基于CT和解剖的三维数字化腕关节模型的构建

目的 探讨基于CT影像重建和虚拟解剖复位的三维数字化腕关节模型的构建及其应用价值,为开展腕关节生物力学功能研究准备前处理形态学模型.方法 采集1例中国青年男性志愿者右前臂高分辨CT图像,应用Mimics软件进行三维骨性重建;通过腕关节标本解剖和数值调查,应用3D-Doetor软件在CT图像软组织灰度区域,分割三角纤维软骨盘和韧带群并三维重建;将骨结构、软骨盘和韧带群导入Geomagic软件进行虚拟解剖复位和模型配准,构建网格优化的腕关节数字模型.结果 建立了包括桡、尺骨,掌骨(包含皮质、松质、髓腔),腕骨,三角纤维软骨复合体,桡腕背侧、桡舟、桡舟头、桡月韧带等结构的三维数字化腕关节模型.模型虚拟构建的韧带、软骨盘等的测量值基本在文献报告的数值范围之内.结论 在目前的个人计算机平台上依据CT影像和解剖资料,利用医学图像处理软件和三维重建软件可以准确、快捷地构建腕关节的三维数字模型,为腕部有限元分析及整个虚拟手的构建提供了技术支撑.     

腕关节的三维可视化研究

[目的]建立腕关节三维数字化可视模型。[方法]获取腕关节0．2mm厚的薄层冠状断层标本，在计算机上对腕骨及主要韧带的断层图像轮廓进行数据分割、对位重建和三维显示。[结果]重建了腕关节桡、尺骨，远近两列（共8块）腕骨，掌骨（5块）及桡尺韧带、腕关节盘（三角纤维软骨）、关节盘同系物、桡月韧带、桡三角韧带、舟头韧带、桡舟头韧带、舟月韧带、月三角韧带、尺三角韧带、尺月韧带、三角头韧带、钩头韧带共28个结构的三维图像。在模型上可对上述结构进行单个结构的显示，也可以进行多个结构的分色显示、透明显示，同时也可以任意放大缩小和任意角度旋转观察。并且，所有结构在任意方向上的径线和角度均可适时测量。[结论]该腕关节三维可视化模型较清晰地反映了腕部骨及韧带的解剖关系，可从多个外科手术角度进行观察，可为腕关节外科手术提供重要的参考资料。     

三角纤维软骨复合体解剖及生物力学研究

目的从解剖完整的腕关节入手,阐明三角纤维软骨复合体各组成部分的解剖特点,评估三角纤维软骨复合体(TFCC)对于维持远侧桡尺关节稳定的重要性。方法对8个新鲜解冻的腕关节和6个经甲醛浸泡的腕关节进行显微解剖。同时对影响远侧桡尺关节稳定性的因素作了初步的评估。前臂中旋位,垂直于尺骨予20N拉力下测量尺骨相对于桡骨的位移,然后先后切断掌背侧桡尺韧带,测量尺骨相对于桡骨的位移变化。结果发现掌背桡尺韧带由三角纤维软骨盘外周增厚而成,止于尺骨茎突基底部,是维持远侧桡尺关节稳定性的主要因素之一,切断掌背侧桡尺韧带会导致远侧桡尺关节明显不稳。结论TFCC由三角纤维软骨盘、掌背侧桡尺韧带、尺骨月骨韧带、尺骨三角骨韧带、尺侧腕伸肌下腱鞘、半月板同源物、尺侧囊组成。掌背桡尺韧带是维持远侧桡尺关节稳定性的主要因素之一,掌背侧桡尺韧带损伤会导致远侧桡尺关节明显不稳。     

