Abstract:
Surgical intervention is a common option for the treatment of wrist joint arthritis and traumatic wrist injury. Whether this surgery is arthrodesis or a motion preserving procedure such as arthroplasty, wrist joint biomechanics are inevitably altered. To evaluate effects of surgery on parameters such as range of motion, efficiency and carpal kinematics, repeatable and controlled motion of cadaveric specimens is required. This study describes the development of a device that enables cadaveric wrist motion to be simulated before and after motion preserving surgery in a highly controlled manner. The simulator achieves joint motion through the application of predetermined displacements to the five major tendons of the wrist, and records tendon forces. A pilot experiment using six wrists aimed to evaluate its accuracy and reproducibility. Biplanar X-ray videoradiography (BPVR) and X-Ray Reconstruction of Moving Morphology (XROMM) were used to measure overall wrist angles before and after total wrist arthroplasty. The simulator was able to produce flexion, extension, radioulnar deviation, dart thrower\'s motion and circumduction within previously reported functional ranges of motion. Pre- and post-surgical wrist angles did not significantly differ. Intra-specimen motion trials were repeatable; root mean square errors between individual trials and average wrist angle and tendon force profiles were below 1° and 2 N respectively. Inter-specimen variation was higher, likely due to anatomical variation and lack of wrist position feedback. In conclusion, combining repeatable intra-specimen cadaveric motion simulation with BPVR and XROMM can be used to determine potential effects of motion preserving surgeries on wrist range of motion and biomechanics.
摘要:
手术干预是治疗腕关节关节炎和创伤性腕关节损伤的常用选择。无论这种手术是关节固定术还是关节成形术等保持运动的手术,腕关节生物力学不可避免地改变。为了评估手术对运动范围等参数的影响,效率和腕关节运动学,尸体标本的可重复和受控运动是必需的。这项研究描述了一种设备的开发,该设备能够以高度受控的方式在运动保留手术之前和之后模拟尸体的手腕运动。模拟器通过将预定位移应用于手腕的五个主要肌腱来实现关节运动,并记录肌腱力。使用六个手腕的试点实验旨在评估其准确性和可重复性。使用双平面X线视频放射摄影(BPVR)和X线运动形态重建(XROMM)测量全腕关节置换术前后的整体腕部角度。模拟器能够产生屈曲,扩展,径向偏差,飞镖投掷器在先前报道的运动功能范围内的运动和绕行。术前和术后腕部角度没有显着差异。标本内运动试验是可重复的;单个试验与平均腕部角度和肌腱力曲线之间的均方根误差分别低于1°和2N。标本间变异较高,可能是由于解剖变异和缺乏手腕位置反馈。总之,将可重复的标本内尸体运动模拟与BPVR和XROMM相结合,可用于确定运动保留手术对腕关节运动范围和生物力学的潜在影响。