kruse, R. W., Sheir-Neiss, G. J. (2003). Backpacks in children. Clinical Orthopaedics and Related Research (1976–2007), 409, 78–84. https://doi.org/10.1097/01.blo.0000058884. 03274.d9
7. Brzęk, A., Dworrak, T., Strauss, M., Sanchis-Gomar, F., Sabbah, I. et al. (2017). The weight of pupils’ schoolbags in early school age and its influence on body posture. BMC Musculoskeletal Disorders, 18(1), 1–11. https://doi.org/
10.1186/s12891-017-1462-z
8. Al-Saleem, S. A., Ali, A., Ali, S. I., Alshamrani, A. A., Almulhem, A. M. (2016). A study of school bag weight and back pain among primary school children in Al-Ahsa, Saudi Arabia. Epidemiology (Sunnyvale), 6(1). https://doi.
org/10.4172/2161-1165.1000222
9. Grimmer, K. A., Williams, M. T., Gill, T. K. (1999). The associations between adolescent head-on-neck posture, backpack weight, and anthropometric features. Spine, 24(21), 2262. https://doi.org/10.1097/
00007632-199911010-00015
10. Chansirinukor,W.,Wilson, D., Grimmer, K., Dansie, B. (2001). Effects of backpacks on students: Measurement of cervical and shoulder posture. Australian Journal of Physiotherapy, 47(2), 110–116. https://doi.org/10.1016/
S0004-9514(14)60302-0
11. Chow, D., Ou, Z., Wang, X., Lai, A. (2010). Short-term effects of backpack load placement on spine deformation and repositioning error in schoolchildren. Ergonomics, 53(1), 56–64. https://doi.org/10.1080/00140130903389050
12. Southard, S. A., Mirka, G. A. (2007). An evaluation of backpack harness systems in non-neutral torso postures. Applied Ergonomics, 38(5), 541–547. https://doi.org/10.1016/j.apergo.2006.08.007
13. Goh, J., Thambyah, A., Bose, K. (1998). Effects of varying backpack loads on peak forces in the lumbosacral spine during walking. Clinical Biomechanics, 13(1), S26–S31. https://doi.org/10.1016/S0268-0033(97)00071-5
14. Cottalorda, J., Bourelle, S., Gautheron, V., Kohler, R. (2004). Backpack and spinal disease: Myth or reality? Revue de Chirurgie Orthopédique et Réparatrice de l’Appareil Moteur, 90(3), 207–214. https://doi.org/10.1016/
S0035-1040(04)70096-3
15. Amiri, M., Dezfooli, M. S., Mortezaei, S. R. (2012). Designing an ergonomics backpack for student aged 7–9 with user centred design approach. Work, 41(Supplement 1), 1193–1201. https://doi.org/10.3233/WOR-2012-0303-1193
16. Putra, N. K., Sriwarno, A. B. (2010). Dynamic modeling and simulation of the suspended-load backpack to obtain optimal suspension parameters and reducing effect of ground reaction force. 6th World Congress of Biomechanics
(WCB 2010), pp. 111–114. Singapore, Springer.
17. Chen, H., Shao, E., Sun, D., Xuan, R., Baker, J. S. et al. (2022). Effects of footwear with different longitudinal bending stiffness on biomechanical characteristics and muscular mechanics of lower limbs in adolescent runners. Frontiers in Physiology, 13, 907016. https://doi.org/10.3389/fphys.2022.907016
18. Zhang, Q., Zhang, Y., Chon, T. E., Baker, J. S., Gu, Y. (2022). Analysis of stress and stabilization in adolescent with osteoporotic idiopathic scoliosis: Finite element method. Computer Methods in Biomechanics and Biomedical Engineering, 26(1). https://doi.org/10.1080/10255842.2022.2044803
19. Zheng, J., Yang, Y., Lou, S., Zhang, D., Liao, S. (2015). Construction and validation of a three-dimensional finite element model of degenerative scoliosis. Journal of Orthopaedic Surgery and Research, 10(1), 189. https://doi.
org/10.1186/s13018-015-0334-1
20. Zhang, Q., Chon, T., Zhang, Y., Baker, J. S., Gu, Y. (2021). Finite element analysis of the lumbar spine in adolescent idiopathic scoliosis subjected to different loads. Computers in Biology and Medicine, 136, 104745.
