- 學位論文
犬隻人工髖關節開發導向之髖關節三維幾何與運動學量測研究
Three-Dimensional Geometric and Kinematic Measurement of Canine Hip Joint in Relation to Development of the Total Hip Replacement
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摘要
髖關節發育不良是大型犬隻一種常見的疾病，常可通過使用一關節鬆弛度指標Norberg角度來作診斷。然而，Norberg角度的量測可能會受到骨盆與股骨的擺位而受影響，目前文獻中並無針對骨盆股骨擺位對Norberg角度量測重複性與量值影響的完整性研究。因此，本研究目的(一)，首先產生了五個不同骨盆傾角與五個不同股骨仰角條件下之合成X光影像，並分別量測Norberg角度，以探討骨盆與股骨擺位對於Norberg角度的量測值與量測重複性的影響。 針對大型犬髖關節發育不全症及併發嚴重退化性關節炎的治療方面，全人工關節置換是目前被認為最有效的方式。然而，目前市面上既有之人工髖關節皆無可避免的仍具有一定的術後脫臼發生率。在造成術後髖關節脫臼的眾多因素之中，髖臼杯的擺位不良被認為是相當重要的原因之一。精準量測三維正常髖關節型態學構造所獲得之資訊，將有助於設計出更適切的人工髖關節與提供人工髖臼杯擺位上的參考。此外透過一新設計加強關節面的結合力亦或是一降低關節脫臼率可行的方法。本研究目的(二)為藉由電腦斷層掃瞄影像所建構出之三維骨表面模型來量測髖關節的型態學參數，參數包括了髖臼窩的方位與髖臼杯的內部幾何構造。在得到這些量化之髖臼杯參數後，本研究目的(三)乃是提出一具備限制型態髖臼杯的全人工髖關節設計，旨在降低髖關節的術後脫臼率並同時保持必需要的運動範圍。最後，將該人工髖關節透過電腦模擬的方式，分析髖臼杯在依照天然髖臼窩方位與存在擺位誤差的情況之下的運動範圍。 研究結果顯示，(一) 在拍攝骨盆股骨腹背側X光影像的情況之下，增加骨盆向後傾斜的角度與股骨仰角將會量測得到一個增加的Norberg角度，組內和組間的量測重複性則是不論在何骨盆股骨擺位的情況下都相當高(ICC > 0.9)。(二) 本研究首次量測了以全人工髖關節設計與擺位為導向之天然髖關節三維型態學參數，並證明天然髖臼窩的角度與既有之人工髖關節製造商所提供之數據有差異，並且髖臼窩的幾何參數與犬隻的身長與身高並無關聯性。(三) 本研究成功設計並提出了一具備限制型態髖臼杯的全人工髖關節，透過電腦輔助手術模擬與分析，此人工髖關節被證明可提供拉不拉多犬足夠的屈曲、伸展、内收、外展與外轉的運動範圍。透過髖臼杯擺位誤差影響分析的結果顯示，正確的擺放髖臼杯的方位將是全人工髖關節滿足生活中所需之髖關節運動範圍的關鍵。
並列摘要
Canine hip dysplasia is a common disease in large-breed dogs, often diagnosed by using the Norberg angle (NA), an index for the laxity of the hip joint. Measurement of the NA may be affected by the pelvic and femoral positioning during imaging, the effects and test-retest reliability of which have not been documented. Therefore, for the 1st aim of study, an investigation on the influence of the malposition of bones on the NA measurement and its test-retest reliability was conducted by using synthetic radiographs generated at positions by combinations of five pelvic tilt angles and five femoral elevation angles. Total hip replacement (THR) has been considered the most effective treatment option for treating dysplasia, advanced osteoarthritis or other disabling conditions of the hip in large breed dogs. However, a proportion of post-THR patients still inevitably suffer prosthesis dislocation for various reasons, which may be addressed by reinforcing the articulations of the THR. Among factors known to contribute to prosthesis dislocation, the orientation of the acetabular component has received much attention. Quantitative data of the three-dimensional morphology of the native normal acetabulum will be helpful for better design and implantation of prosthetic components. For the 2nd aim of the study, three-dimensional (3D) morphological parameters of the native acetabulum in Labrador Retriever dogs, including acetabular orientations and acetabular geometry, were measured using 3D CT computerized surface model. With the quantitative parameters of the acetabulum, the 3rd aims of the study were to propose a new THR with constrained acetabular component that aimed to decrease the incidence of postoperative dislocation while maintaining the necessary range of motion (ROM); and to evaluated for the ROM with and without malpositioning of the acetabular component. It was concluded that (i) both the increase in caudal pelvic tilt and femoral elevation would increase the measured NA. The intra- and inter-examiner reliability was very good (ICC > 0.9) irrespective of the test positions. (ii) Three-dimensional morphological parameters of the native acetabulum in dogs were firstly reported in relation to the design and implantation of the THR. The native acetabular orientations were shown to be discrepant with manufactures’ recommendations, and the acetabular geometry did not correlate with the height and length of the body. (iii) A new THR with constrained acetabular cup was designed. From the computer-aided surgical simulations, the new THR was found to have sufficient functional ranges for flexion, extension, abduction, adduction and external rotation for Labrador Retrievers. Analysis of the malpositioning of the acetabular component suggests that accurate placement of the acetabular component is critical for achieving desirable ROM for daily activities.
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