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Bioengenharia

ビプラナービデオラジオグラフィーを用いた3Dインビボショルダーキネマティクスの測定

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

Summary

複葉機のビデオラジオグラフィーは、高い精度で肩の運動学を定量することができます。本明細書に記載されているプロトコルは、平面上腕立て上げの間に肩甲骨、上腕骨、および肋骨を追跡するように特別に設計され、データ収集、処理、および分析の手順を概説する。データ収集に関する固有の考慮事項についても説明します。

Abstract

肩は人体の最も複雑な関節システムの1つで、4つの個々の関節、複数の靭帯、約20の筋肉の協調的な作用によって動きが起こります。残念ながら、肩の病理(例えば、ローテーターカフ涙、関節脱臼、関節炎)が一般的であり、実質的な痛み、障害、および生活の質の低下をもたらす。これらの病態の多くについての具体的な病因は完全には理解されていないが、肩の病理学はしばしば変化した関節運動に関連していると一般的に受け入れられている。残念ながら、動きに基づく仮説を調査するために必要な精度のレベルで肩の動きを測定することは簡単ではありません。しかし、放射能ベースの運動測定技術は、動きに基づく仮説を調査し、肩機能の機械学的理解を提供するために必要な進歩を提供してきました。したがって、この記事の目的は、カスタムバイプラナービデオラジオグラフィーシステムを使用して肩の動きを測定するためのアプローチを説明することです。この記事の具体的な目的は、肩複合体のバイプラナービデオ放射画像を取得し、CTスキャンを取得し、3D骨モデルを開発し、解剖学的ランドマークを見つけ、双平面放射画像から上腕骨、肩甲骨、胴体の位置と向きを追跡し、運動学的結果測定を計算するためのプロトコルを記述することです。さらに、このアプローチを使用して関節運動学を測定する際の肩に特有の特別な考慮事項について説明します。

Introduction

肩は人体の最も複雑な関節システムの1つで、4つの個々の関節、複数の靭帯、約20の筋肉の協調的な作用によって動きが起こります。肩はまた、身体の主要な関節の動きの最大の範囲を有し、しばしば移動性と安定性の間の妥協として記述される。残念ながら、肩の病理は一般的であり、実質的な痛み、障害、および生活の質の低下をもたらす。例えば、ローテーターカフ涙は601,2,3歳以上の人口の約40%に影響を及ぼし、年間約25万個のローテーターカフ修理が行われ、米国では年間3~50億ドルの経済的負担が見込まれる。さらに、肩の転位は一般的であり、しばしば慢性機能不全に関連する6。最後に、グレノフメラル関節変形性関節症(OA)は、65歳以上の成人のおよそ15%〜20%がグレノフメラルOA7,8の放射線証拠を有することを示す人口研究で、肩を含むもう一つの重大な臨床的問題である。これらの条件は、痛みを伴う活動レベルを損なう、生活の質を低下させる。

これらの病態の病因は完全には理解されていないが、変化した肩の動きは多くの肩の病理に関連していると一般に受け入れられている9,10,11。具体的には、異常な関節運動が病理9,12に寄与し得るか、または病理が異常な関節運動につながる可能性がある13,14。関節運動と病理の関係は複雑である可能性が高く、肩の関節運動の微妙な変化が重要である可能性があります。例えば、角度運動はグレノヒューマー関節で起こる主要な運動ですが、肩の動きの間にも関節の翻訳が起こります。通常の条件下では、これらの翻訳は、おそらく数ミリメートル15、16、17、18、19を超えないため、いくつかの測定技術のインビボ精度のレベルを下回る可能性があります。関節運動の小さな偏差は臨床的影響がほとんどないかもしれないと考えたいかもしれませんが、長年にわたる肩活動にわたる微妙な偏差の累積的な影響が組織の治癒と修復のための個人の閾値を超える可能性があることを認識することも重要です。さらに、グリーノヒューマー関節のインビボ力は重要ではありません。カスタム計装されたグリーノフメラル関節インプラントを使用して、以前の研究では、伸ばした腕で2kgの体重を頭の高さに上げることは、体重の70%から238%の範囲の輝く関節力をもたらすことが示されています。その結果、関節運動の微妙な変化とグレノイドの小さな耐荷重表面積に集中した高い力の組み合わせは、変性肩の病理の発達に寄与する可能性がある。

歴史的に、肩の動きの測定は、様々な実験的アプローチを通じて達成されてきました。これらのアプローチには、肩の動きをシミュレートするために設計された複雑なカダビリック試験システムの使用が含まれています23,24,25,26,27、表面マーカーを備えたビデオベースのモーションキャプチャシステム28,29,31、表面取り付け電磁センサー32,33,34,35、反射マーカーまたは他のセンサーが付いている骨ピン36,37,38、静的2次元医学画像(すなわち、蛍光コピー39、40、41およびX線写真17、42、43、44、45)、MRI46、47を用いた静的(3D)医学画像投射、コンピュータ断層撮影48、および動的な3D単一面透視イメージング49,50,51。最近では、ウェアラブルセンサー(慣性測定ユニットなど)が、実験室外の肩の動きを測定し、自由な生活環境で人気を集めています52,53,54,55,56,57。

近年、ショルダ58,59,60,61,62の動的3Dインビボ運動を正確に測定するように設計された複葉機の放射線または蛍光顕微鏡システムが普及しています。この記事の目的は、カスタムバイプラナービデオラジオグラフィーシステムを使用して肩の動きを測定するための著者のアプローチを説明することです。この記事の具体的な目的は、肩複合体のバイプラナービデオ放射画像を取得し、CTスキャンを取得し、3D骨モデルを開発し、解剖学的ランドマークを見つけ、双平面放射画像から上腕骨、肩甲骨、胴体の位置と向きを追跡し、運動学的結果測定を計算するためのプロトコルを記述することです。

Protocol

データ収集の前に、参加者は書面によるインフォームド・コンセントを提供しました。調査はヘンリー・フォード・ヘルス・システムの制度審査委員会によって承認された。 複葉機の放射能運動データを取得、処理、分析するためのプロトコルは、画像システム、データ処理ソフトウェア、および目的の結果尺度に大きく依存しています。以下のプロトコルは、肩甲骨?…

Representative Results

52歳の無症候性女性(BMI = 23.6 kg/m2)は、以前の調査の一環として募集され、彼女の支配的な(右)肩65で運動試験(コロナ・プレーン拉致)を受けた。データ収集の前に、参加者は書面によるインフォームド・コンセントを提供しました。調査はヘンリー・フォード・ヘルス・システムの制度審査委員会によって承認された。データ収集は、前述のプロトコルを使用して実行…

Discussion

ここで説明する技術は、動的活動中の3D関節運動の正確な測定を提供することにより、肩の動き(すなわち、キャダベリシミュレーション、2D画像、静的3Dイメージング、ビデオベースのモーションキャプチャシステム、ウェアラブルセンサーなど)を評価するための従来の手法に関連するいくつかの欠点を克服します。本明細書に記載されたプロトコルの精度は、放射体型分析(RSA)のゴールドス…

Declarações

The authors have nothing to disclose.

Acknowledgements

この出版物で報告された研究は、賞番号R01AR051912の下で国立関節炎および筋骨格および皮膚疾患研究所によってサポートされました。コンテンツは著者の責任であり、必ずしも国立衛生研究所(NIH)の公式見解を表すものではありません。

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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