長時間固定受傷及複雜之不穩定關節時常導致諸如攣縮及關節僵硬等無可避免及具破壞性之結果。對肘關節治療而言，則著重於術後期間使用主動或被動式肘關節活動以避免術後之不適。具關節牽引功能(即動態牽引術)之動態絞鏈型骨外固定器是一種對於治療肘關節等傷後疾病之技術。它能夠提供恢復關節功能，尤其年輕病患更為顯著。目前市場上宣稱具有此功能之肘關節骨外固定器，通常體積龐大且設計複雜，且此技術需要完美之手術將骨外固定器之旋轉軸與肘關節之自然旋轉軸對齊是極為困難，同時術後也可能造成病患進行關節牽引與復健之不方便。
本論文首先對動態牽引術定義出三項基本功能：軸心對齊、關節牽引與術後復健功能，隨後設計出具有上述三項功能之肘關節骨外固定器。就橋式肘關節而言，理想動態牽引之先決條件為受牽引之橋式肘關節結構於肘關節全範圍運動期間能夠平順地沿一簡單絞鏈旋轉軸旋轉。以運動學角度觀察，橋式肘關節之架構形成一封閉連桿系統。關節牽引及軸心對齊則很可能與設備、手術方式及關節本身因素有密切關係。首先運用齊次轉換矩陣探討肘關節角度及固定骨釘植入等初始參數對新型肘關節骨外固定器之可調功能的影響，並利用三角幾何模型驗證數值解之正確性。因此，對於軸心對齊功能而言，骨外固定器關節設計之自由度伴演著重要之角色。
建立以電腦斷層掃描影像為參考之三維肘關節模型與新型骨外固定器所結合之橋式肘關節的有限元素分析模型，以位移控制模式探討橋式肘關節受骨外固定器之牽引裝置牽引時，關節牽引與軸心對齊間之交互機制及牽引負載於橋式肘關節結構間之傳遞機制。結果發現(1)肱尺關節面間之偏向分離應因於牽引負載與連線之非垂直性而總會存在。然而採用較剛性之固定骨釘以收斂植入模式下啟動肱骨端牽引裝置之120°橋式肘關節能獲得較均向分離之肱尺關節面；(2)受骨外固定器輔助之牽引會使得骨外固定器之導引骨釘朝牽引端之反向偏移。初始導引骨釘之近端偏移之理想量約為牽引裝置受啟動牽引量之一半；(3)牽引裝置牽引距離之向量轉換及固定骨釘之橈曲將影響關節面有效牽引量。
本論文之研究成果可提供給骨科醫師於臨床應用的評估依據，並給予醫學工程領域之工程師於研發肘關節骨外固定器的設計依據與方法。

Prolonged immobilization of elbow fracture-dislocations and complex instability often lead to inevitable, devastating consequences. For the therapy of elbow joint, active or passive motion of elbow are stressed to avoid the pain during postoperative period. Hinge dynamic fixation with joint distraction (i.e.arthrodiatasis) is a technique for treatment of post-traumatic disease of the elbow. It provides restoration of joint function, particular in young patients. There have been some commercial elbow fixators to claim to provide with such a technique. However, they are often bulky and design-complicated, thus inducing difficulty in aligning the hinges of fixator-elbow construct and inconvenience during distraction arthroplasty and postoperatively rehabilitation.
The current study firstly defines three basic functions of the elbow external fixator with arthrodiatasis: hinge-alignment, arthroplasty-distraction, and rehabilitation-training. Secondly, one new elbow external fixators with aforementioned three functions is developed. The prerequisite for an ideal dynamic distraction for the bridged elbow joint is that the distracted elbow-pin-fixator construct rotates smoothly along a single hinge axis, throughout the full range of elbow motion. From a kinematic viewpoint, the elbow-pin-fixator construct forms a closed linkage system. The functions of joint distraction and hinge alignment might be closely related to some device, surgery, and joint factors. The principle of homogeneous transformation matrix of robotics is applied to the kinematic analysis of such a chain system. Consequently, the fixing pin placement and elbow angle are parameterized, and their kinematic influences on the adjustability of the new fixator are analyzed. The numerical results of the current study are validated by the trigonometric model and computerized simulation.
The finite element models of bridged elbow are constructed by three-dimensional elbow joint, based on the CT-images, and new fixator. Displacement controlled mode is utilized to analyze the interactive mechanism between hinge alignment and joint distraction, and load-transferring path of distraction force for the distracted bridged elbow. The results of current study show that (1) the eccentric separation of the humeroulnar surfaces is a response to the nonorthogonality of the distracting force and joining line. The humeroulnar separation is more concentric in the situation of the 120° humeral distraction by using stiffer pins with convergent placement. (2) the fixator-aided distraction causes the guide pin to be shifted towards the opposite side at the distraction stage. The ideal value of the initial proximal pin shift is about half the distance activated by the distractor. (3) the distraction-loss mechanism is attributed to vectorial transformation of distracted length and lateral deflection of fixing pins.
The results of this dissertation could be of design and surgery significance for fixator bioengineers and orthopedic surgeons.

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