https://doi.org/10.1016/j.compbiomed.2021.104745
21. Zhang, L., Zhang, Q., Zhang, Y., Arthur, M., Teo, E. C. et al. (2022). The effect of concave-side intertransverse ligament laxity on the stress of AIS lumbar spine based on finite element method. Bioengineering, 9(12), 724.
https://doi.org/10.3390/bioengineering9120724
22. Rohlmann, A., Neller, S., Bergmann, G., Graichen, F., Claes, L. et al. (2001). Effect of an internal fixator and a bone graft on intersegmental spinal motion and intradiscal pressure in the adjacent regions. European Spine
Journal, 10(4), 301–308. https://doi.org/10.1007/s005860100295
23. Wilke, H. J., Claes, L., Schmitt, H., Wolf, S. (1994). A universal spine tester for in vitro experiments with muscle force simulation. European Spine Journal, 3(2), 91–97. https://doi.org/10.1007/BF02221446
24. Zander, T., Rohlmann, A., Calisse, J., Bergmann, G. (2001). Estimation of muscle forces in the lumbar spine during upper-body inclination. Clinical Biomechanics, 16, S73–S80. https://doi.org/10.1016/S0268-0033(00)00108-X
25. Zhang, Q., Zhang, Y., Chon, T. E., Baker, J. S., Gu, Y. (2023). Analysis of stress and stabilization in adolescent with osteoporotic idiopathic scoliosis: Finite element method. Computer Methods in Biomechanics and Biomedical Engineering, 26(1), 12–24. https://doi.org/10.1080/10255842.2022.2044803
26. Mohd, K., Zailina, H., Shamsul, B., Nurul, M., Mohd, M. et al. (2010). Neck, upper back and lower back pain and associated risk factors among primary school children. Journal of Applied Sciences, 10(5), 431–435. https://doi.org/10.3923/jas.2010.431.435
27. Farhood, H. F. (2013). Low back pain in schoolchildren: The role of school bag weight and carrying way. Journal Natural Sciences Research, 3(8), 156–164.
28. Grimmer, K., Dansie, B., Milanese, S., Pirunsan, U., Trott, P. (2002). Adolescent standing postural response to backpack loads: A randomised controlled experimental study. BMC Musculoskeletal Disorders, 3, 1–10. https://doi.org/10.1186/1471-2474-3-10
29. Dianat, I., Javadivala, Z., Allahverdipour, H. (2011). School bag weight and the occurrence of shoulder, hand/wrist and low back symptoms among Iranian elementary schoolchildren. Health Promotion Perspectives, 1, 76–85. https://doi.org/10.5681/hpp.2011.008
30. Hundekari, J., Chilwant, K., Vedpathak, S., Wadde, S. (2013). Does alteration in backpack load affects posture of school children. Group, 2, 10–20.
31. Costello, K. E., Matrangola, S. L., Madigan, M. L. (2012). Independent effects of adding weight and inertia on balance during quiet standing. Biomedical Engineering OnLine, 11(1), 1–13. https://doi.org/10.1186/1475-925X-11-20
32. Brackley, H. M., Stevenson, J. M. (2004). Are children’s backpack weight limits enough? A critical review of the relevant literature. Spine, 29(19), 2184–2190. https://doi.org/10.1097/01.brs.0000141183.20124.a9
33. Devroey, C., Jonkers, I., Becker, A., Lenaerts, G., Spaepen, A. (2007). Evaluation of the effect of backpack load and position during standing and walking using biomechanical, physiological and subjective measures. Ergonomics, 50(5), 728–742. https://doi.org/10.1080/00140130701194850
34. Bobet, J., Norman, R. (1984). Effects of load placement on back muscle activity in load carriage. European Journal of Applied Physiology and Occupational Physiology, 53(1), 71–75. https://doi.org/10.1007/BF00964693
35. Khalil, A. L., Qato, A. (2012). The influence of backpacks on students backs: A cross-sectional study of schools in Tulkarm district (Master’s Thesis). An-Najah National University, Nablus, Palestine.
