利用機械手臂量測距下關節骨融合術對外側韌帶應變與踝關節接觸力學之影響

Abstract

踝關節在日常生活中扮演重要的角色，不管走路、跑步、運動都會用到踝關節，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，而前距腓韌帶的破裂或撕裂佔有 73%，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，59％的運動員有明顯的殘留症狀和殘疾。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特殊性，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距骨活動性喪失，進一步的造成踝關節力量轉換機制失靈，特別是在內翻測試上，骨融合後之踝關節試體前距腓韌帶之伸長量增加，同時，跟腓韌帶和後距腓韌帶之伸長量卻減少，造成踝關節力量分配不均，使踝關節軟組織應力集中之現象增加，提高受傷之風險，說明距骨於踝關節力量分配中之重要性，本研究所得之關節位移、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。

The ankle joint injured more often in sports activity rather than occupational injury. Sever ankle joint injury might lead to loss of function in ankle joint. In all of the ankle injuries, ankle sprain stands more than 80%. About 77% of the sprain in ankle joint are the lateral ankle sprain. And, tearing ATFL involve in 73% of all the lateral ankle sprain. If the ankle sprain is not treated properly, 73% of the athletes will encounter ankle sprain again, moreover, 59% of the athletes will have residual symptoms and disability significantly. Ankle sustain weight bearing in daily activity. However, not like another weight-bearing joint, the prevalence of symptomatic arthritis in the ankle is much lower than the knee and hip. Studying particular biomechanical property in ankle joint might reveal how different ankle joint sustain weight during daily activity. This study aims to find the interaction between articular surface and the lateral ligaments in the ankle joint and the effect of subtalar joint arthrodesis. Kinetic and kinematic data recorded during anterior, posterior drawer test and varus, valgus tilt test. We found that arthrodesis results in stress concentration in several components during tests. This might be the result of the restrict motion from subtalar joint arthrodesis which implies that talus motion is highly relative to the biomechanics of loading distribution. Patients who had this surgery might be the caution to avoid unexpected loading in ligaments or articular surface.