膝关节三维运动测量方法与应用研究
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摘要
膝关节置换前后的运动学对比，是研究膝关节损伤机理和评估术后重建效果的重要依据。目前，在膝关节动态三维运动的精确测量上，还存在技术难点，全膝置换（TKA）假体对膝关节运动功能的影响，有待于深入研究。
本文围绕膝关节三维运动测量与分析开展研究工作，利用动态X线影像技术和高精度光学三维跟踪技术分别进行了在体和离体的实验研究，测量了膝关节置换前后的三维运动学参数，分析了后稳定型假体对髌股关节运动及髌韧带的影响。
首先，利用二维动态X线透视影像与膝关节三维模型进行注册，重建和跟踪膝关节在体三维运动过程。为提高图像与模型的注册效率，本文在二维影像与三维模型的自动化注册等关键技术上进行了算法设计与实现，缩短了注册时间，提高了注册精度，算法稳定可靠。利用该技术测量了正常膝关节爬楼梯和高屈膝时的三维运动，研究了TKA术前术后膝关节活动度、髌股关节及髌韧带的运动学变化。
膝关节个性化建模是研究在体膝关节三维运动学的基础，目前还主要依赖计算机X射线断层扫描（CT）或核磁共振成像（MRI）等影像技术，前者电离辐射较高，后者成本高且建模耗时。为了突破以上瓶颈，本文利用可变形统计模型技术，实现了膝关节骨骼和软骨模型的快速三维重建。经过论证，该技术与CT、MRI影像技术的建模精度相当，是个性化膝关节建模的一种新方法，为研究在体膝关节运动学提供了新途径。
针对膝关节研究中在体运动难以精确测量的技术难题，本文采用光学三维跟踪测量技术，通过离体实验，高精度地测量了尸体膝关节的三维运动，并着重研究了全膝置换假体对髌骨轨迹和髌韧带的影响。同时，针对膝关节运动范围受X线透视成像空间尺寸限制的情况，利用体表标记点跟踪下肢大范围内的运动，测量了下蹲过程中正常膝关节的三维运动和Q角参数。
综上，本文对膝关节三维运动测量的关键技术进行了研究，对膝关节置换前后三维运动学差异进行了对比和分析。同时，应用统计模型进行膝关节个性化三维建模，降低了辐射和成本。本文的方法和研究结果对临床有参考价值，测量方法和建模技术还可应用于人体其他关节的三维运动学研究。
The kinematic comparison between the native knee and artificial knee is animportant way to understand the joint disease mechanism and assess the clinicaloutcomes. Currently, the accurate measurement of the dynamic knee joint motion inthree dimensions (3D) is still a challenging issue in technique. The kinematic differenceof the knees underwent total knee arthroplasty (TKA) needs to be investigated in clinic.
In this study, the X-ray images and optical tracking technique were applied tomeasure the3D kinematics of the in-vivo and in-vitro knees. The joint kinematicsbefore and after the posterior stabilized TKA were measured. The effect of the TKAdesigns to the patellofemoral joint and patellar tendon was investigated.
A2D-3D image-model registration technique was applied to reconstruct the3Dmotion of the in-vivo knee joint. An algorithm of2D-3D automatic registration wasdeveloped to enhance the method, which simplified the time-consuming process. Theaccuracy and repeatability were improved. The technique was applied to study thenormal knees during stair ascending and deep flexion and the knees after TKAs.
The patient-specific knee model is the basis to study the in-vivo3D knee jointkinematics. Currently, the CT or MRI images can be used to reconstruct3D kneemodels, but with high radiation and cost. In order to overcome the above disadvantages,a statistical deformable model was developed to generate the knee models with boneand cartilage, which was accurate enough to study knee joint kinematics.
In vivo studies, the accurate tracking of the knee joint is difficult, and the motion islimited by the X-ray imaging zone. The marker-based optical tracking technique wasused to track the motion of the cadaveric patella in this study. Different types of TKAprosthesis were compared. Due to the capability of tracking large range of motion inspace, the technique was used to measure the knee kinematics and Q angle during squat.
