PDF(Pubmed)
Abstract：
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.
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.
摘要：
背景：肩关节骨间韧带损伤很普遍，并且在影像学诊断中经常具有挑战性。四维CT允许在运动期间显示腕骨。我们提出了一个顺序韧带切片（“损伤”）的尸体模型，以量化它们对the骨关节和肩cap骨间隔的骨间近端的影响。我们假设受伤，手腕位置,它们的相互作用会影响腕关节运动学。
方法：在受伤后，通过屈伸和桡尺偏来移动8个尸体腕部。使用第二代双源CT扫描仪在每种受伤情况下获取每种运动的动态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接近分布。将中骨间接近度标准化并按腕部位置分类。线性混合效应模型和边际均值检验用于比较中位骨间接近度的分布。
结果：腕部位置对桡骨关节屈伸和尺尺偏均有显著影响；损伤对肩胛骨间期屈伸的影响显著；两者相互作用对肩胛骨间期的尺尺偏有显著影响。跨手腕位置，radioscapoid正中骨间近端较少区分损伤状况和肩胛骨近端。当手腕弯曲时，肩胛骨间隔的中骨间近端主要能够检测到较少（GeisslerI-III）与较多（GeisslerIV）严重损伤之间的差异，扩展,尺骨偏离。
结论：动态CT增强了我们对SLIL损伤尸体模型中腕关节运动学的理解。屈曲中的肩胛骨正中骨间近端，扩展,尺骨偏离最好地表现出韧带的完整性。
方法：在受伤后，通过屈伸和桡尺偏来移动8个尸体腕部。使用第二代双源CT扫描仪在每种受伤情况下获取每种运动的动态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接近分布。将中骨间接近度标准化并按腕部位置分类。线性混合效应模型和边际均值检验用于比较中位骨间接近度的分布。
结果：腕部位置对桡骨关节屈伸和尺尺偏均有显著影响；损伤对肩胛骨间期屈伸的影响显著；两者相互作用对肩胛骨间期的尺尺偏有显著影响。跨手腕位置，radioscapoid正中骨间近端较少区分损伤状况和肩胛骨近端。当手腕弯曲时，肩胛骨间隔的中骨间近端主要能够检测到较少（GeisslerI-III）与较多（GeisslerIV）严重损伤之间的差异，扩展,尺骨偏离。
结论：动态CT增强了我们对SLIL损伤尸体模型中腕关节运动学的理解。屈曲中的肩胛骨正中骨间近端，扩展,尺骨偏离最好地表现出韧带的完整性。
