限制與非限制鬆弛度測試下正常踝關節之關節穩定度與距骨運動之量測與比較

Comparisons of the Normal Ankle Laxity and Motion of the Talus during Constrained and Unconstrained Laxity Tests

鍾宜倫(I-Lun Chung)

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(2015年)

https://doi.org/10.6342/NTU.2015.10737

摘要

踝關節傷害好發於各種運動。在眾多踝關節傷害中，踝關節扭傷占 75%，其中有 85% 的扭傷為內翻扭傷。若受傷後未妥善處理，73% 曾經扭傷的運動員有復發性踝關節扭傷，且當中 59% 的運動員有顯著殘疾與殘留症，造成踝關節不穩定，影響運動表現，因此針對踝關節穩定度的探討是個重要的議題。
本研究以踝關節做為研究對象，試著了解在受拉伸試驗下踝關節之穩定度與距骨運動情形。本次實驗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以及影像處理，以獲得足夠的生物力學資訊。實驗會模擬臨床理學檢查進行踝關節的前拉試驗，過程中利用高畫素相機進行同步的動態拍攝；拉伸試驗後，更改控制方式，在拉伸試驗過程中對於前後向以外的自由度進行力量控制，重複上述實驗，以觀察不同控制方法對於關節穩定度與距骨運動造成的影響。最後利用數位影像相關法進行軟骨面的三維模型重建，接著與電腦斷層掃描出的骨頭模型進行對位可獲完整包含軟骨的骨頭模型，而在動態過程中脛骨端與距骨端軟骨中交錯的區域及代表軟骨受到壓縮變形，進而推算出其關節軟骨於動態過程中之變形分布。
研究結果發現，模擬臨床理學檢查的限制條件前拉測試中，軟骨受力面積較大、軟骨形變量較大，且距骨移動路徑較不規則，踝關節鬆弛度較不穩定，關節穩定較差；而對踝關節六個自由度進行力量與位移控制之前拉測試則較無上述問題。面對臨床上踝關節受傷患者，傳統的理學檢查可能會因為人為控制力量的不恰當造成踝關節二度傷害，且影響結果因子太多，使得臨床檢查結果不易判讀。

關鍵字

踝關節 ； 機械手臂關節測試系統 ； 數位影像相關法 ； 前拉測試

並列摘要

Ankle injuries occur in a variety of sports. Among the many ankle injuries, ankle sprain is accounted for 75%, including 85% of the sprain is inversion trauma. Not properly handled when after numerous ankle injuries, 73% of sprained athletes have recurrent ankle sprains, and 59% of athletes who suffered recurrent ankle sprains have significant residual symptoms and disability, resulting in ankle instability which further affect athletic performance. Therefore, explore for ankle stability is an important issue.
The main target of this study was to measure ankle stability and motion of talus under anterior drawer test in different conditions. This study combined the digital image correlation system (DIC), biomedical image process, and robotic-based joint testing system (RJTS). The experiments were conducted simulating clinical physical examination of anterior drawer test and using high-pixel synchronized cameras to capture talus motion during the process. Then altered the control method, conducted the anterior drawer test with position control in the anterior/posterior direction while force control in other five degree-of-freedoms. Three-dimensional articular surfaces were reconstructed using DIC system. These articular surfaces were matched with bone models reconstructed by CT scan to get complete bone models which contains cartilages and bones. During the anterior drawer test, the interlaced sections of cartilages of tibia and talus are considered the deformations of cartilage, and the distribution of deformation on the articular surfaces can be derived by proper calculation.
The results suggested that during simulated clinical physical examination of anterior drawer test compared to the force controlled anterior drawer test, the contact area of articular surfaces is larger, the cartilage deformation is more significant, the motion of talus is more unpredictable, the joint laxity is less stable, and the joint stability is poorer. This indicates that clinical treatments could be harmful if improper force is applied on injured ankle.

並列關鍵字

Ankle Joint ； Robotic-based Joint Testing System ； Digital Image Correlation ； Anterior Drawer Test

參考文獻

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