利用雙平面動態X光量測外側韌帶不穩定患者在功能性動作下踝關節之三維運動

In vivo Three-Dimensional Kinematics of the Ankle Joint Complex in Patients with Lateral Ankle Instability During Functional Activities Using Biplane Fluoroscopy

盧欣怡(Hsin-Yi Lu)

指導教授 ： 呂東武

共同指導教授 ： 林正忠(Cheng-Chung Lin)

國立臺灣大學/工學院/醫學工程學研究所/碩士(2018年)

https://doi.org/10.6342/NTU201802670

摘要

踝關節扭傷是常見的運動傷害之一，且往往導致外側韌帶損傷。而外側韌帶的損傷已被證實會影響踝關節的正常運動，並且會改變關節原有的運動模式，從而導致軟骨損傷和長期的踝關節不穩定。慢性外側踝關節不穩定也與創傷後關節炎之發生率有相當高的相關性。但是相關的運動學變化，以及外側韌帶對於踝關節穩定性之影響尚未有完整研究。
本研究目的為建構以雙平面動態X光結合斷層掃描重建骨頭模型方法為基礎的踝關節運動學量測平台，量測健康踝關節受試者與慢性外側踝關節不穩定患者在功能性動作情況下之三維踝關節運動學，更進一步搭配磁振造影而得的韌帶計算其長度變化，探討功能性動作中外側韌帶損傷對踝關節運動學之影響，釐清外側韌帶在控制踝關節活動與穩定所扮演的角色。本研究目的為建構以雙平面動態X光結合斷層掃描重建骨頭模型方法為基礎的踝關節運動學量測平台，量測健康踝關節受試者與慢性外側踝關節不穩定患者在功能性動作情況下之三維踝關節運動學，探討功能性動作中外側韌帶損傷對踝關節運動學之影響，釐清外側韌帶在控制踝關節活動與穩定所扮演的角色。
本研究結果顯示，外側踝關節不穩定會改變距骨脛骨關節和距下關節之運動模式，使得矢狀面與橫切面上的旋轉活動度與運動往返路徑變異性增加，並且會使距骨有顯著往前後方向滑動的現象，而在內轉和蹠曲時會使前距腓韌帶伸長量明顯增加。研究活體人體踝關節在功能性動作下的運動學分析有助於瞭解踝關節及其周圍軟組織結構於健康或損傷時之功能，進而瞭解踝關節疾病與損傷之機制與病因，以提供治療與後續復健計畫評估所需的重要訊息。

關鍵字

扭傷 ； 慢性外側踝關節不穩定 ； 動態X光 ； 功能性動作 ； 踝關節運動學 ； 韌帶伸長量

並列摘要

Among the sport injuries of the lower extremities, ankle sprain is arguably the most frequent injury, which often results in lateral ligament injuries. Lateral ligament injuries of the ankle joint complex (AJC) had been found to alter the normal kinematic patterns of the AJC during weight-bearing activities. Abnormal kinematics of the AJC may contribute to the lesion of the articular cartilage and chronic instability of the joint, leading to persistent pain. Chronic lateral instability of the ankle has been shown to be associated with various pathological conditions of the ligaments, capsules and cartilage with high risk of joint osteoarthritis (OA).
The purposes of the current study were to establish a platform for measuring AJC kinematics during functional activities based on the technique combining CT bone models and bi-planer fluoroscopy. The health AJC subjects and the patients with CAI are recruited, aiming to measure the AJC kinematics during during functional activities. The lateral ligament elongation of AJC is calculated from MRI model. This study will provide a better understanding of the effect of lateral instability on the kinematics of the AJC during functional activities and clarify the roles of the lateral ligaments in controlling the mobility and stability of the AJC.
The results show that, chronic ankle instability (CAI) alters the kinematic of the talocrural and subtalat joint. Furthermore, CAI leads to increased range of motion and variability in the return path of kinematic motion of the talocrural joint and subtalar joint in the sagittal plane and transverse plane. The coupled patterns of the motion component in sagittal plane significantly different between joints with CAI with and health ankle joints. Additionally, CAI joints demonstrate the greater change in length of ATFL during plantarflexion and internal rotation. In-vivo measurement of the three-dimensional kinematics of the ankle joint complex during functional activities helps to establish a better understanding of the functions of the AJC as well as its surrounding passive and active structures in the normal and pathological conditions. Such study hence provides necessary knowledge for the establishment of the mechanisms of relevant injuries, the etiology and diagnosis of joint diseases, as well as the planning and evaluation of subsequent treatment and rehabilitation programs.

並列關鍵字

sprain ； chronic lateral ankle instability ； fluoroscopy ； functional activities ； ankle kinematics ； ligament elongation

參考文獻

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