慢性踝关节不稳定的在体运动学研究

发布时间：2018-05-26 18:46

本文选题：踝关节 + 不稳定　；参考：《上海交通大学》2015年博士论文

【摘要】：研究背景和目的:踝关节复合体由胫距和距下关节组成,承负着整个人体的体重并在日常及体育活动中起到关键作用。慢性踝关节不稳定多由于体育活动或日常生活中发生的踝关节扭伤后导致,可出现一系列的踝足部病理改变,例如各组成骨相对位移和角度等运动学的变化、踝关节撞击、关节面应力大小及分布的变化、踝后足排列异常等影像学变化。这些病理改变直接导致一系列踝足部长期肿痛等不适症状的产生,部分患者还会伴随出现距骨或/和胫骨的骨软骨损伤及骨性关节炎。慢性踝关节不稳定的病理表现多与踝关节在体运动学变化有关,故详细研究其在体运动方式的改变至关重要。方法:本研究通过应用双透视系统(DFIS)和三维运动捕捉系统(Vicon)对10名正常志愿者和6名慢性踝关节不稳定患者在设定速度的科学计量跑步机上行走时的踝关节复合体在体运动方式进行动态捕捉。在使用DFIS系统进行人体运动学研究之前使用尸体标本进行静态各平面活动度及动态运动方式的准确性验证。将DFIS系统得到的踝关节运动的动态影像与CT扫描得到的踝关节各组成骨的静态形态影像进行半自动六维空间匹配,得到胫骨、距骨和跟骨在每个时间点的空间位置,通过CT及解剖坐标系统的转换进一步得到踝关节和距下关节的运动角度和位移,从而得出正常人群的踝关节在体运动方式。使用以上方法得到慢性踝关节不稳定患者的踝关节在体运动方式,并与正常人群比较。结果:DFIS系统尸体标本准确性验证:平均位置误差为0.03±0.35mm,平均旋转误差为0.25±0.81°,结果显示此技术能够准确定量测试体内踝关节复合体活动度。正常人群的在体运动学结果显示踝关节背伸-跖屈活动时胫距关节起主要作用,而内外翻活动时距跟关节起主要作用,步态中间站立晚期到足趾离地期的距跟关节内外翻和内外旋角度大于足跟着地期到中间站立早期的活动度。慢性踝关节不稳定患者胫骨-跟骨间及胫骨-距骨间在足跟着地到站立中期内翻、内旋角度增大,前移距离增大,在站立中期到足趾离地期内旋角度增大;距骨-跟骨间两个步态时期的相对运动角度和骨与骨之间的位移都无显著性差异。结论:联合使用双透视系统(DFIS)和模型追踪方法能够精确测量踝关节复合体各组成骨动态活动时的在体活动角度和位移。慢性踝关节不稳定(CAI)患者在行走时踝关节在体运动学发生变化,特别是足跟着地前后踝关节内翻内旋前移幅度增加,可能是出现踝关节撞击、骨软骨损伤、后足力线异常、骨关节炎等一系列病理表现的重要原因。
[Abstract]:Background and purpose: the ankle complex consists of the tibial and subtalar joints, bearing the body's weight and plays a key role in daily and physical activities. Chronic ankle instability may result in a series of ankle and foot pathological changes, such as each of the ankle joints caused by physical activity or daily life. Changes in the kinematics of the relative displacement and angle of the bone, the impact of the ankle, the size and distribution of the stress and distribution of the joint, the abnormal arrangement of the posterior foot of the ankle, and so on. These pathological changes directly result in a series of discomfort symptoms such as the long-term swelling and pain of the ankle and foot, and some patients also accompany the osteochondral damage of the talus or / and the tibia. The pathological manifestations of chronic ankle instability are mostly associated with the change of the ankle joint in body kinematics, so it is very important to study the changes in the body movement in detail. Methods: 10 normal volunteers and 6 chronic ankle joint instability were used in this study by using the dual fluoroscopy system (DFIS) and the three-dimensional motion capture system (Vicon). The ankle joint complex is dynamically captured by the ankle joint complex when walking on a speed treadmill. Before using the DFIS system for human body kinematics, the accuracy of the static motion and dynamic motion is verified by using the corpse specimens. The movement of the ankle joint is obtained by the DFIS system. The static morphologic images of the bone formation in each group of the ankle joint were matched with the CT scan, and the space position of the tibia, talus and calcaneus at each time point was obtained. The movement angles and displacements of the ankle and suballocating joints were further obtained by the conversion of CT and anatomic coordinate system, thus the ankle of the normal population was obtained. The way of movement of the joint in body. Using the above method to get the movement mode of the ankle joint in the patients with chronic ankle instability, and compared with the normal population. Results: the accuracy of DFIS system cadaver specimens is verified: the mean position error is 0.03 + 0.35mm and the mean rotation error is 0.25 + 0.81 degrees. The result shows that this technique can be used to test the body accurately and quantitatively. The activity of the ankle joint complex. The results of the body kinematics in the normal population show that the tibial joint plays a major role in the ankle dorsum and metatarsal movement, while the internal and external movements are mainly from the heel joint. The distance from the late stage of the gait to the toe off the ground and the outer and internal rotation angles of the joint are greater than the heel ground to the middle standing. Early activity. The tibial - calcaneus and tibia - talus between the tibia and the tibia and the talus were in the heel to the middle of the stand, the angle of the internal rotation increased, the forward distance increased, the angle of the internal rotation increased from the middle of the standing to the toe to the ground, and the relative movement angle between the talus and the two gait and the displacements between the bone and the bone Conclusion: the combined use of double fluoroscopy system (DFIS) and model tracking method can accurately measure the body movement angle and displacement of the ankle complex in the dynamic movement of the bone. The ankle joint movement changes in the patients with chronic ankle instability (CAI) during walking, especially the ankle joint varus around the heel. Increased amplitude of internal rotation may be an important reason for a series of pathological manifestations such as ankle impact, osteochondral injury, posterior foot line abnormalities, osteoarthritis, and so on.
【学位授予单位】：上海交通大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R684

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