本文選題：踝關(guān)節(jié) + 不穩(wěn)定��； 參考：《上海交通大學(xué)》2015年博士論文

【摘要】：研究背景和目的:踝關(guān)節(jié)復(fù)合體由脛距和距下關(guān)節(jié)組成,承負(fù)著整個(gè)人體的體重并在日常及體育活動(dòng)中起到關(guān)鍵作用。慢性踝關(guān)節(jié)不穩(wěn)定多由于體育活動(dòng)或日常生活中發(fā)生的踝關(guān)節(jié)扭傷后導(dǎo)致,可出現(xiàn)一系列的踝足部病理改變,例如各組成骨相對(duì)位移和角度等運(yùn)動(dòng)學(xué)的變化、踝關(guān)節(jié)撞擊、關(guān)節(jié)面應(yīng)力大小及分布的變化、踝后足排列異常等影像學(xué)變化。這些病理改變直接導(dǎo)致一系列踝足部長(zhǎng)期腫痛等不適癥狀的產(chǎn)生,部分患者還會(huì)伴隨出現(xiàn)距骨或/和脛骨的骨軟骨損傷及骨性關(guān)節(jié)炎。慢性踝關(guān)節(jié)不穩(wěn)定的病理表現(xiàn)多與踝關(guān)節(jié)在體運(yùn)動(dòng)學(xué)變化有關(guān),故詳細(xì)研究其在體運(yùn)動(dòng)方式的改變至關(guān)重要。方法:本研究通過(guò)應(yīng)用雙透視系統(tǒng)(DFIS)和三維運(yùn)動(dòng)捕捉系統(tǒng)(Vicon)對(duì)10名正常志愿者和6名慢性踝關(guān)節(jié)不穩(wěn)定患者在設(shè)定速度的科學(xué)計(jì)量跑步機(jī)上行走時(shí)的踝關(guān)節(jié)復(fù)合體在體運(yùn)動(dòng)方式進(jìn)行動(dòng)態(tài)捕捉。在使用DFIS系統(tǒng)進(jìn)行人體運(yùn)動(dòng)學(xué)研究之前使用尸體標(biāo)本進(jìn)行靜態(tài)各平面活動(dòng)度及動(dòng)態(tài)運(yùn)動(dòng)方式的準(zhǔn)確性驗(yàn)證。將DFIS系統(tǒng)得到的踝關(guān)節(jié)運(yùn)動(dòng)的動(dòng)態(tài)影像與CT掃描得到的踝關(guān)節(jié)各組成骨的靜態(tài)形態(tài)影像進(jìn)行半自動(dòng)六維空間匹配,得到脛骨、距骨和跟骨在每個(gè)時(shí)間點(diǎn)的空間位置,通過(guò)CT及解剖坐標(biāo)系統(tǒng)的轉(zhuǎn)換進(jìn)一步得到踝關(guān)節(jié)和距下關(guān)節(jié)的運(yùn)動(dòng)角度和位移,從而得出正常人群的踝關(guān)節(jié)在體運(yùn)動(dòng)方式。使用以上方法得到慢性踝關(guān)節(jié)不穩(wěn)定患者的踝關(guān)節(jié)在體運(yùn)動(dòng)方式,并與正常人群比較。結(jié)果:DFIS系統(tǒng)尸體標(biāo)本準(zhǔn)確性驗(yàn)證:平均位置誤差為0.03±0.35mm,平均旋轉(zhuǎn)誤差為0.25±0.81°,結(jié)果顯示此技術(shù)能夠準(zhǔn)確定量測(cè)試體內(nèi)踝關(guān)節(jié)復(fù)合體活動(dòng)度。正常人群的在體運(yùn)動(dòng)學(xué)結(jié)果顯示踝關(guān)節(jié)背伸-跖屈活動(dòng)時(shí)脛距關(guān)節(jié)起主要作用,而內(nèi)外翻活動(dòng)時(shí)距跟關(guān)節(jié)起主要作用,步態(tài)中間站立晚期到足趾離地期的距跟關(guān)節(jié)內(nèi)外翻和內(nèi)外旋角度大于足跟著地期到中間站立早期的活動(dòng)度。慢性踝關(guān)節(jié)不穩(wěn)定患者脛骨-跟骨間及脛骨-距骨間在足跟著地到站立中期內(nèi)翻、內(nèi)旋角度增大,前移距離增大,在站立中期到足趾離地期內(nèi)旋角度增大;距骨-跟骨間兩個(gè)步態(tài)時(shí)期的相對(duì)運(yùn)動(dòng)角度和骨與骨之間的位移都無(wú)顯著性差異。結(jié)論:聯(lián)合使用雙透視系統(tǒng)(DFIS)和模型追蹤方法能夠精確測(cè)量踝關(guān)節(jié)復(fù)合體各組成骨動(dòng)態(tài)活動(dòng)時(shí)的在體活動(dòng)角度和位移。慢性踝關(guān)節(jié)不穩(wěn)定(CAI)患者在行走時(shí)踝關(guān)節(jié)在體運(yùn)動(dòng)學(xué)發(fā)生變化,特別是足跟著地前后踝關(guān)節(jié)內(nèi)翻內(nèi)旋前移幅度增加,可能是出現(xiàn)踝關(guān)節(jié)撞擊、骨軟骨損傷、后足力線異常、骨關(guān)節(jié)炎等一系列病理表現(xiàn)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.
【學(xué)位授予單位】：上海交通大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R684

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