应用动态双平面成像技术研究在体肘关节主动屈伸运动特征

In vivo Kinematic Characteristics of the Elbow during Active Flexion-Extension Motion Using Dual Fluoroscopic Imaging System

目的探讨健康肘关节屈伸运动时关节的相对位移和旋转角度变化,为肘关节不稳以及严重肘关节损伤的治疗提供参考。方法选取10名健康并且无上肢外伤史的受试者。应用动态双平面X线透视成像系统,测量右侧肘关节从旋后最大伸直位至旋后最大屈曲位运动过程中,肱桡与肱尺关节6自由度运动学数据。使用相关性分析评价肘关节不同自由度运动的耦合度。结果从最大伸直位到最大屈曲位,肱尺关节外翻角从15.2°±3.1°降低到5.3°±2.3°,肱桡关节外翻角从19.7°±4.2°减小到8.2°±2.4°,肱尺与肱桡关节外翻角与屈曲角呈线性相关;肱尺关节内外旋角先内旋后外旋,呈二次非线性相关,在屈曲110°时达到最大内旋值(4.0°±4.9°),后达到最大外旋值(5.1°±4.2°);肱桡关节一直呈内旋增大变化,从内旋3.2°±16.0°增加到内旋27.2°±18.0°。结论在正常肘关节屈伸过程中,肱尺关节存在外翻角线性减小、内外旋角先内旋后外旋的非线性变化,肱桡关节存在外翻角线性减小、内旋角线性增大的变化。在屈伸过程中,肘关节并非单纯铰链关节,并且肱尺、肱桡关节存在运动学差异。临床上治疗复杂肘关节损伤、肘关节不稳以及肘关节置换手术时,应考虑关节间不同运动特征,以提高术后临床效果。

Objective To investigate the translation and rotation of healthy elbow joints during active flexion and extension,so as to provide references for the treatment of elbow instability and injuries.Methods Ten healthy subjects with no history of upper extremity trauma were recruited.Dual fluoroscopic imaging system( DFIS) was applied to quantify six-degree-of-freedom( 6-DOF) kinematics of humeroulnar and humeroradial joint from full extension to maximum flexion in supination position.Correlation analysis was used to evaluate the relationship between the 6-DOF kinematics of the elbow joint.Results Valgus angle of humeroulnar joint gradually decreased from 15.2° ± 3.1° to 5.3° ± 2.3° with the flexion increasing.Valgus angle of humeroradical joint gradually decreased from 19.7° ± 4.2° to 8.2° ± 2.4° from full extension to maximum flexion.The valgus angle of humeroulnar and humeroradial joint was linearly related to the flexion angle during flexion and extension.The internal rotation of humeroulnar joint was quadratic nonlinearly related to the flexion angle during motion.The maximum internal rotation of the ulnar was 4.0° ± 4.9° at 110° flexion,and the maximum external rotation was 5.1° ± 4.2°. The internal rotation of humeroulnar joint gradually increased from 3.2° ± 16.0° to 27.2° ± 18.0°. Conclusions During normal flexion and extension of the elbow,the valgus angle of humeroulnar joint decreased linearly,while the internal and external rotation angle showed a nonlinear change,which first rotated internally and then rotated externally.The valgus angle of humeroradial joint decreased linearly and the internal rotation angle increased linearly.Therefore,humeroulnar joint is not a hinge joint during elbow flexion and extension.There is a kinematic difference between humeroulnar joint and humeroracial joint.For clinical treatment of complex elbow injuries,elbow instability and elbow replacement,different motion characteristics in joints should be considered to improve the outcome after surgery.