腕关节极度过伸位时韧带长度变化的活体研究

目的 探讨腕关节在中立位、极度过伸位及过伸桡偏位时腕关节韧带长度的变化情况.方法 对6名志愿者腕关节进行CT扫描,获取腕关节在中立位、极度过伸位及过伸桡偏位时的断层扫描图像,利用Mimics10.0软件进行三维重建,测量并比较此3种位置下的腕关节掌与背侧共9根韧带的长度. 结果 与中立位相比,腕关节极度过伸位时桡舟头、桡舟月、长桡月、尺月、尺头、尺三角及背侧骨间韧带止于舟骨部分明显伸长,差异有统计学意义(P＜0.05)；背侧桡腕、背侧骨间韧带止于小多角骨部分明显缩短,差异有统计学意义(P＜0.05)；而从极度过伸位至极度过伸桡偏位时,桡舟头、尺月、长桡月、背侧骨间韧带止于舟骨和三角骨部分明显缩短,差异有统计学意义(P＜0.05)；尺三角、尺头、桡舟月及背侧桡腕韧带明显伸长,差异有统计学意义(P＜0.05). 结论 腕过伸位时尺头韧带、尺三角韧带、桡舟月韧带、尺月韧带、桡舟头韧带、长桡月韧带、背侧骨间韧带止于舟骨部分张力较大；而背侧桡腕韧带、背侧骨间韧带止于小三角骨部分张力较小,这些变化规律有助于了解腕部韧带损伤的发生及损伤范围.     

腕关节韧带解剖及组织学特性研究

目的了解腕关节韧带解剖及组织学特性。方法成人腕关节标本34侧,其中32侧为福尔马林固定标本,2侧为新鲜标本。解剖并观察腕关节韧带的起止、走行、与关节囊的关系及韧带的比邻;测量其长度,取每条韧带的中段测量其宽度和厚度。8侧福尔马林固定标本,解剖出部分腕关节韧带石蜡包埋、切片、HE染色,光镜观察。结果腕关节韧带掌侧较强韧,同时数量也多。相邻韧带形成多个“V”形结构。桡舟韧带、桡舟头韧带和桡月韧带的组织结构相似,由肌腱样的胶原纤维束组成,胶原纤维束之间有少量的疏松组织,其间有血管分布,胶原纤维束呈小的波浪状。桡舟月韧带主要由疏松结缔组织组成,没有粗大的肌腱样胶原纤维束,胶原纤维束很少,而血管束丰富。舟月骨间韧带和月三角骨间韧带的掌侧、背侧和近侧的3个部分不同,特别是近侧部与掌侧、背侧部分。背侧部分主要由粗大成束的横行胶原纤维束组成;掌侧部分也由胶原纤维束组成,其排列方向是斜行,在桡舟月韧带与舟月骨间韧带结合处,可见桡舟月韧带的血管束进入舟月骨间韧带掌侧部分;近侧部分主要由纤维软骨成份构成,其间无血管神经分布。结论大部分腕关节韧带由密集粗大的胶原纤维束为主构成。而桡舟月韧带,则主要由疏松结缔组织组成,其间血管丰富,其功能主要是供血。舟月骨间韧带和月三角骨间韧带的近侧部分,主要由纤维软骨成份组成,其间没有血管。     

腕投掷运动时腕关节韧带长度变化的活体研究

目的 探讨腕关节在投掷运动过程中腕关节韧带长度的变化.方法 对6例志愿者腕关节进行CT扫描,获取腕关节在投掷运动过程中的5个位置,即桡偏20°背伸60°,桡偏10°背伸30°,中立位,尺偏20°掌屈30°,尺偏40°掌屈60°时各腕骨、尺桡骨远段的三维重建图像,在重建图像基础上利用Mimics软件测得在腕关节投掷运动过程中掌、背侧腕关节韧带的长度.结果 腕关节由中立位至桡偏20°背伸60°时桡舟头韧带、长桡月韧带、尺头韧带、尺三角韧带长度显著伸长,分别延长(3.4±0.5)、(2.0±0.2)、(2.6±0.5)、(2.1±0.4)mm,差异均有统计学意义(P<0.05);腕关节由中立位至尺偏400掌屈60°时背侧桡腕韧带、背侧骨间韧带止于小多角骨部分长度显著伸长,分别延长(1.7 ±0.2)、(3.8 ±0.4)mm,差异有统计学意义(P<0.05).尺月韧带、背侧骨问韧带止于舟骨部分在投掷运动过程中其长度均较中立位时旱增长趋势.结论 腕关节在桡背伸至尺掌屈运动过程中,桡舟头韧带、长桡月韧带、尺头韧带、尺三角韧带缩短,提示张力减低,背侧桡腕韧带、背侧骨间韧带止于小多角骨部分伸长,张力增大,尺月韧带、背侧骨间韧带止于舟骨部分于中立位时张力最小,其变化规律有助于指导临床腕关节韧带损伤的修复.     

