研究生: |
張天豪 Tin-Hao Chang |
---|---|
論文名稱: |
具關節牽引功能之動態腕關節外固定器之設計與運動學研究 Design and Kinematic Study of a Wrist External Fixator with Arthrodiatasis |
指導教授: |
趙振綱
Ching-Kong Chao |
口試委員: |
林上智
none 鄧昭瑞 none |
學位類別: |
碩士 Master |
系所名稱: |
工程學院 - 機械工程系 Department of Mechanical Engineering |
論文出版年: | 2005 |
畢業學年度: | 93 |
語文別: | 中文 |
論文頁數: | 110 |
中文關鍵詞: | 齊次轉換矩陣 、骨折 、骨外固定器 |
外文關鍵詞: | fracture, fixator, htm |
相關次數: | 點閱:310 下載:8 |
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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.
參考文獻
[1] McQueen M. Redisplaced unstable fractures of the distal radius: A randomised, prospective study of bridging versus non-bridging external fixation. J Bone Joint Surg [Br] 1998;80-B:665-9
[2] 沈清良,實用解剖學,第74~103頁,台北,華杏出版社,1995。
[3] Shell 原著,黃啟仲、陳偉淦、陳益祥、賴凌平、劉絮愷 編譯,大體解剖學,藝軒圖書出版社,第391-452頁。
[4] Bunnell S : The normal hand. In Bunnell S (ed). Surgery of the hand . Ed 3. Philadelohia, 1985; JB Lippincott 34-37.
[5] Yougle Youm, Robert Y, Mcmurtry. Kinematics of the wrist. The journal of bone and joint surgery, American Volume 1978; 4: 423-31
[6] Berger RA, Blair WF, Crowninshield RD: The scapholunate ligament. J Hand Surgery 1982:7:87–91.
[7] Andrews JG, Youm YA: A biomechanical investigation of wrist kinematics. J Biomech 1979: 12: 83–93.
[8] Tagare HD, Elder KW, Stoner D, et al: Location and geometric description of carpal bones in CT images. Ann Biomech Eng 1993; 21:715–726.
[9] Viegas SF, Hillman GR, Elder KW, et al: Measurement of carpal bone geometry by computer analysis of three-dimensional CT images. J Hand Surgery 1993:18A:341–349.
[10] Patterson RM, Nicodemus CL, Viegas SF, et al:High-speed, three-dimensional kinematic analysis of the normal wrist. J Hand Surgery 1998:23A:446–453.
[11] Agee JM. External Fixation. Technical advances based upon multiplanar ligamentotaxis. Orthopedic Clinics of North America 1993 ; 24:265-74.
[12] Cooney WP. External fixation of distal radial fractures. Clinical Orthopaedics & Related Research 1983; (180)44-9.
[13] Nakata RY, Chand Y, Matiko. JD, Frykman GK, Wood VE. External fixators for wrist fractures : a biomechanical and clinical study. Journal of Hand Surgery 1985; 10: 845-51.
[14] Clyburn TA. Dynamic external fixation for comminuted intra-articular fractures of the distal end of the radius. Journal of Bone & Joint Surgery
1987; 69: 248-54.
[15] Leung KS , So WS, Chiu VD, Leung PC. Ligamentotaxis for comminuted distal fracture modified by primary cancellous grafting and functional bracing : long-term results. Journal of Orthopaedic Trauma 1991; 5: 265-71.
[16] Abe Y, Doi K, Kuwata N, Yamamoto H, Sunago K, Kawai S. Surgical options for distal radial fractures: indications and limitations. Archives of
Orthopaedic & Trauma Surgery 1998; 117: 188-92.
[17] Krishnan J, Chipchase LS, Slavotinek J. Intraarticular fractures of the distal radius treated with metaphseal external fixation. Early clinical results. Journal of Hand Surgery –British 1998 ; 23:396-9.
[18] Nepola JA. External fixation. In: Rockwood CA, Green DP, Bucholz RW, Heckman JD. Fractures in Adults. Philadelphia: Lippincott-Raven 1996. p. 229-59.
[19] W. De, W. Klein, H. Rieger. Reduction techniques in distal radius fractures. Injury, Int. J. Care Injured 31 (2000) 48-55.
[20] Franck WM, Dahlen C, Amlang M, Friese F, Zwipp H. Distal radius fracture--is non-bridging articular external fixator a therapeutic alternative? A prospective randomized study. Unfallchirurg. 103(10):826-33, 2000 Oct.
[21] T. Gausepohl, D. Pennig, K. Mader. Principles of external fixation and supplementary techniques in distal radius fractures. Injury, Int. J. Care Injured 31 (2000) 56-70.
[22] D. Pennig, T. Gausepohl, K. Mader. Corrective osteotomies in malunited distal radius fractures:external fixation as one stage and hemicallotasis procedures. Injury, Int. J. Care Injured 31 (2000) 78-91.
[23] Jacob, Roland P. and Ralph Hertel. “The Small AO External Fixator–A Versatile Device.” Injury 1994, Vol. 25, Suppl. 4: S-D28–S-D34.
[24] Jupiter, Jesse B and Diego L. Fernandez. “Complications Following Distal Radius Fractures.” The Journal of Bone and Joint Surgery(American) 83: 1244-1265. 2001.
[25] 林宗鴻, 手腕骨外固定器之機械測試與調整範圍分析, 國立台灣科技大學機械工程技術研究所,民國93年。
[26] 陳修毅,骨外固定器簡化機構之研究, 國立台灣科技大學機械工程技術研究所,民國93年。