前距腓韌帶對踝關節面之接觸力學影響

Role of Anterior Talofibular Ligament on the Contact Mechanics of the Ankle Joint

簡碩辰(Shuo-Chen Jian)

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(2014年)

https://doi.org/10.6342/NTU.2014.01043

摘要

踝關節在人體的日常動作中扮演了相當重要的腳色，常常需要承受人體大部分的重量，如行走或是跑步時。在大部分的下肢運動傷害中，踝關節扭傷是最常見的運動傷害，關節受傷後若沒有進行適當的治療，很容易會造成二次扭傷;根據研究顯示，超過73%的運動員都有過踝關節二次扭傷的問題。踝關節的扭傷位置大部分都發生在外側韌帶，韌帶損傷除了造成疼痛之外，更間接破壞了原本關節之間各組織的平衡狀態，長期處於不穩定狀態下，便容易導致關節炎的發生。
本研究將以踝關節做為研究對象，試著了解在受拉伸試驗下前距腓韌帶對踝關節軟骨面的交互作用。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。實驗會先進行踝關節的拉伸試驗，包含了前拉測試和距骨傾斜測試，過程中利用高畫素相機進行同步的動態拍攝，拉伸試驗後剪斷前距腓韌帶重複上敘實驗，以觀察韌帶斷裂後造成的影響。最後利用數位影像相關法進行軟骨面的三圍模型重建，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。
研究的結果發現當前距腓韌帶斷裂後，在前拉以及內翻的動作時關節軟骨的接觸面積會減少，平均的變形量會增加，特別是在蹠屈的時候最明顯。而變形量過大長期下來容易造成軟骨面過度的磨損，衍生出關節炎的問題。另外軟骨接觸面積過小時，代表此時的力量都是由鄰近的關節所承擔，容易使這些組織承受過大的力量而提高受傷的風險以及衍生出新的關節炎。

關鍵字

踝關節 ； 機械手臂關節測試系統 ； 數位影像相關法 ； 前距腓韌帶

並列摘要

The ankle joint plays a very important role in the control of the body motion while sustaining several times of the body weight during various of daily activities, such us walking and running. Among the sport injuries of the lower extremities, ankle sprain is the most frequent injury. Without suitable treatment, the injured ankle may suffer from recurrent sprain. An epidemiological study showed that as much as 73 % of athletes had the problem of recurrent ankle sprain. Lateral ligament injuries of the ankle joint had been found to alter the normal kinematic patterns of the joint. Abnormal kinematics of the ankle joint may contribute to the lesion of the articular cartilage.
The main target of the study is to measure the deformation of articular surface and the mechanical interaction between ligament and articular surface under external loads. The study combined the digital image correlation system (DIC), biomedical image process, and robotic-based joint testing system (RJTS). There will also cut the Anterior Talofibular Ligaments (ATFL) to observe the influence of the ATFL in deformation of articular surface. First, we used RJTS to control joint motion by anterior drawer test and talar tilt test in different flexion angles ankle specimen. After draw test, orthopedist will remove ligaments and expose the articular surface and then Coating random speckle on the articular surface. The photo can be reconstructed to the three-dimensional surface by DIC system. The dynamic bone surface data will combine with articular surface data. The thickness of the articular surface can be revealed by the difference between CT model and the articular surface data, and the deformation of the articular surface in dynamic equals to the interlaced parts. Finally, we can research the mechanical interaction between ligaments and articular surface under external loads to get more biomechanical information.
The results suggested that the contact area of the ankle cartilage was getting smaller in anterior drawer test and varus test after ATFL cutting. The average deformation of ankle cartilage was getting larger in anterior drawer test after ATFL cutting. Too much deformation and the small contact area will increase the risk of injury and also resulting in excessive wear of the articular surface of adjacent joint and deriving arthritis.

並列關鍵字

Ankle Joint ； Robotic-based Joint Testing System ； Digital Image Correlation ； Anterior Talofibular Ligaments

參考文獻

[27]徐徹菖, (2005), 利用工業機械手臂發展關節生物力學測試系統之研究, 國立臺灣大學醫學工程學研究所.

[28]陳淳皓, (2013), 以數位影像相關法與機械手臂系統研究距下關節固定術對踝關節面之生物力學影響,” 國立臺灣大學醫學工程學研究所.

[34]張立德, (2013), 利用機械手臂關節測試系統研究距下關節骨融合術對踝關節穩定度與外側韌帶之影響, 國立臺灣大學醫學工程學研究所.

[25]張方杰, (2011), 利用機械手臂關節測試系統與有限元素法研究前距腓與跟腓韌帶之生物力學, 國立臺灣大學醫學工程學研究所.

[1]Garrick, J. G. and R. K. Requa, (1973). Role of external support in the prevention of ankle sprains. Medicine and Science in Sports and Exercise 5(3),pp .200-203.