中文摘要

橈骨遠端骨折為常見的骨折之ㄧ，近年來，一些特殊設計的腕外固定器已廣泛地用來治療此類的骨折與手術後遺症，有關腕關節外固定器主要有兩種固定器，分別為非跨腕關節式外固定器（non-briding fixator）與跨腕關節式外固定器（briding fixator）。非跨腕關節式外固定器能直接將其架設於橈骨上方，在術後手腕活動可不受到限制，具有比跨腕關節式固定器更大的活動角度與恢復時間，但缺點是無法適用於涉及關節面或較粉粹性的骨折。跨腕關節式外固定器則將骨釘分別打入橈骨與第二掌骨上，再將固定器架設於骨釘上，這類的外固定器因為跨越過腕關節的部份，通常設計為具鉸鏈或球關節的裝置，目的是能與腕關節軸心對齊，以在術後提供腕關節活動的空間，避免手腕僵硬等的後遺症，除此之外，通常會進一步搭配牽引裝置以進行復健等動作。但目前市場上外固定器，通常設計複雜且功能無法兼顧，術後也造成病患關節拉伸與復健的不方便。
本文的研究首先針對目前商品化的骨外固定器進行改良，設計出新型之腕關節骨外固定器，並運用機械人學的齊次轉換矩陣，針對骨釘施打的手術參數，在外固定器與腕關節同軸心的條件下，分析對新型腕外固定器可調功能的影響，再利用三角幾何模型及電腦模擬來驗證數值解的正確性，最後則以田口法分析手術參數對新型外固定器之貢獻度影響。
本論文的研究成果除了開發出具有新型的腕關節外固定器之外，同時也成功地運用齊次轉換矩陣與田口法來確認外固定器的可調範圍。提供醫師瞭解此類技術在手術上的限制。除了腕關節之外，本研究成果與概念未來也可運用在其他如膝與踝等具有鉸鏈功能之關節。

Abstract

Distal radius fracture is one of the common fractures. Recently some specially designed external fixators have been widely used for the treatment of such fracture and surgically related complications. There are two kinds of wrist external fixator: non-briding fixator and briding fixator. Non-briding fixator can fix on the radius directly; there is no mechanical restriction of wrist movement with a non-bridging fixator after treatment. It has widely ROM and better reduction of distal radius fractures. But it can’t be used in the fracture with articular surfaces or comminuted fracture. Briding fixator has first insert pins to the radius and second metacarpal individually, when set fixator to the pin. Because those fixators have set across the axis of wrist, it’s usually designed as a device composed of hinge or ball joint, the main purpose of this design is in line with the axis of wrist, it can supply to the range of motion of the wrist and avoid the squeal of the wrist joint stiffness. Besides, the continuously passive motion can be done by detraction device. However, there have been some commercial wrist fixators which are often bulky and design complicated, inducing inconvenience during the rehabilitation.
In this study, we firstly improved now commercial fixators and designed a new wrist fixator. Assuming a new wrist fixator and the associated radius and second metacarpal bone as a close chain system, the principle of homogeneous transformation matrix of robotics is applied in the kinematic analysis of such a chain system. Consequently, the pin placements are parameterized and their kinematic influences on the adjustability, which are in line with wrist axis of the new fixators, are analyzed. The numerical results of the current study are validated by the trigonometric model and computerized simulation. In addition, the contribution for each design parameter of external fixator was thus investigated by the Taguchi method
In conclusion, the current study has designed a newly wrist external fixator. Furthermore, the new fixator is validated by the homogeneous transformation matrix and Taguchi method. The results of this study can help orthopedic surgeons take insight into the operation restraints of such a new technique. In the future, the same concept can be clinically applied to the treatment of the hinged knee and ankle joints.

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