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使用计算机断层扫描测量距下关节的体内活动范围。

In-vivo range of motion of the subtalar joint using computed tomography.

作者信息

Beimers Lijkele, Tuijthof Gabriëlle Josephine Maria, Blankevoort Leendert, Jonges Remmet, Maas Mario, van Dijk C Niek

机构信息

Department of Orthopedic Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.

出版信息

J Biomech. 2008;41(7):1390-7. doi: 10.1016/j.jbiomech.2008.02.020. Epub 2008 Apr 10.

Abstract

Understanding in vivo subtalar joint kinematics is important for evaluation of subtalar joint instability, the design of a subtalar prosthesis and for analysing surgical procedures of the ankle and hindfoot. No accurate data are available on the normal range of subtalar joint motion. The purpose of this study was to introduce a method that enables the quantification of the extremes of the range of motion of the subtalar joint in a loaded state using multidetector computed tomography (CT) imaging. In 20 subjects, an external load was applied to a footplate and forced the otherwise unconstrained foot in eight extreme positions. These extreme positions were foot dorsiflexion, plantarflexion, eversion, inversion and four extreme positions in between the before mentioned positions. CT images were acquired in a neutral foot position and each extreme position separately. After bone segmentation and contour matching of the CT data sets, the helical axes were determined for the motion of the calcaneus relative to the talus between four pairs of opposite extreme foot positions. The helical axis was represented in a coordinate system based on the geometric principal axes of the subjects' talus. The greatest relative motion between the calcaneus and the talus was calculated for foot motion from extreme eversion to extreme inversion (mean rotation about the helical axis of 37.3+/-5.9 degrees, mean translation of 2.3+/-1.1 mm). A consistent pattern of range of subtalar joint motion was found for motion of the foot with a considerable eversion and inversion component.

摘要

了解距下关节的体内运动学对于评估距下关节不稳、距下关节假体的设计以及分析踝关节和后足的手术操作都很重要。目前尚无关于距下关节正常运动范围的准确数据。本研究的目的是介绍一种方法,该方法能够使用多探测器计算机断层扫描(CT)成像对负重状态下距下关节运动范围的极限进行量化。在20名受试者中,向一个脚板施加外部负荷,并将原本不受约束的脚强制置于八个极端位置。这些极端位置包括足背屈、跖屈、外翻、内翻以及上述位置之间的四个极端位置。分别在足中立位和每个极端位置采集CT图像。在对CT数据集进行骨分割和轮廓匹配后,确定跟骨相对于距骨在四对相对极端足部位置之间运动的螺旋轴。螺旋轴在基于受试者距骨几何主轴的坐标系中表示。计算了从极端外翻到极端内翻的足部运动中跟骨与距骨之间的最大相对运动(绕螺旋轴的平均旋转为37.3±5.9度,平均平移为2.3±1.1毫米)。对于具有相当大外翻和内翻分量的足部运动,发现了距下关节运动范围的一致模式。

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