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標題: | 足部過度旋前與正常排列族群於承重狀態下核磁共振影像之足踝運動學比較 Compare ankle kinematics between individuals with excessive foot pronation and normal alignment using a weight bearing MRI approach |
作者: | Yu-Feng Kuo 郭于鳳 |
指導教授: | 陳譽仁(Yu-Jen Chen) |
關鍵字: | 過度旋前,核磁共振成像,負重,足踝, Excessive Pronation,Magnetic Resonance Imaging (MRI),weight-bearing,ankle segmental, |
出版年 : | 2019 |
學位: | 碩士 |
摘要: | 背景: 過度足旋前之定義為內側縱弓的平坦化或喪失。它的結構複雜,具有許多小骨骼、複雜的關節組成、眾多的肌肉和韌帶,以至於與許多肌肉骨骼症狀的發生有關,例如膝關節和背部疼痛。關於足部的生物力學和運動學,很難根據大體相關研究結果推論活體的狀態,也因此缺乏兩者比較的研究。外翻、背屈和外展多方面的交互作用,使得精準且直接地測量關節活動角度在操作上有很多的困難與挑戰。用動態分析系統透過體表反光球運動代表深層骨骼運動軌跡是常見的研究方法,但臨床應用仍然有限。然而隨著3D成像的發展,研究者得以用非侵入性、無體表反光球的方式量化活體資訊,並直接看到足部的形態和位置。使用核磁共振和模擬負重機制的方法,準確量化骨骼解剖結構,分析組間舟狀骨高度及中足動作的差異,可能增加臨床上對足部的了解,並能做出更精準地量化後的決定。
目的:第一,使用依受試者個別化的腳踝核磁共振造影掃描,比較正常腳踝和過度足旋前受試者的足部排列,二,驗證組間足部姿勢指數(FPI)與舟狀骨高度及核磁共振造影掃描中運動學參數的回歸關係。 設計:橫斷式研究設計 方法:招募15位過度旋前的受試者和15位正常排列的受試者,記錄所有受試者資訊,並在兩組間進行比較。所有核磁共振掃描均使用3T核磁共振成像掃描儀。客製 化負重置與角度可調踏板模擬承重10-20%,模仿步態中足跟著地期、站立中期和擺盪前期的狀態。在三個實驗條件後都會再掃描一次靜止的條件,掃描之後,使用核磁共振造影資訊分析矢狀面上內側縱足弓角度、舟狀骨高度變化、額狀面上中足動作,已得到運動學資訊,再進行組間比較。 結果:本研究共計收入30位受試者(正常:15位,過度足旋前:15位)。除了足部姿勢指數(FPI)之外,組間所有人口學資料都沒有顯著差異。舟狀骨高度的角度變化有組間(P = .04) 及組內 (P < .01) 的顯著差異。在舟狀骨高度變化沒有交互作用,然而中足角度變化有交互作用 (F=3.81; P < .03) 。接著事後比較檢定發現中足角度變化在背屈姿勢 (P < .000) 與站立中期有顯著的組間差異 (P < .01) 。 在組內方面只有腳內翻那組在背屈及站立中期的條件下不顯著之後的線性迴歸分析發現站立中期的舟狀骨高度與足部姿勢指數有顯著的線性關係。 結論:影像提供了非侵入性、不用體表反光球而直接看到足部的形態和位置的量化方式。只有在舟狀骨高度的組間以及組內差異有主要效果 。 中足角度變化的確有找到交互作用與背屈與站立中期組間差異有關 。在組內差異方面,只有過度腳內翻組在背屈及站立中期的條件下沒有顯著差異,結論就是舟狀骨高度與FPI分數有高度相關性。未來的研究可考慮足部骨骼位置3D模型重建,有休息狀態基準的情況下,以研究步態中的三個主要分期,即腳跟著地期、腳趾離地期及站立中期。加入肌肉長度的考量也能增進對於正常排列及過度足旋前的了解,進一步影響臨床決定。 Background: Excessive foot pronation has been defined as a flattening or loss of the medial longitudinal arch and decrease in navicular height. With having its complex structures, many small bones and intricate joints, muscles and ligaments, it has been associated with greater incidence of musculoskeletal symptoms including knee and back pain. Many regards to foot biomechanics and kinematics, the relevance of in vitro studies to the in vivo condition is difficult to comment since studies comparing the two are lacking. With involving a multifaceted interaction of eversion, dorsiflexion, and abduction, it may be a challenge and difficult to accurately and directly measure. Common, and yet inadequate representation of underlying bone motion of skin-mounted marker trajectories with optical motion capture systems, are considered limited in its ability to understand fully to use at clinical practice. However, with the development of three-dimensional (3D) imaging, it has allowed researchers to offer quantification of in vivo, markerless, non-invasive and direct visualizations of morphology and positions of the foot. For this upcoming approach, the use of magnetic resonance imaging (MRI) and customized weight-bearing jig, for quantifying accurate boney anatomy, in analyzing navicular height between groups and comparing midtarsal motion, may further impact the clinical understanding of the foot and can give quantifiable decision making with greater accuracy than has been previously available. Purpose: First, to utilize the subject-specific ankle MRI scans to compare lower extremity kinematics between individuals with excessive foot pronation and normal ankle and foot alignment, and second to validate the correlation between Foot Posture Index scores and navicular height in MRI scans between groups. Design: Cross-sectional design Method: Recruiting fifteen excessive pronation and fifteen normal alignment subjects, all subject information will be recorded, and compared between groups. A 3T MRI scanner will be used for all MRI scans. Custom made weight-bearing loading belt jig will be used to provide 10-20% of the body weight resistance with adjustable footplate, to simulate the heel strike (dorsiflexion), mid stance and pre-swing (plantarflexion) conditions. Resting condition will be scanned after all three conditions. After scanning, MRI data will then be analyzed for navicular height changes from the sagittal plane, and midtarsal motion comparison from the frontal plane to obtain kinematic data to compare between groups. Results: A total of 30 participants enrolled in this study (Normal:15, Excessive Pronation: 15) There were no significant difference in all demographic data except for Foot Posture Index (FPI) (P < .01). There was main effect significance between group (P = .04) and within group (P < .01) in navicular height changes. There was no group x condition interaction effect the navicular height changes, however, there was a group x condition interaction effect (F=3.81; P < .03) in the changes of midtarsal angle. Follow up post hoc analysis detected significant differences of the midtarsal angle changes between groups in dorsiflexion (P < .01) and midstance (P < .01). Within group, only the pronated group in the changes of dorsiflexion and midstance is not significant (P = .09). Later, there was a significant correlation analysis between midstance condition’s navicular height and FPI scores. Conclusion: Imaging offer quantifications of in vivo, markless, non-invasive and direct visualization of morphology and positions of the foot. There were only main effects between and within groups of navicular height. Changes in midtarsal angle did find many group x condition interaction effect and mainly there were group differences in dorsiflexion and midstance. Within group, only the excessive pronated group changes in dorsiflexion and midstance did not have a significant difference. Both navicular height and FPI scores are highly correlated at the end. Further studies can consider 3D reconstruction models of the foot bone positions to study all three main phase of gait analysis; heel-strike, toe-off, and midstance, while having a baseline of resting condition. Including muscle length also can further impact clinical decisions in understanding the difference between normal alignment and excessive pronated subjects. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/71399 |
DOI: | 10.6342/NTU201900450 |
全文授權: | 有償授權 |
顯示於系所單位: | 物理治療學系所 |
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