呂東武2006-07-262018-06-292006-07-262018-06-292005-07-31http://ntur.lib.ntu.edu.tw//handle/246246/22396退化性關節炎病人接受全人工膝 關節置換手術後，如何恢復其日常動 作的功能，以提高其生活品質，是現 階段新型全人工膝關節設計一個相當 重要的課題。以往由於道德上的考量 以及技術上的限制，直接量取人工膝 關節移動時相對的角度及兩元件接觸 點的位置有其困難，因此本研究旨在 發展一個整合動態X 光攝影系統、動 作分析系統、測力板以及數學模型分 析的新技術以探討活體人工膝關節之 生物力學，進而提供人工膝關節在從 事單關節運動與功能性運動時，更精 確與更好之運動學與動力學描述。由 於本研究之受試者兩膝分別植入後十 字韌帶置換(posterior cruciate substituting, PS)型與後十字韌帶保留 (posterior cruciate retaining, CR)型之人 工膝關節，故可避免受試者間各項變 數干擾研究結果。提供了一個探討解 釋這兩種不同類型之膝關節設計的絕 佳機會，對於瞭解後十字韌帶對於人 工膝關節之功能有所幫助。本計畫共 分二階段進行。 第一階段(年)包含建立一個整合 動態X 光攝影系統以及動作分析儀器 設備包括紅外線攝影機、測力板以及 肌電圖等，用以量測完整運動學與動 力學資料的系統。實驗記錄同時植入 PS 型與與CR 型人工膝關節之病人進 行之主動、被動單關節動作及功能性 動作包括步行、做到站等之過程。利 用實驗資料進行下肢生物力學分析， 並特別著重於脛骨股骨關節之力學交 互作用。 第二階段(年)旨在發展一個新的 利用電腦模型與動態X 光資料評估三 維人工膝關節運動學之最佳化方法。 此一新方法將與兩種文獻中既有的方 法比較，透過電腦模擬與驗証實驗， 評估三者的精度與信度。 藉由驗證實驗的結果證實，本研 究結果相當精確。目前本研究所提出 的量測方法是唯一能在非侵入的狀況 下，不受皮膚移動誤差影響而精確測 得人工膝關節患者動態關節三維運動 學及力學的方法。 經過臨床實驗後，透過人工膝關 節患者主動運動、被動運動及功能性 動作之測試了解到人工膝關節患者與 正常人膝關節確有不同的運動學行 為，導致膝關節力學模式跟著改變， 即使保留了後十字韌帶的患者也因其 無法發揮韌帶的正常功能，導致膝關 節運動受限，影響到人工膝關節的受 力狀況。 本計畫全部依據既定時程完成一 個新的三維全人工膝關節量測技術， 並將之應用到全人工膝關節元件相對 運動的測量，所得結果與文獻及全人 工膝關節動作分析實驗數據均相當一 致。本年度計畫成果除有助了解膝關 節運動時韌帶受力及各種不同的擷抗 作用情形，臨床上能幫助置換人工膝關節時更多的資料與改進之處。Total knee arthroplasty has been the main choice of treatment for advanced degenerative knee osteoarthritis over the last few decades. It is essential to provide full functional performances to patients on total knee replacement (TKR) design. Due to ethical considerations and technical limitation, direct measurement of angles during motion and contact points of two components in the Total knee is difficult. The main purposes of the project are to develop a new technique that integrates video-fluoroscopy systems, motion analysis systems, forceplates and electromyography (EMG), as well as mathematical modeling and analysis for in vivo study of total knee biomechanics, providing more accurate and better descriptions of the TKR kinematics and kinetics during isolated joint movement and functional activities. Subjects with PS (posterior cruciate substituting) type TKR in one leg and CR (posterior cruciate retaining) type in another in the present study offer an exceptional opportunity for study of these two different types of knee designs without inter-subject variations, which is helpful for the clarification of the function of posterior cruciate ligament (PCL) in TKR’s. This project will be carried out in two parts (years). In the first part (year) of the project, a complete kinematic and kinetic measurement system integrating a video-fluoroscopy system and motion analysis equipments, namely infrared cameras, forceplates and EMG, was established. Patients with both PS and CR type TKR’s performed passive and active isolated joint movements and functional activities including gait and sit-to-stand while kinematic and kinetic data were measured. Kinematic and kinetic analysis of the lower limb with special attention on the interaction of the tibiofemoral was performed. In the second part, a new optimization method for model-based estimation of the three-dimensional kinematics of TKR using dynamic fluoroscopic data was developed. Comparisons of the accuracy and reliability of the new method with two existing methods was performed based on computer simulations and experimental data. Present study proposed a new technique for improving the accuracy of 3D pose estimation and accelerate computational process without manual operation. All 2D real data and projection silhouettes are warped to stick on 3D spherical surface before the matching process. Therefore, template matching based on shape invariant can be applied for perspective projection system and can divide 6 degrees of freedom (DOF) of model to calculate respectively. The results from the current study showed that the majority of patients experienced kinematics is not similar to those of a normal knee. However, the extent of lateral femoral condyle posterior rollback and the extent of axial rotation were less.application/pdf570173 bytesapplication/pdfzh-TW國立臺灣大學醫學工程學研究所reporthttp://ntur.lib.ntu.edu.tw/bitstream/246246/22396/1/932213E002118.pdf