距下關節骨融合術對外側韌帶應變與踝關節接觸力學之影響

Effects of Subtalar Arthrodesis on Strains of Lateral Ligaments and Talocrural Articular Contact Mechanics

周文開(Wen-Kai Chau)

指導教授 ： 呂東武

國立臺灣大學/工學院/醫學工程學研究所/碩士(2016年)

https://doi.org/10.6342/NTU201602917

摘要

關節在日常活動之中占有重要的角色，是人體主要的負重關節之一，相較於車禍意外、居家意外和職業傷害等等，運動造成的踝關節傷害佔有踝關節傷害很大一部分，嚴重的踝關節傷害可能會導至踝關節功能上的限制和失能。在眾多踝關節傷害中，踝關節扭傷佔有80%以上的比例，大約77%的踝關節扭傷是屬於外側扭傷，而前距腓韌帶的破裂或撕裂佔有73%。踝關節扭傷除了疼痛和踝關節活動的限制之外，可能造成骨折或脛骨肌肉群損傷，造成踝關節各軟組織之間的不平衡，間接破壞踝關節的穩定性，若踝關節長期處於不穩定的狀態之下，可能進而導致退化性關節炎或創傷性的發生，然而，相比其他下肢之負重關節，膝關節以及髖關節踝關節，雖然承受更大的壓應力，但踝關節關節炎的盛行率卻遠低於膝關節以及髖關節，因此研究踝關節的生物力學特殊性，是一個重要的議題。
本研究結合了三維全域變形及應變量測系統、機械手臂關節測試系統，由此探討距下關節骨融合術對踝關節之影響。　本研究包含前後拉伸試驗與內外翻模擬試驗，進行軟骨面重建，藉由模型對位可獲完整軟骨和骨頭模型，並推算出其關節軟骨形變及韌帶之應變，本研究發現，距下骨融合術將會造成距骨活動性喪失，進一步的造成踝關節力量轉換機制失靈，特別是在內翻測試上，骨融合後之踝關節試體前距腓韌帶之伸長量增加，同時，跟腓韌帶和後距腓韌帶之伸長量卻減少，造成踝關節力量分配不均，使踝關節軟組織應力集中之現象增加，提高受傷之風險，說明距骨於踝關節力量分配中之重要性，本研究所得之關節位移、力量，韌帶應變之變化和關節面軟骨的形變結果，位來將可以用來驗證，其他踝關節外側韌帶之電腦模擬結果，並成為外科踝關節手術和術後復健之依據。

關鍵字

踝關節 ； 機械手臂關節測試系統 ； 數位影像相關法 ； 踝關節外側韌帶 ； 骨融合術

並列摘要

The ankle joint injured more often in sport activity rather than other accidents or occupational injury. Sever ankle joint injury might lead to loss of function in ankle joint. In all of the ankle injuries, ankle sprain stand more than 80%. About 77% of sprain in ankle joint are lateral ankle sprain. And, tearing ATFL involve in 73% of all the lateral ankle sprain. Ankle sustain weight bearing in daily activity. However, not like another weight bearing joint, the prevalence of symptomatic arthritis in the ankle is much lower than the knee and hip. Studying particular biomechanical property in ankle joint might reveal how different ankle joint sustain weight during daily activity.
This study is aim to find the interaction between articular surface and the lateral ligaments in ankle joint and the effect of subtalar joint arthrodesis. Kinetic and kinematic data were record during anterior, posterior drawer test and varus, valgus tilt test. We found that arthrodesis result in stress concentration in several component during tests. This might be the result of restrict motion from subtalar joint arthrodesis which imply that talus motion is highly relative to the biomechanics of loading distribution. Patients who had this surgery might be caution to avoid unexpected loading in ligaments or articular surface.

並列關鍵字

Ankle Joint ； Robotic-based Joint Testing System ； Digital Image Correlation ； Lateral Ligaments in Ankle Joint ； Arthrodesis

參考文獻

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