中国组织工程研究

中国组织工程研究 ›› 2012, Vol. 16 ›› Issue (4): 613-617.doi: 10.3969/j.issn.1673-8225.2012.04.010

• 骨与关节生物力学 bone and joint biomechanics • 上一篇    下一篇

前交叉韧带损伤膝关节6个自由度静态加载体的稳定性*☆

李凭跃1，尹庆水1，黄华扬1，李鉴轶2，沈洪园1，王泽锦1，王  庆1   

  1. 1解放军广州军区广州总医院全军创伤骨科中心，广东省广州市 510010；2南方医科大学广东省重点生物力学实验室，广东省广州市   510515
  • 收稿日期:2011-08-03 修回日期:2011-11-15 出版日期:2012-01-22 发布日期:2014-04-04
  • 作者简介:李凭跃☆，男，1976年生，江西省九江市人，汉族，2009年南方医科大学毕业，博士，副主任医师，主要从事关节外科及运动医学研究。lipingyue09@126.com
  • 基金资助:

    国家自然科学基金(30600302)：运动员膝关节在体稳定性评价及运动损伤防治的研究。

Six degrees of freedom in vivo stability of the knee with anterior cruciate ligament injury under anterior loading   

Li Ping-yue1, Yin Qing-shui1, Huang Hua-yang1, Li Jian-yi2, Shen Hong-yuan1, Wang Ze-jin1, Wang Qing1   

  1. 1Department of Orthopedic Trauma Center, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou  510010, Guangdong Province, China; 2Key Laboratory of Biomechanics, Southern Medical University, Guangzhou  510515, Guangdong Province, China
  • Received:2011-08-03 Revised:2011-11-15 Online:2012-01-22 Published:2014-04-04
  • About author:Li Ping-yue☆, Doctor, Associate chief physician, Department of Orthopedic Trauma Center, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou 510010, Guangdong Province, China lipingyue09@126.com
  • Supported by:
     the National Natural Science Foundation of China, No. 30600302*
     

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摘要：

背景：由于膝关节的体外标本无法模拟膝关节的真实运动，而体内的运动测试又无法获得骨结构的运动信息，因而不能得到准确的膝关节稳定性数据，也就无法对膝关节损伤的早期诊断及防治措施进行深入的研究。
目的：应用计算机三维重建技术、2D/3D图像配准技术及图像处理技术对前交叉韧带损伤膝关节6个自由度变化进行静态加载体内稳定性测试。
方法：8例患者单侧膝关节前交叉韧带断裂而对侧正常，膝关节在屈曲0°，30°，60°和90°时分别进行134 N前加载。采集各角度相互垂直的2D图像，与3D CT图像在虚拟X射线投射系统进行2D/3D图像配准，还原膝关节不同角度时的股骨和胫骨相对3D位置关系，获得膝关节6个自由度数据。
结果与结论：前交叉韧带断裂后胫骨前移均明显增加，在完全伸直(0°)时胫骨前移最小，胫骨前移在30°时达到最大；胫骨前移在60°和90°时逐渐减小，各角度间比较差异均有显著性意义(P=0.000)。前交叉韧带断裂后，膝关节胫骨内旋、内移均较健侧增加(P=0.000)。提示通过2D/3D图像配准技术可以实现对膝关节静态加载的体内稳定性分析；前交叉韧带损伤后膝关节前移、内旋和内移均明显增加。

关键词: 前交叉韧带损伤, 膝关节, 三维重建, 2D/3D图像配准, 稳定性测试, 体内

Abstract:

BACKGROUND: Because in vitro specimen of knee joint cannot simulate real movement of knee joint, and in vivo movement test cannot obtain movement information of bone structure, so accurate stability data of knee joint is not obtain which causes further study on early diagnosis and prevention measures of knee injury is unable.
OBJECTIVE: To study in vivo stability of the 6 degrees of freedom knee kinematics in patients with anterior cruciate ligament (ACL) injury under 134 N anterior loading by using three-dimensional (3D) reconstruction, two-dimensional (2D)/3D image registration and image processing technology.
METHODS: Totally 8 volunteers with unilateral ACL rupture and contralateral normal knee, CT (3D) images and 2D orthogonal images of the knee at 0°, 30°, 60°, and 90° under 134 N anterior loading were captured. These orthogonal images were used to recreate the in vivo knee positions at each of the targeted flexion angles by the method of 2D/3D registration. Comparison between the motion data of the mirror imaging uninjured knee and the injured knee was to get the 6 degrees of freedom kinematic difference of the intact and ACL deficient knee.
RESULTS AND CONCLUSION: After ACL injury, tibia antelocation were all increased. Tibia antelocation was minimal at 0°, maximal at 30°, gradually decreased at 60° and 90° and all the differences in each angle have statistical significance (P=0.000). The ACL injury knee has increased internal tibial rotation and internal tibial shift than intact knee (P=0.000). It is indicated that in vivo stability analysis of knee joint under static loading can achieve by the method of 2D/3D registration technique, and the ACL injured knee has increased tibia antelocation, internal tibial rotation and internal tibial shift.

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