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研究生： 鄧經弘
Teng, Ching-Hung
論文名稱： 不同全人工拇指腕掌關節設計的穩定性分析
In Vitro Stability Analysis of the Trapeziometacarpal Joint Implants
指導教授： 蘇芳慶
Su, Fong-Chin
學位類別： 碩士
Master
系所名稱： 工學院 - 生物醫學工程學系
Department of BioMedical Engineering
論文出版年： 2014
畢業學年度： 102
語文別： 英文
論文頁數： 78
中文關鍵詞： 拇指腕掌關節 、關節置換 、鞍狀曲率
外文關鍵詞： Trapeziometacarpal joint, joint arthroplasty, curvature ratio of saddle type
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    • 人類大拇指的拇指腕掌關節有別於其他四指，為特殊的雙凹型、鞍狀關節，包含16條韌帶以限制其動作範圍並提供關節穩定性，因此人類的大拇指關節可以執行特有的拇指對掌動作，即以拇指觸碰到小指，使手部能操作更精細及複雜性的動作。人類的拇指腕掌關節已經演化為較平坦的曲率，使在活動過程中可以表現出較大力量，並承受較大的軸向力以避免脫臼發生。但是曲率較小的關節面雖然可以在動作過程中承受較大的力量，但是相對也會造成關節上的不穩定。
    本研究是以六具手部大體實驗，探討不同曲率之鞍狀拇指腕掌關節及球窩關節置換前後之穩定性。實驗方式，先以徒手被動的方式帶動拇指做向上─向下、向外─向內及拇指環狀運動，計算最大的關節動作角度，而後利用自行設計的特製機械儀器帶動與徒手相同的動作範圍角度，並利用電磁場記錄即時性的動作位置。先收取未進行手術的五個動作，爾後，進行關節置換後再次記錄五個動作分別在不同關節情況下帶動的最大活動範圍，並比較關節置換前後，不同曲率與型態對於拇指腕掌關節穩定度之變化。
    結果顯示，在與原始關節相同曲率、較大的曲率及球窩關節型態，關節活動範圍和手術前相比，平均分別減少了23.08 %、4.60 % 和14.39 %，但是在較平坦的曲率則是增加了33.40 %。第一掌骨的關節面中心移動出來的軌跡顯是在斜方骨關節表面上，與原始關節在相同的曲率較手術前向橈側及掌側移動，但是在其他兩種關節曲率和球窩關節型態分別向橈側背側和掌側遠端移動。而軌跡的位移和手術前相比較，在與原始關節相同曲率、較大的曲率及較平坦的曲率，平均分別增加了9.90 %、7.07 % 和69.75 %，但是在球窩關節形態則減少了26.99 %。
    在結論的部分，較大的關節曲率下會提供較大的穩定性，但是相對會限制活動範圍和軌跡位移，然而在球窩關節形態和鞍狀關節形態相比較，則會提供較大的關節穩定。

    Human hands have a unique opposition movement that allow the performance of dexterous and complex motions. These movements are enabled by the Trapeziometacarpal (TMC) joint of the thumb. The TMC joint has two mutually saddle-like articular surfaces and is constrained by 16 supporting ligaments, which limit the range of motion. The TMC joint is flat enough for bearing large axial forces, and the curvature is sufficient to avoid subluxation to perform more powerful strength than other joint can. In addition, flatter joint curvature surface can deal with larger axial loads, but may cause instability during movement.
    Six fresh frozen cadaver hands were used for total joint arthroplasty in this study. The prostheses contained three different saddle type curvature implants and one ball-and socket type implant. The electromagnetic tracking device was used to record real-time movement when guiding the thumb movements. The passive motion was first guided by using the manual-control to the maximum end range for four directions, upward-downward and inward-outward, also the circumduction of the thumb. Nest, the simulator was set at the same movement as the manual-control with movement trajectory calculated from manual control. When the intact data were recorded, specimens would have the joint arthroplasty surgery for replacing the articular surface and repeated the tests.
    The results showed the ROM of the TMC joint decreased 23.08 %, 4.60 %, and 14.39 % on original curvature, greater curvature, and ball-and socket implant, but increase 35.40 % in prostheses with lower curvature comparison with intact condition in the average. The original curvature shifted the path of the first metacarpal articular surface center to radial-volar side on the articular surface of trapezium bone, but the two different curvature implants and ball-and-socket prostheses shifted to ulnar-volar and volar-distal side. The displacement of the path increased 9.90 %, 7.07 % and 69.75 % on original curvature, greater curvature and lower curvature, but decreased 26.99 % on ball-and socket type comparison with intact condition in the average.
    Implants with greater curvature provide greater stability but limit range of motion and joint displacement. However, the ball-and-socket type implant provide greater joint stability than saddle type implants.

    中文摘要 I Abstract III 致謝 V Contents VI List of Table i List of Figure ii Chapter 1 Introduction 1 1.1 Background 1 1.2 The antomy of the thumb 2 1.3 The kinematics and kinetics of the TMC joint 5 1.3.1 The curvature of the TMC joint 6 1.3.2 The stability of the TMC joint 7 1.4 The osteoarthritis of the TMC joint 9 1.4.1 The classification of the osteoarthritis in the TMC joint 9 1.4.2 Treatments for the osteoarthritis in the TMC joint 11 1.5 Evaluation of TMC joint functions after treatments 13 1.6 Motivation 15 1.7 Purpose 15 1.8 Hypothesis 15 Chapter 2 Materials and Methods 16 2.1 Specimens preparation 16 2.2 Reconstruction of three-dimensional model of bones 18 2.2.1 Image acquirement of bones from computer topography 18 2.2.2 Building the 3D model of metacarpal, trapezium, and reference points 18 2.2.3 Joint coordinate system of trapeziometacarpal joint 19 2.3 Preparation of the arthroplasty prostheses with different types 21 2.3.1 The arthroplasty prostheses of saddle-type joint with different curvatures 22 2.3.2 The arthroplasty prostheses of ball-and-socket type joint 24 2.4 Experimental Apparatuses 25 2.4.1 The setting 25 2.4.2 The electromagnetic tracking device 26 2.4.3 The simulator system 27 2.5 Experimental setup 29 2.6 Experimental procedure 30 2.6.1 The surgery of the TMC total joint arthroplasty 31 2.7 The data processing 32 2.8 Parameters 34 2.8.1 Range of motion 35 2.8.2 Instant center of rotation 36 2.8.3 Path of the center of the articular surface 36 2.8.4 Displacement 38 2.9 Statistical analysis 38 Chapter 3 Results 39 3.1 The basic data and the implants sequence 39 3.2 Range of motion 41 3.2.1 The movement in four directions 41 3.2.2 The movement of circumduction 43 3.3 Trajectories of instant center of rotation 45 3.4 Path of the center of the articular surface 48 3.5 Displacement 52 3.5.1 The path displacement of the articular surface center during four directions movements 52 3.5.2 The displacement in three directions of the articular surface center during circumduction movement 54 Chapter 4 Discussion 57 4.1 The curvature fiiting of the TMC joint 57 4.2 Range of motion 57 4.3 Trajectories of instant center of rotation 61 4.4 Path of the center of the articular surface 63 4.5 Displacement 63 4.6 Limitation 64 4.7 Solution 66 Chapter 5 Conclusion 67 5.1 Future work 68 Acknowledgement 68 References 69 Appendix 75

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