36. Ramprasad, M., Alias, J., Raghuveer, A. (2010). Effect of backpack weight on postural angles in preadolescent children. Indian Pediatrics, 47(7), 575–580. https://doi.org/10.1007/s13312-010-0130-2
37. Copley, P. C., Tilliridou, V., Kirby, A., Jones, J., Kandasamy, J. (2019). Management of cervical spine trauma in children. European Journal of Trauma and Emergency Surgery, 45(5), 777–789. https://doi.org/10.1007/s00068-018-0992-x
38. Mosaad, D. M., Abdel-Aziem, A. A. (2015). Backpack carriage effect on head posture and ground reaction forces in school children. Work, 52(1), 203–209. https://doi.org/10.3233/WOR-152043
39. Song, Q., Yu, B., Zhang, C., Sun, W., Mao, D. (2014). Effects of backpack weight on posture, gait patterns and ground reaction forces of male children with obesity during stair descent. Research in Sports Medicine, 22(2), 172–184. https://doi.org/10.1080/15438627.2014.881823
40. Orantes-Gonzalez, E., Heredia-Jimenez, J., Beneck, G. J. (2017). Children require less gait kinematic adaptations to pull a trolley than to carry a backpack. Gait & Posture, 52, 189–193. https://doi.org/10.1016/j.gaitpost.2016.11.041
41. Snijders, C. J., Hermans, P. F., Niesing, R., Spoor, C. W., Stoeckart, R. (2004). The influence of slouching and lumbar support on iliolumbar ligaments, intervertebral discs and sacroiliac joints. Clinical Biomechanics, 19(4), 323–329. https://doi.org/10.1016/j.clinbiomech.2004.01.006
42. Mallakzadeh, M., Javidi, M., Azimi, S., Monshizadeh, H. (2016). Analyzing the potential benefits of using a backpack with non-flexible straps. Work, 54(1), 11–20. https://doi.org/10.3233/WOR-162293
43. Ji, Y., Zhang, Q., Song, Y., Hu, Q., Fekete, G. et al. (2022). Biomechanical characteristics of 2 different posterior fixation methods of bilateral pedicle screws: A finite element analysis. Medicine, 101(36), e30419. https://doi.org/10.1097/MD.0000000000030419
44. Negrini, S., Carabalona, R. (2002). Backpacks on! Schoolchildren’s perceptions of load, associations with back pain and factors determining the load. Spine, 27(2), 187–195. https://doi.org/10.1097/00007632-200201150-00014
45. Bajin, M., Kojić, M., Romanov, R., Ahmetović, Z. (2022). Neglected problem: Influence of school bag on lumbar segment in children. Frontiers in Pediatrics, 10, 1045666. https://doi.org/10.3389/fped.2022.1045666
46. Ge, T., Hu, B., Zhang, Q., Xiao, J., Wu, X. et al. (2023). Biomechanical evaluation of two-level oblique lumbar interbody fusion combined with posterior four-screw fixation: A finite element analysis. Clinical Neurology and Neurosurgery, 225(1), 107597. https://doi.org/10.1016/j.clineuro.2023.107597
47. Zhang, Q., Zhang, Y., Huang, J., Teo, E. C., Gu, Y. (2022). Effect of displacement degree of distal chevron osteotomy on metatarsal stress: A finite element method. Biology, 11(1), 127. https://doi.org/10.3390/biology11010127
2. Ramprasad, M., Alias, J., Raghuveer, A. K. (2010). Effect of backpack weight on postural angles in preadolescent children. Indian Pediatrics, 47(7), 575–580. https://doi.org/10.1007/s13312-010-0130-2
3. Whittfield, J., Legg, S. J., Hedderley, D. I. (2005). Schoolbag weight and musculoskeletal symptoms in New Zealand secondary schools. Applied Ergonomics, 36(2), 193–198. https://doi.org/10.1016/j.apergo.2004.10.004
4 Calvo-Muñoz, I., Kovacs, F. M., Roqué, M., Seco-Calvo, J. (2020). The association between the weight of schoolbags and low back pain among schoolchildren: A systematic review, meta-analysis and individual patient data meta-analysis. European Journal of Pain, 24(1), 91–109. https://doi.org/10.1002/ejp.1471
5. Mackie, H. W., Stevenson, J. M., Reid, S. A., Legg, S. J. (2005). The effect of simulated school load carriage configurations on shoulder strap tension forces and shoulder interface pressure. Applied Ergonomics, 36(2),199–206. https://doi.org/10.1016/j.apergo.2004.10.007
6. Mackenzie, W. G., Sampath, J. S., Kruse, R. W., Sheir-Neiss, G. J. (2003). Backpacks in children. Clinical Orthopaedics and Related Research (1976–2007), 409, 78–84. https://doi.org/10.1097/01.blo.0000058884. 03274.d9
7. Brzęk, A., Dworrak, T., Strauss, M., Sanchis-Gomar, F., Sabbah, I. et al. (2017). The weight of pupils’ schoolbags in early school age and its influence on body posture. BMC Musculoskeletal Disorders, 18(1), 1–11. https://doi.org/
10.1186/s12891-017-1462-z
8. Al-Saleem, S. A., Ali, A., Ali, S. I., Alshamrani, A. A., Almulhem, A. M. (2016). A study of school bag weight and back pain among primary school children in Al-Ahsa, Saudi Arabia. Epidemiology (Sunnyvale), 6(1). https://doi.