In summary, key techniques were presented in this study to measure the kinematicsof the knee joints before and after TKAs. Meanwhile a new method to reconstructpatient-specific knee model was developed. The result has an essential significance inclinic. The techniques can be used to measure the3D kinematics of other human joints.
本文围绕膝关节三维运动测量与分析开展研究工作，利用动态X线影像技术和高精度光学三维跟踪技术分别进行了在体和离体的实验研究，测量了膝关节置换前后的三维运动学参数，分析了后稳定型假体对髌股关节运动及髌韧带的影响。
首先，利用二维动态X线透视影像与膝关节三维模型进行注册，重建和跟踪膝关节在体三维运动过程。为提高图像与模型的注册效率，本文在二维影像与三维模型的自动化注册等关键技术上进行了算法设计与实现，缩短了注册时间，提高了注册精度，算法稳定可靠。利用该技术测量了正常膝关节爬楼梯和高屈膝时的三维运动，研究了TKA术前术后膝关节活动度、髌股关节及髌韧带的运动学变化。
膝关节个性化建模是研究在体膝关节三维运动学的基础，目前还主要依赖计算机X射线断层扫描（CT）或核磁共振成像（MRI）等影像技术，前者电离辐射较高，后者成本高且建模耗时。为了突破以上瓶颈，本文利用可变形统计模型技术，实现了膝关节骨骼和软骨模型的快速三维重建。经过论证，该技术与CT、MRI影像技术的建模精度相当，是个性化膝关节建模的一种新方法，为研究在体膝关节运动学提供了新途径。
针对膝关节研究中在体运动难以精确测量的技术难题，本文采用光学三维跟踪测量技术，通过离体实验，高精度地测量了尸体膝关节的三维运动，并着重研究了全膝置换假体对髌骨轨迹和髌韧带的影响。同时，针对膝关节运动范围受X线透视成像空间尺寸限制的情况，利用体表标记点跟踪下肢大范围内的运动，测量了下蹲过程中正常膝关节的三维运动和Q角参数。
综上，本文对膝关节三维运动测量的关键技术进行了研究，对膝关节置换前后三维运动学差异进行了对比和分析。同时，应用统计模型进行膝关节个性化三维建模，降低了辐射和成本。本文的方法和研究结果对临床有参考价值，测量方法和建模技术还可应用于人体其他关节的三维运动学研究。
The kinematic comparison between the native knee and artificial knee is animportant way to understand the joint disease mechanism and assess the clinicaloutcomes. Currently, the accurate measurement of the dynamic knee joint motion inthree dimensions (3D) is still a challenging issue in technique. The kinematic differenceof the knees underwent total knee arthroplasty (TKA) needs to be investigated in clinic.
In this study, the X-ray images and optical tracking technique were applied tomeasure the3D kinematics of the in-vivo and in-vitro knees. The joint kinematicsbefore and after the posterior stabilized TKA were measured. The effect of the TKAdesigns to the patellofemoral joint and patellar tendon was investigated.
A2D-3D image-model registration technique was applied to reconstruct the3Dmotion of the in-vivo knee joint. An algorithm of2D-3D automatic registration wasdeveloped to enhance the method, which simplified the time-consuming process. Theaccuracy and repeatability were improved. The technique was applied to study thenormal knees during stair ascending and deep flexion and the knees after TKAs.
The patient-specific knee model is the basis to study the in-vivo3D knee jointkinematics. Currently, the CT or MRI images can be used to reconstruct3D kneemodels, but with high radiation and cost. In order to overcome the above disadvantages,a statistical deformable model was developed to generate the knee models with boneand cartilage, which was accurate enough to study knee joint kinematics.
In vivo studies, the accurate tracking of the knee joint is difficult, and the motion islimited by the X-ray imaging zone. The marker-based optical tracking technique wasused to track the motion of the cadaveric patella in this study. Different types of TKAprosthesis were compared. Due to the capability of tracking large range of motion inspace, the technique was used to measure the knee kinematics and Q angle during squat.
In summary, key techniques were presented in this study to measure the kinematicsof the knee joints before and after TKAs. Meanwhile a new method to reconstructpatient-specific knee model was developed. The result has an essential significance inclinic. The techniques can be used to measure the3D kinematics of other human joints.
引文
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