結合動態X光及電腦骨骼模型量測正常人與前十字韌帶缺損患者之膝關節三維運動

Measurement of the Kinematics of Normal and ACL Deficient Knees Using Fluoroscopy with Computer Bone Models

蔡宗遠(Tzong-Yuan Tsai)

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(2004年)

https://doi.org/10.6342/NTU.2004.02343

摘要

截至目前為止，並沒有一種量測方法可以在非侵入式的情況下，量測活體骨骼三維運動學。本研究的目的之ㄧ便是發展一種量測方法，以準確得到關節的運動學資料。
本研究使用動態Ｘ光配合電腦骨骼模型，量測活體關節三維運動學。動態X光紀錄動態關節影像；電腦斷層掃描，得到骨骼之斷面影像。將骨骼斷面影像重建為立體骨骼模型，另一方面，使用程式模擬動態Ｘ光系統，在其中將模型投影至影像平面，藉由最佳化方法控制模型位置，推估實驗時模型之空間位置及方向。其中，最佳化運算花費的時間遠低於過去文獻方法所需時間。同時，本方法能夠方便、快速的應用在各個不同關節的運動學量測。
研究結果發現，正常人膝關節進行自主伸屈運動，無論無載重或有載重狀況，其伸直與彎曲過程的運動模式皆具有相似性。正常人自主伸屈之運動模式也符合迴旋機制(screw-home mechanism)。前十字韌帶缺損(ACLD)患者之膝關節在無載重自主運動時，其伸直與彎曲過程的運動模式較為不穩定，與正常人膝關節運動模式不同。同時，其運動模式也不符合正常膝關節之迴旋機制。ACLD患者之膝關節在載重自主運動時，其伸直與彎曲過程的運動模式相較於無載重狀況較為穩定，推測之可能原因為拮抗肌肉共同作用造成穩定性提高之結果。
未來，希望能應用我們所發展的方法，量測不同關節及其他骨骼肌肉系統疾患，以利未來骨科、復健科、物理治療、職能治療、運動醫學、電腦輔助手術與人工關節設計等領域的進步。

關鍵字

膝關節運動學 ； 電腦骨骼模型 ； 動態Ｘ光 ； 動作分析

並列摘要

Knowledge of the kinematics of the knee is essential for the understanding of its function. To the best knowledge of the author, no study has investigated the in vivo kinematics of the knee using non-invasive method. The purposes of the study were to develop a non-invasive method for the determination of three-dimensional (3D) dynamic skeletal motions in vivo using fluoroscopy and to apply this method to the study of the knee kinematics during isolated knee flexion/extension under loaded and unloaded conditions in normal and anterior cruciate ligament deficient (ACLD) subjects.

The new method involves the match of two-dimensional (2D) fluoroscopic images of the knee during motion with projections of the computer knee models reconstructed from serial computer tomography images. The 3D knee position that produced best-matched projection with the fluoroscopic image was then taken as the special position of the tested knee. Computer simulations were performed and results show an estimate accuracy of 1 mm and 0.5 degrees. A rotating stage was constructed induce to control accurately the motion of a cadaver calcaneus for validation of the study. The result of our validation experiment showed that the accuracy is within 0.8 degrees and 1.9 mm for orientation and translation respectively.

The results of the in vivo studies showed that screw home mechanism existed and movement of unloaded knee can be described by an envelope of active flexion. In normal subjects, patterns of both unloaded and loaded active motion were similar to those of reported in the literature. However, the variation of the active motion in loaded condition was bigger than that in unloaded condition which may be due to the variation of muscle control to counteract the external forces. In ACLD subjects, either unloaded or loaded active motions at knee were different from those in the normal ones. The results indicated that the ACL played an important role in the control of the stability and mobility of normal knee motions.

並列關鍵字

video-fluoroscopy system ； computer models ； motion analysis ； knee joint kinematics

參考文獻

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