org/10.4172/2161-1165.1000222
9. Grimmer, K. A., Williams, M. T., Gill, T. K. (1999). The associations between adolescent head-on-neck posture, backpack weight, and anthropometric features. Spine, 24(21), 2262. https://doi.org/10.1097/
00007632-199911010-00015
10. Chansirinukor,W.,Wilson, D., Grimmer, K., Dansie, B. (2001). Effects of backpacks on students: Measurement of cervical and shoulder posture. Australian Journal of Physiotherapy, 47(2), 110–116. https://doi.org/10.1016/
S0004-9514(14)60302-0
11. Chow, D., Ou, Z., Wang, X., Lai, A. (2010). Short-term effects of backpack load placement on spine deformation and repositioning error in schoolchildren. Ergonomics, 53(1), 56–64. https://doi.org/10.1080/00140130903389050
12. Southard, S. A., Mirka, G. A. (2007). An evaluation of backpack harness systems in non-neutral torso postures. Applied Ergonomics, 38(5), 541–547. https://doi.org/10.1016/j.apergo.2006.08.007
13. Goh, J., Thambyah, A., Bose, K. (1998). Effects of varying backpack loads on peak forces in the lumbosacral spine during walking. Clinical Biomechanics, 13(1), S26–S31. https://doi.org/10.1016/S0268-0033(97)00071-5
14. Cottalorda, J., Bourelle, S., Gautheron, V., Kohler, R. (2004). Backpack and spinal disease: Myth or reality? Revue de Chirurgie Orthopédique et Réparatrice de l’Appareil Moteur, 90(3), 207–214. https://doi.org/10.1016/
S0035-1040(04)70096-3
15. Amiri, M., Dezfooli, M. S., Mortezaei, S. R. (2012). Designing an ergonomics backpack for student aged 7–9 with user centred design approach. Work, 41(Supplement 1), 1193–1201. https://doi.org/10.3233/WOR-2012-0303-1193
16. Putra, N. K., Sriwarno, A. B. (2010). Dynamic modeling and simulation of the suspended-load backpack to obtain optimal suspension parameters and reducing effect of ground reaction force. 6th World Congress of Biomechanics
(WCB 2010), pp. 111–114. Singapore, Springer.
17. Chen, H., Shao, E., Sun, D., Xuan, R., Baker, J. S. et al. (2022). Effects of footwear with different longitudinal bending stiffness on biomechanical characteristics and muscular mechanics of lower limbs in adolescent runners. Frontiers in Physiology, 13, 907016. https://doi.org/10.3389/fphys.2022.907016
18. Zhang, Q., Zhang, Y., Chon, T. E., Baker, J. S., Gu, Y. (2022). Analysis of stress and stabilization in adolescent with osteoporotic idiopathic scoliosis: Finite element method. Computer Methods in Biomechanics and Biomedical Engineering, 26(1). https://doi.org/10.1080/10255842.2022.2044803
19. Zheng, J., Yang, Y., Lou, S., Zhang, D., Liao, S. (2015). Construction and validation of a three-dimensional finite element model of degenerative scoliosis. Journal of Orthopaedic Surgery and Research, 10(1), 189. https://doi.
