利用機械手臂與順序韌帶切除法量測距下關節骨融合術前術後踝關節勁度與韌帶及關節面受力

Measurement of Ankle Joint Stiffness and Loadings in the Ligaments and Articular Surfaces Using Robot-Based Joint Testing System with Sequential Ligament Resection Before and After Subtalar Arthrodesis

蔡帛霖(Po-Lin 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(2019年)

https://doi.org/10.6342/NTU201902246

摘要

踝關節是人體之中最重要的樞紐及承重關節，也容易受傷，在運動傷害中造成的踝關節傷害佔25%，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，如果踝關節扭傷治療不當，73％的扭傷運動員踝關節扭傷反復發作。踝關節扭傷時會產生疼痛症狀和踝關節活動的限制之外，嚴重可能會造成骨折或脛骨肌肉群損傷，導致踝關節與各軟組織之間的不平衡，間接影響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，可能導致退化性關節炎或創傷性的發生，然而，踝關節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，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與機械手臂關節測試系統，由此探討距下關節骨融合術前術後對踝關節之影響。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，與量測出骨頭運動學資訊，推算出踝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踝關節活動度下降，針對前後拉測試結果，造成勁度在各角度都明顯提升，而內外翻在各角度則造成勁度下降，同時前距腓韌帶和跟腓韌帶提供給踝關節在前後拉內外翻的穩定性，說明踝關節之力量分配的重要性，本研究所得術前術後之關節位移、力量計算出勁度，韌帶應變之變化和關節面軟骨的形變與各韌帶在其個角度的貢獻結果，未來將可以用來驗證，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 is the most important hub and load-bearing joint in the human body. It is also prone to injury. The ankle injury caused by sports injuries accounts for 25%. A severe ankle injury may lead to ankle joint function limitation and disability. Among the many ankle injuries, the ankle sprain accounts for more than 80% of the ankle sprain. About 77% of the ankle sprains belong to the lateral sprain. If the ankle sprain is not treated properly, 73% of the sprained athletes have an ankle sprain. In addition to the pain symptoms and ankle movement restrictions in the ankle sprain, it may cause damage to the fracture or the tibial muscle group, resulting in an imbalance between the ankle joint and each soft tissue, indirectly affecting the stability of the ankle joint. Long-term instability of the ankle joint may lead to degenerative arthritis or traumatic development. However, the ankle joint has greater compressive stress than the other lower limbs, the knee joint, and the hip joint. However, the prevalence of ankle arthritis is much lower than that of the knee joint and the hip joint. Therefore, studying the biomechanics of the ankle joint is an important issue.
This study combines a three-dimensional global deformation and strain measurement system with a mechanical arm joint test system to explore the effects of pre- and post-operative articular fusion on the ankle joint. This study included pre- and post-tension test and internal-external simulation test for cartilage surface reconstruction. The model can be used to obtain intact cartilage and bone models, and the bone kinematics information can be measured to calculate the deformation of the ankle cartilage and the strain of the ligament. This study found that subtalar fusion will cause the ankle joint to decrease inactivity. The results of the anterior-posterior pull test result in a significant increase in stiffness at all angles, while the internal and external vertices cause stiffness reduction at various angles, while the Anterior talofibular ligament and the Calcaneofibular ligament provide the stability of the ankle joint in the anterior and posterior valgus, indicating the importance of the force distribution of the ankle joint. The joint displacement, the strength of the force calculated before and after the study, the change of the ligament strain and The deformation of the articular cartilage and the contribution of each ligament at its angle will be used in the future to verify the computer simulation results of other lateral ankle ligaments and become the basis for surgical ankle surgery and postoperative rehabilitation.

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

1. Baumhauer, J.F., et al., A Prospective-Study of Ankle Injury Risk-Factors. American Journal of Sports Medicine, 1995. 23(5): p. 564-570.

2. Garrick, J.G. and R.K. Requa, The Epidemiology of Foot and Ankle Injuries in Sports. Clinics in Sports Medicine, 1988. 7(1): p. 29-36.

3. G Garrick, J., The frequency of injury, mechanism of injury, and epidemiology of ankle sprains. Vol. 5. 1977. 241-2.

4. G. Garrick, J. and R. K. Requa, Role of external support in the prevention of ankle sprains. Vol. 5. 1973. 200-3.

5. Yeung, M.S., et al., An epidemiological survey on ankle sprain. British journal of sports medicine, 1994. 28(2): p. 112-116.