基于动态透视图像匹配技术的功能性踝关节不稳病理性运动机制研究

Functional ankle instability is one of the most common sports-related injuries. The pathological kinematic mechanism remains unclear, and the current diagnostic procedure and treatment options in standard care are mostly based on the physicians’ subjective judgements rather than objective criteria. This disorder, therefore, has become a serious healthcare problem to the patients and the public. The use of conventional kinematic analytical techniques is unable to detect the micro-motion changes due to their precision defects. Recently, we have successfully developed and validated the dynamic fluoroscopic image matching technique for foot and ankle joints, with its mean accuracy being controlled under 1°and 1 mm for rotational and translational motions, respectively. This novel techniques will allow us to measure the in vivo kinematics of the small joints in foot and ankle precisely during dynamic movements. Furthermore, our preliminary results have indicated that there is the significant difference in time-space motion pattern in ankle and hindfoot joints between the patients with functional ankle instability and the normal controls. The proposed project is based on our previous work and designed to systematically measure the three-dimensional six-degree of freedom motions of the ankle and hindfoot joints of the patients with functional ankle instability during standard body movements and to explore the underlying mechanism of pathological movement. This proposed program will establish the diagnostic referential standard for functional ankle instability, based on the large amount of clinical and kinematic data, and the guidelines for the use of currently available treatments. It is hoped that the results from the proposed project will improve our understanding of the pathogenesis of the disorder and facilitate the early diagnosis and standardized treatment of functional ankle instability.

功能性踝关节不稳是临床最为常见的运动损伤。由于其损伤后病理性失稳机制不明，目前其诊断及治疗仍基于主观判断，无客观参考标准，已成为临床棘手问题。以往运动学分析技术精度上无法满足对足踝微动关节检测的需求，也影响临床与基础研究。我们前期开发、优化了足踝部动态透视图像匹配技术，已将旋转及平移精度控制于1°及1 mm以内，实现了在活体动态环境下对踝足小关节进行高精度空间运动检测。通过预实验已发现功能性踝关节不稳患者的踝及后足关节时空运动规律与正常人存在显著差异。本项目基于该运动分析技术及前期结果，将系统检测功能性踝关节不稳患者在标准化动作环境下踝足关节的三维六自由度空间运动及联动规律变化，阐明功能性踝关节不稳的病理性运动机制。基于大量关节运动数据，建立功能性踝关节不稳的客观诊断标准及临床治疗方案的适用标准。本项目对功能性踝关节不稳的疾病本质认识、早期诊断及选择合理治疗手段具有重要意义。

功能性踝关节不稳多继发于踝关节扭伤，是最常见的足踝部运动损伤疾病之一。由于缺乏有效手段研究功能性踝关节不稳的病理性运动机制，目前临床诊断及治疗均依赖主观判断，缺乏客观指标，影响该疾病的早期诊断及合理治疗。为了探寻功能性踝关节不稳患者的病理性失稳机制，国际上开展了相关运动学研究。这些研究主要基于传统的表观运动捕捉系统，即多角度摄像系统捕捉放置于皮肤表面的标记。但由于该技术精度缺陷、空间自由度检测限制及患者运动动作的差异，不能得到精确、统一、量化的结果。.我们前期在足踝部运动分析技术上实现突破，开发、优化了足踝部双平面动态透视图像匹配技术，实现了对足踝部小关节的三维运动实时监测，平移精度达到 0.67mm，旋转精度达到 0.24°，与国际上同类技术达到同步水平。.本项目顺利完成预期研究目标，阐述了功能性踝关节不稳患者在平地行走、下楼梯、内翻坡行走等过程中踝足四关节的运动特点，发现与扭伤后代偿患者相比，功能性踝关节不稳患者的距下关节存在过度运动，率先提出了“距下关节不稳”在踝关节不稳发病机制中的作用。发现功能性踝关节不稳患者在多种日常生活运动中均存在距下关节过度活动，且该活动度是区别于扭伤后代偿患者的关键因素之一。相关成果发表于权威生物力学杂志杂志J Orthop Res、Gait Posture。.同时发现佩戴踝关节护具后功能性踝关节不稳患者的踝关节屈伸活动度没有显著变化，距下关节内外翻活动度明显减小。证明了踝关节护具主要通过限制距下关节内外翻运动而起到保护作用。相关成果发表于SCI杂志Gait Posture、Biomed Res Int。.本项目相关成果对功能性踝关节不稳临床检测与诊断标准的形成、足部辅具的设计，有理论指导意义。本项目优化的足踝部双平面动态透视图像匹配系统能够在后期进一步应用于足踝部关节生理运动与病理机制研究。