org/10.1186/s13018-015-0334-1
20. Zhang, Q., Chon, T., Zhang, Y., Baker, J. S., Gu, Y. (2021). Finite element analysis of the lumbar spine in adolescent idiopathic scoliosis subjected to different loads. Computers in Biology and Medicine, 136, 104745.
https://doi.org/10.1016/j.compbiomed.2021.104745
21. Zhang, L., Zhang, Q., Zhang, Y., Arthur, M., Teo, E. C. et al. (2022). The effect of concave-side intertransverse ligament laxity on the stress of AIS lumbar spine based on finite element method. Bioengineering, 9(12), 724.
https://doi.org/10.3390/bioengineering9120724
22. Rohlmann, A., Neller, S., Bergmann, G., Graichen, F., Claes, L. et al. (2001). Effect of an internal fixator and a bone graft on intersegmental spinal motion and intradiscal pressure in the adjacent regions. European Spine
Journal, 10(4), 301–308. https://doi.org/10.1007/s005860100295
23. Wilke, H. J., Claes, L., Schmitt, H., Wolf, S. (1994). A universal spine tester for in vitro experiments with muscle force simulation. European Spine Journal, 3(2), 91–97. https://doi.org/10.1007/BF02221446
24. Zander, T., Rohlmann, A., Calisse, J., Bergmann, G. (2001). Estimation of muscle forces in the lumbar spine during upper-body inclination. Clinical Biomechanics, 16, S73–S80. https://doi.org/10.1016/S0268-0033(00)00108-X
25. Zhang, Q., Zhang, Y., Chon, T. E., Baker, J. S., Gu, Y. (2023). Analysis of stress and stabilization in adolescent with osteoporotic idiopathic scoliosis: Finite element method. Computer Methods in Biomechanics and Biomedical Engineering, 26(1), 12–24. https://doi.org/10.1080/10255842.2022.2044803
26. Mohd, K., Zailina, H., Shamsul, B., Nurul, M., Mohd, M. et al. (2010). Neck, upper back and lower back pain and associated risk factors among primary school children. Journal of Applied Sciences, 10(5), 431–435. https://doi.org/10.3923/jas.2010.431.435
27. Farhood, H. F. (2013). Low back pain in schoolchildren: The role of school bag weight and carrying way. Journal Natural Sciences Research, 3(8), 156–164.
28. Grimmer, K., Dansie, B., Milanese, S., Pirunsan, U., Trott, P. (2002). Adolescent standing postural response to backpack loads: A randomised controlled experimental study. BMC Musculoskeletal Disorders, 3, 1–10. https://doi.org/10.1186/1471-2474-3-10
29. Dianat, I., Javadivala, Z., Allahverdipour, H. (2011). School bag weight and the occurrence of shoulder, hand/wrist and low back symptoms among Iranian elementary schoolchildren. Health Promotion Perspectives, 1, 76–85. https://doi.org/10.5681/hpp.2011.008
30. Hundekari, J., Chilwant, K., Vedpathak, S., Wadde, S. (2013). Does alteration in backpack load affects posture of school children. Group, 2, 10–20.
31. Costello, K. E., Matrangola, S. L., Madigan, M. L. (2012). Independent effects of adding weight and inertia on balance during quiet standing. Biomedical Engineering OnLine, 11(1), 1–13. https://doi.org/10.1186/1475-925X-11-20
32. Brackley, H. M., Stevenson, J. M. (2004). Are children’s backpack weight limits enough? A critical review of the relevant literature. Spine, 29(19), 2184–2190. https://doi.org/10.1097/01.brs.0000141183.20124.a9
33. Devroey, C., Jonkers, I., Becker, A., Lenaerts, G., Spaepen, A. (2007). Evaluation of the effect of backpack load and position during standing and walking using biomechanical, physiological and subjective measures. Ergonomics, 50(5), 728–742. https://doi.org/10.1080/00140130701194850
34. Bobet, J., Norman, R. (1984). Effects of load placement on back muscle activity in load carriage. European Journal of Applied Physiology and Occupational Physiology, 53(1), 71–75. https://doi.org/10.1007/BF00964693
35. Khalil, A. L., Qato, A. (2012). The influence of backpacks on students backs: A cross-sectional study of schools in Tulkarm district (Master’s Thesis). An-Najah National University, Nablus, Palestine.
