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Bioengenharia

使用双平面影像学测量 3D 体内肩部运动学

Published: March 12, 2021
doi:
10.3791/62210
, ,
1Bone and Joint Center, Department of Orthopaedic Surgery,Henry Ford Health System

Summary

双平面视频放射成像可以高精度地量化肩部运动学。本文中描述的方案专门设计用于在平面肱骨抬高期间跟踪肩胛骨，肱骨和肋骨，并概述了数据收集，处理和分析的程序。还介绍了数据收集的独特注意事项。

Abstract

肩部是人体最复杂的关节系统之一，运动通过四个关节，多个韧带和大约20块肌肉的协调作用发生。不幸的是，肩部病变（例如肩袖撕裂、关节脱位、关节炎）很常见，导致剧烈疼痛、残疾和生活质量下降。许多这些病理状况的具体病因尚不完全清楚，但人们普遍认为肩部病理学通常与关节运动改变有关。不幸的是，以必要的精度水平测量肩部运动以研究基于运动的假设并非易事。然而，基于放射影像学的运动测量技术为研究基于运动的假设和提供肩部功能的机械理解提供了必要的进步。因此，本文的目的是描述使用自定义双平面视频放射成像系统测量肩部运动的方法。本文的具体目的是描述获取肩部复合体的双平面视频放射成像图像，获取CT扫描，开发3D骨模型，定位解剖学标志，从双平面放射成像图像跟踪肱骨，肩胛骨和躯干的位置和方向，并计算运动学结果测量。此外，本文还将描述使用此方法测量关节运动学时肩部特有的特殊注意事项。

Introduction

肩部是人体最复杂的关节系统之一，运动通过四个关节，多个韧带和大约20块肌肉的协调作用发生。肩部也具有身体主要关节的最大活动范围，通常被描述为活动性和稳定性之间的折衷。不幸的是，肩部病变很常见，导致严重的疼痛，残疾和生活质量下降。例如，肩袖撕裂影响约 40% 的 601 岁以上人群，2，3，每年进行约 250，000 次肩袖修复手术4，估计美国每年的经济负担为 30-50 亿美元5。此外，肩关节脱位很常见，通常与慢性功能障碍有关6。最后，盂肱关节骨关节炎（OA）是另一个涉及肩部的重大临床问题，人群研究表明，大约15%-20%的65岁以上的成年人有盂肱肱OA7，8的影像学证据。这些情况是痛苦的，损害活动水平，并降低生活质量。

虽然这些疾病的发病机制尚不完全清楚，但人们普遍认为肩部运动改变与许多肩部病变有关9，10，11。具体而言，异常关节运动可能导致病理学9，12，或者病理学可能导致异常关节运动13，14。关节运动与病理学之间的关系可能很复杂，关节运动的细微改变在肩部可能很重要。例如，虽然角运动是发生在盂肱关节的主要运动，但在肩部运动期间也会发生关节平移。在正常情况下，这些翻译可能不超过几毫米15，16，17，18，19，因此可能低于某些测量技术的体内精度水平。虽然人们可能很容易认为关节运动中的小偏差可能几乎没有临床影响，但重要的是要认识到，多年肩部活动期间细微偏差的累积效应可能超过个体组织愈合和修复的阈值。此外，盂肱关节处的体内力并非无关紧要。使用定制的器械盂肱关节植入物，先前的研究表明，伸出手臂将2公斤的重量提高到头部高度可导致盂肱关节力，其范围为体重的70%至238%20，21，22。因此，关节运动的细微变化和集中在关节盂小承重表面积上的高力的组合可能有助于退行性肩部病变的发展。

从历史上看，肩部运动的测量是通过各种实验方法完成的。这些方法包括使用复杂的尸体测试系统，旨在模拟肩部运动23，24，25，26，27，基于视频的运动捕获系统，带有表面标记28，29，31，表面安装的电磁传感器32，33，34，35、附有反射标记物或其他传感器的骨针36、37、38、静态二维医学成像（即荧光透视39、40、41 和 X 线照片17、42、43、44、45）、使用 MRI46、47 的静态三维 （3D） 医学成像，计算机断层扫描48和动态3D单平面透视成像49，50，51。最近，可穿戴传感器（例如惯性测量单元）在实验室环境之外和自由生活条件下测量肩部运动方面越来越受欢迎52，53，54，55，56，57。

