In vivo three-dimensional kinematics of the midcarpal joint of the wrist
In vivo three-dimensional kinematics of the midcarpal joint of the wrist
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DOI：
10.2106/jbjs.d.02885
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发表时间：
2006-03-01
影响因子：
5.3
通讯作者：
Yoshikawa, H
中科院分区：
文献类型：
--
作者：
Moritomo, H;Murase, T;Yoshikawa, H
背景：人体腕骨是一个复杂的关节系统。手腕出现的许多问题都是由于腕间运动改变的结果。虽然腕中关节是腕关节的主要组成部分，但腕中关节的整体运动学尚未被描述。本研究的目的是对腕中关节的运动和功能提供一个简单的描述。方法：采用无标记骨配准技术研究腕骨中关节的体内三维运动学。24名健康志愿者在投掷飞镖运动或手腕屈伸运动时获得了手腕的磁共振图像。创建了离体腕中关节的三维动画。对相对腕中部运动进行定性和定量研究。结果：头状骨相对舟状骨的运动方向基本一致，均为斜向运动，且在尺桡偏、抛镖运动和屈伸运动中均从桡侧向尺侧延伸。头状骨相对于月骨和三方骨的运动方向有相似的倾斜，而运动范围几乎没有变化。随着腕关节运动由尺桡偏曲变为屈伸运动，头状骨相对舟状骨的旋转幅度减小，而月状骨相对舟状骨的旋转幅度增大。无论腕关节运动的类型如何，腕关节所有关节面位移的位置都位于腕关节卵圆空间内，连接腕关节关节面中心的一条线可以用缠绕腕关节卵圆的字母“C”来表示。结论：腕中运动本质上是三种关节系统的联合运动：(1)舟状骨与远端排之间的单轴关节；(2)月骨、三髋和远端排之间的双轴关节；(3)近排腕间关节，其具有适应机制，可在腕中关节中容纳上述两种关节系统。临床相关性：我们提倡使用“卵形/C”概念来描述腕中关节的功能，它有助于腕关节的稳定性和灵活性，以帮助临床医生更好地理解腕关节的运动学。
Background: The human carpus is a complex joint system. Many problems that arise in the wrist are the result of an alteration of intercarpal motion. Although the midcarpal joint is a major component of the wrist joint, the global kinematics of the midcarpal joint have not been described. The purpose of this study was to provide a simplified description of the motion and function of the midcarpal joint.Methods: We studied the in vivo three-dimensional kinematics of the midcarpal joint with use of a markerless bone-registration technique. Magnetic resonance images of the wrists of twenty-four healthy volunteers were acquired during a dart-throwing motion or flexion-extension motion of the wrist. Three-dimensional animations of the isolated midcarpal joint were created. Relative midcarpal motions were investigated qualitatively and quantitatively.Results: The direction of the capitate motion relative to the scaphoid was always similar: it was oblique and it extended from radiodorsal to ulnopalmar in radioulnar deviation, in the dart-throwing motion, and in the flexion-extension motion. The directions of the capitate motions relative to the lunate and triquetrum inclined in a similar way, while the ranges of motion were almost unchanged. As the wrist motion changed from radioulnar deviation to flexion-extension motion, the range of the capitate rotation relative to the scaphoid decreased while the range of the lunate rotation relative to the scaphoid increased. Regardless of the type of wrist motion, the loci of the displacement of all of the joint surfaces of the midcarpal joint were located within a midcarpal ovoid space, and a line connecting the centers of the joint surfaces of the midcarpal joint could be schematized as a letter '' C '' entwining the midcarpal ovoid.Conclusions: Midcarpal motion is essentially the combined motion of three types of joint systems: (1) the uniaxial joint between the scaphoid and the distal row; (2) the biaxial joint between the lunate and triquetrum and the distal row; and (3) the intercarpal joints of the proximal row, which have an adaptive mechanism that accommodates the above-mentioned two types of joint systems in the midcarpal joint.Clinical Relevance: We advocate use of the '' ovoid/C '' concept to describe the function of the midcarpal joint that contributes to both the stability and the mobility of the wrist, to assist clinicians in achieving a better understanding of the kinematics of the wrist joint.