36. Ramprasad, M., Alias, J., Raghuveer, A. (2010). Effect of backpack weight on postural angles in preadolescent children. Indian Pediatrics, 47(7), 575–580. https://doi.org/10.1007/s13312-010-0130-2
37. Copley, P. C., Tilliridou, V., Kirby, A., Jones, J., Kandasamy, J. (2019). Management of cervical spine trauma in children. European Journal of Trauma and Emergency Surgery, 45(5), 777–789. https://doi.org/10.1007/s00068-018-0992-x
38. Mosaad, D. M., Abdel-Aziem, A. A. (2015). Backpack carriage effect on head posture and ground reaction forces in school children. Work, 52(1), 203–209. https://doi.org/10.3233/WOR-152043
39. Song, Q., Yu, B., Zhang, C., Sun, W., Mao, D. (2014). Effects of backpack weight on posture, gait patterns and ground reaction forces of male children with obesity during stair descent. Research in Sports Medicine, 22(2), 172–184. https://doi.org/10.1080/15438627.2014.881823
40. Orantes-Gonzalez, E., Heredia-Jimenez, J., Beneck, G. J. (2017). Children require less gait kinematic adaptations to pull a trolley than to carry a backpack. Gait & Posture, 52, 189–193. https://doi.org/10.1016/j.gaitpost.2016.11.041
41. Snijders, C. J., Hermans, P. F., Niesing, R., Spoor, C. W., Stoeckart, R. (2004). The influence of slouching and lumbar support on iliolumbar ligaments, intervertebral discs and sacroiliac joints. Clinical Biomechanics, 19(4), 323–329. https://doi.org/10.1016/j.clinbiomech.2004.01.006
42. Mallakzadeh, M., Javidi, M., Azimi, S., Monshizadeh, H. (2016). Analyzing the potential benefits of using a backpack with non-flexible straps. Work, 54(1), 11–20. https://doi.org/10.3233/WOR-162293
43. Ji, Y., Zhang, Q., Song, Y., Hu, Q., Fekete, G. et al. (2022). Biomechanical characteristics of 2 different posterior fixation methods of bilateral pedicle screws: A finite element analysis. Medicine, 101(36), e30419. https://doi.org/10.1097/MD.0000000000030419
44. Negrini, S., Carabalona, R. (2002). Backpacks on! Schoolchildren’s perceptions of load, associations with back pain and factors determining the load. Spine, 27(2), 187–195. https://doi.org/10.1097/00007632-200201150-00014
45. Bajin, M., Kojić, M., Romanov, R., Ahmetović, Z. (2022). Neglected problem: Influence of school bag on lumbar segment in children. Frontiers in Pediatrics, 10, 1045666. https://doi.org/10.3389/fped.2022.1045666
46. Ge, T., Hu, B., Zhang, Q., Xiao, J., Wu, X. et al. (2023). Biomechanical evaluation of two-level oblique lumbar interbody fusion combined with posterior four-screw fixation: A finite element analysis. Clinical Neurology and Neurosurgery, 225(1), 107597. https://doi.org/10.1016/j.clineuro.2023.107597
47. Zhang, Q., Zhang, Y., Huang, J., Teo, E. C., Gu, Y. (2022). Effect of displacement degree of distal chevron osteotomy on metatarsal stress: A finite element method. Biology, 11(1), 127. https://doi.org/10.3390/biology11010127
Published
2023-06-21
How to Cite
Li, F., Sun, D., Zhang, Q., Chen, H., Bíró, I., Zheng, Z., & Gu, Y. (2023). Effect of a Double Helical Spring Decompression Structure Backpack on the Lumbar Spine Biomechanics of School-Age Children: A Finite Element Study. Molecular & Cellular Biomechanics, 20(1), 35-47. Retrieved from https://sin-chn.com/index.php/mcb/article/view/54
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