近年来，双翼射线照相或透视系统激增，旨在精确测量肩部的动态3D体内运动58，59，60，61，62。本文的目的是描述作者使用定制的双平面视频放射成像系统测量肩部运动的方法。本文的具体目的是描述获取肩部复合体的双平面视频放射成像图像，获取CT扫描，开发3D骨模型，定位解剖学标志物，从双平面放射成像图像跟踪肱骨，肩胛骨和躯干的位置和方向以及计算运动学结果测量的方案。

Protocol

在收集数据之前，参与者提供了书面知情同意书。该调查得到了亨利福特卫生系统机构审查委员会的批准。 用于获取、处理和分析双平面射线照相运动数据的协议高度依赖于成像系统、数据处理软件和感兴趣的结果度量。以下方案专门设计用于在肩胛骨平面或冠状面外展期间跟踪肩胛骨、肱骨以及第三和第四肋骨，并量化盂肱、肩胛胸和肱胸运动学。 1. CT…

Representative Results

一名 52 岁无症状女性（BMI = 23.6 kg/m2）被招募为既往调查的一部分，并在其显性（右）肩上接受了运动试验（冠状平面外展）65。在收集数据之前，参与者提供了书面知情同意书。该调查得到了亨利福特卫生系统机构审查委员会的批准。数据收集是使用前面描述的协议执行的（图3）。 参与者的盂肱、肩胛胸和肱胸运动学分别如?…

Discussion

这里描述的技术通过提供动态活动期间3D关节运动的精确测量，克服了与评估肩部运动的传统技术（即尸体模拟，2D成像，静态3D成像，基于视频的运动捕获系统，可穿戴传感器等）相关的几个缺点。本文描述的方案的准确性是为盂肱关节与放射立体分析（RSA）的金标准±0.5°和±0.4 mm67，68而建立的。类似的方案已经开发用于其他关节，如膝盖<sup class="xref…

Declarações

The authors have nothing to disclose.

Acknowledgements

本出版物中报告的研究得到了国家关节炎和肌肉骨骼和皮肤病研究所的支持，奖项编号为R01AR051912。内容完全由作者负责，并不一定代表美国国立卫生研究院（NIH）的官方观点。

Materials

Calibration cube Built in-house N/A 10 cm Lucite box with a tantalum bead in each corner and four additional beads midway along the box’s vertical edges (12 beads total). The positions of each bead are precisely known relative to a corner of the box that serves as the origin of the laboratory coordinate system.
Distortion correction grid Built in-house N/A Lucite sheet that covers the entire face of the 16 inch image intensifier and contains an orthogonal array of tantalum beads spaced at 1 cm.
ImageJ National Institutes of Health N/A Image processing software used to prepare TIFF stack of bone volumes.
Markerless Tracking Workbench Custom, in house software N/A A workbench of custom software used to digitize anatomical landmarks on 3D bone models, constructs anatomical coordinate systems, uses intensity-based image registration to perform markerless tracking, and calculates and visualize kinematic outcomes measures.
MATLAB Mathworks, Inc N/A Computer programming software. For used to perform data processing and analysis.
Mimics (version 20) Materialise, Inc N/A Image processing software used to segment humerus, scapula, and ribs from CT scan.
Open Inventor Thermo Fisher Scientific N/A 3D graphics program used to visualize bones
Phantom Camera Control (PCC) software (version 3.4) N/A Software for specifying camera parameters, and acquiring and saving radiographic images
Pulse generator (Model 9514) Quantum Composers, Inc. N/A Syncs the x-ray and camera systems and specifies the exposure time
Two 100 kW pulsed x-ray generators (Model CPX 3100CV) EMD Technologies N/A Generates the x-rays used to produce radiographic images
Two 40 cm image intensifiers (Model P9447H110) North American Imaging N/A Converts x-rays into photons to produce visible image
Two Phantom VEO 340 cameras Vision Research N/A High speed cameras record the visible image created by the x-ray system
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Keywords: 3D In-vivo Shoulder KinematicsBiplanar VideoradiographyJoint Motion QuantificationRadiation ExposureParticipant PositioningLead-lined Protective VestLow Fluoroscopy ModeRadiographic Image Acquisition
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Lawrence, R. L., Zauel, R., Bey, M. J. Measuring 3D In-vivo Shoulder Kinematics using Biplanar Videoradiography. J. Vis. Exp. (169), e62210, doi:10.3791/62210 (2021).
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