In vivo radiocarpal kinematics and the dart thrower's motion
In vivo radiocarpal kinematics and the dart thrower's motion
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DOI：
10.2106/jbjs.d.03058
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发表时间：
2005-12-01
影响因子：
5.3
通讯作者：
Wolfe, SW
中科院分区：
文献类型：
--
作者：
Crisco, JJ;Coburn, JC;Wolfe, SW
背景：腕关节的运动依赖于桡腕关节处舟状骨和月状骨的复杂关节。然而，对桡腕关节的了解仅限于解剖学上定义的屈曲、伸展、桡偏和尺偏运动。本研究的目的是确定整个腕关节运动范围内舟状骨和月骨的三维体内运动学，特别关注飞镖投掷者的腕关节运动，从桡侧伸展到尺侧屈曲。方法：头状骨，舟骨，计算14名健康男性受试者双侧手腕的连续计算机断层扫描结果（平均年龄，25.6岁;范围，22至34岁）和14名健康女性受试者（平均年龄，23.6岁;范围，21至28岁），共获得504个不同手腕位置的数据。结果：舟骨和月骨主要向腕关节运动的各个方向屈曲或伸展，其旋转与腕关节运动的方向呈线性变化（R（2）分别为0.90和0.82）。舟状骨和月骨的运动在飞镖投掷者运动的路径上比在手腕运动的任何其他方向上显著地沿着较少（对于两个腕骨p < 0.01）。舟骨和月骨径向平移（2至4毫米）时，延长，但他们没有翻译明显的flexed.Conclusions：飞镖投掷的路径定义的舟骨和月骨的屈曲和伸展旋转之间的过渡，并确定腕关节的位置，舟骨和月骨运动接近零。这些研究结果表明，腕关节运动的这一路径赋予了一个独特程度的桡腕关节稳定性，并表明这个方向，而不是腕关节屈曲伸展和桡尺偏的解剖方向，是桡腕关节的主要功能方向。临床相关性：重建手术治疗舟骨、月骨或其骨间韧带损伤的目的是最大限度地愈合，稳定性和术后活动度。我们在体内的研究结果表明，具体的康复方案，采用飞镖投掷运动可以被设计为限制桡腕关节的运动，同时提供的好处，保持手腕运动。
Background: Wrist motion is dependent on the complex articulations of the scaphoid and lunate at the radiocarpal joint. However, much of what is known about the radiocarpal joint is limited to the anatomically defined motions of flexion, extension, radial deviation, and ulnar deviation. The purpose of the present study was to determine the three-dimensional in vivo kinematics of the scaphoid and lunate throughout the entire range of wrist motion, with special focus on the dart thrower's wrist motion, from radial extension to ulnar flexion.Methods: The three-dimensional kinematics of the capitate, scaphoid, and lunate were calculated from serial computed tomography scans of both wrists of fourteen healthy male subjects (average age, 25.6 years; range, twenty-two to thirty-four years) and fourteen healthy female subjects (average age, 23.6 years; range, twenty-one to twenty-eight years), which yielded data on a total of 504 distinct wrist positions.Results: The scaphoid and lunate primarily flexed or extended in all directions of wrist motion, and their rotation varied linearly with the direction of wrist motion (R(2) = 0.90 and 0.82, respectively). Scaphoid and lunate motion was significantly less along the path of the dart thrower's motion than in any other direction of Wrist motion (p < 0.01 for both carpal bones). The scaphoid and lunate translated radially (2 to 4 mm) when extended, but they did not translate appreciably when flexed.Conclusions: The dart thrower's path defined the transition between flexion and extension rotation of the scaphoid and lunate, and it identified wrist positions at which scaphoid and lunate motion approached zero. These findings indicate that this path of wrist motion confers a unique degree of radiocarpal stability and suggests that this direction, rather than the anatomical directions of wrist flexion-extension and radioulnar deviation, is the primary functional direction of the radiocarpal joint.Clinical Relevance: The goal of reconstructive surgery for the treatment of injuries involving the scaphoid, the lunate, or their interosseous ligaments is to maximize healing, stability, and postoperative range of motion. Our in vivo findings suggest that specific rehabilitation protocols employing the dart thrower's motion could be designed to limit radiocarpal motion while providing the benefits of maintaining wrist motion.