Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States of America; Mayo Clinic Medical Scientist Training Program, Mayo Clinic, Rochester, MN, United States of America; Biomedical Engineering and Physiology Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN, United States of America.
Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States of America.
Clin Biomech (Bristol). 2023 Jul;107:106007. doi: 10.1016/j.clinbiomech.2023.106007. Epub 2023 May 22.
Scapholunate interosseous ligament injuries are prevalent and often challenging to diagnose radiographically. Four-dimensional CT allows visualization of carpal bones during motion. We present a cadaveric model of sequential ligamentous sectionings ("injuries") to quantify their effects on interosseous proximities at the radioscaphoid joint and scapholunate interval. We hypothesized that injury, wrist position, and their interaction affect carpal arthrokinematics.
Eight cadaveric wrists were moved through flexion-extension and radioulnar deviation after injuries. Dynamic CT images of each motion were acquired in each injury condition using a second-generation dual-source CT scanner. Carpal osteokinematics were used to calculate arthrokinematic interosseous proximity distributions during motion. Median interosseous proximities were normalized and categorized by wrist position. Linear mixed-effects models and marginal means tests were used to compare distributions of median interosseous proximities.
The effect of wrist position was significant for both flexion-extension and radioulnar deviation at the radioscaphoid joint; the effect of injury was significant for flexion-extension at the scapholunate interval; and the effect of their interaction was significant for radioulnar deviation at the scapholunate interval. Across wrist positions, radioscaphoid median interosseous proximities were less able to distinguish injury conditions versus scapholunate proximities. Median interosseous proximities at the scapholunate interval are majoritively able to detect differences between less (Geissler I-III) versus more (Geissler IV) severe injuries when the wrist is flexed, extended, and ulnarly-deviated.
Dynamic CT enhances our understanding of carpal arthrokinematics in a cadaveric model of SLIL injury. Scapholunate median interosseous proximities in flexion, extension, and ulnar deviation best demonstrate ligamentous integrity.
舟月骨间韧带损伤较为常见，且影像学诊断具有挑战性。四维 CT 可在运动过程中对腕骨进行可视化。我们提出了一种连续韧带切开（“损伤”）的尸体模型，以量化它们对桡腕关节和舟月间隙的骨间近侧的影响。我们假设损伤、腕部位置及其相互作用会影响腕骨的关节运动学。
8 个尸体腕关节在损伤后进行屈伸和桡尺偏运动。使用第二代双源 CT 扫描仪在每个损伤条件下采集每个运动的动态 CT 图像。腕骨运动学用于计算运动过程中的关节运动学骨间近侧分布。将骨间近侧中位数归一化并按腕部位置分类。线性混合效应模型和边缘均值检验用于比较骨间近侧中位数的分布。
腕部位置对桡腕关节屈伸和桡尺偏均有显著影响；损伤对舟月间隙屈伸有显著影响；其相互作用对舟月间隙桡尺偏有显著影响。在各个腕部位置中，桡腕骨间中位数近侧距离更难以区分损伤情况与舟月骨间近侧距离。当腕关节弯曲、伸展和尺偏时，舟月骨间中位数近侧距离更能检测到较轻（Geissler I-III）与较重（Geissler IV）损伤之间的差异。
动态 CT 增强了我们对 SLIL 损伤尸体模型中腕骨关节运动学的理解。在屈伸和尺偏时，舟月骨间中位数近侧距离最能显示韧带完整性。