三角纤维软骨复合体的大体解剖和腕关节镜对比观察研究

目的观察腕尺侧三角纤维软骨复合体的大体结构和腕关节镜下相对应部位的结构的表现,为腕关节镜下组织结构辨认提供解剖学上的依据。方法 采用正常新鲜冷冻人尸体上肢标本5只,先在腕关节镜下,分别通过＂桡腕关节入路＂和＂远侧桡尺关节表面直接入路＂,观察三角纤维软骨复合体的远侧和近侧组成结构（三角纤维软骨,掌侧和背侧桡尺韧带）的外观、起止点和走行。然后,切开腕关节囊,肉眼大体观察以上各个组成的形态;并在开放状态下,再次用关节镜观察,对比辨认相应位置的组织结构。最后,将三角纤维软骨复合体从尺桡骨远端切下,测量、记录。结果 大体解剖测量表明,三角纤维软骨延续于桡骨远端关节面月骨窝的尺侧部分,覆盖于尺骨小头的表面,中间菲薄,呈三角形,其掌侧和背侧部分增厚,形成远侧桡尺韧带。该韧带的桡侧起点处融为一体,向尺侧走行,逐渐分开形成浅部和深部,浅部包绕止于在尺骨茎突根部,深部汇聚止于尺骨茎突基底的小凹处。通过和大体观察的对比,腕关节镜经常规的＂桡腕关节入路＂,可以清楚地观察到三角纤维软骨复合体平滑地起于桡骨远端关节面的尺侧月骨窝的尺侧缘,三角纤维软骨与月骨窝的关节软骨没有明显的界限,三角纤维软骨的掌侧和背侧部分增厚,形成掌侧和背侧桡尺韧带的浅部,与尺侧关节囊融为一体。通过＂远侧桡尺关节表面直接入路＂,可以较为＂自由＂地观察到三角纤维软骨的近侧面、远侧桡尺韧带的深部、尺骨小头和桡骨的乙状切迹,三角纤维软骨复合体呈＂穹窿状＂从桡侧走向尺侧。结论 腕关节镜是观察三角纤维软骨复合体的有效工具,＂远侧桡尺关节表面直接入路＂可以用作观察三角纤维软骨复合体的近侧组成结构。镜下结构的表现和大体相应部位的对比观察,可以提高关节镜下组织结构辨认的准确性,为进一步的病理诊疗提供帮助。     

腕尺桡偏运动时腕韧带长度变化的活体研究

目的 研究腕关节在尺桡偏运动过程中,腕关节韧带长度的变化.方法 对6名志愿者腕关节进行CT扫描,获得腕关节在桡偏20°至尺偏40°内每隔20°的运动范围内各腕骨及尺桡骨远段三维重建图像.男3名,女3名,仅研究单侧右侧腕关节.年龄20～32岁,平均24岁.在腕关节尺桡偏运动过程中,在重建各腕骨及尺桡骨结构图像上以软件测量掌、背侧腕韧带的长度.结果 腕关节尺偏时桡舟头韧带、长桡月韧带、背侧腕间韧带止于舟骨、大多角骨和小多角骨部分的长度较中立位显著伸长,分别伸长(2.4±0.3)mm、(2.3±0.8)mm、(1.2±0.6)mm、(1.2±1.2)mm与(2.6±1.0)mm,差异均有统计学意义(P＜0.05);腕关节桡偏时尺头韧带与背侧桡腕韧带长度显著伸长(P＜0.05),分别为(0.8±0.6)mm和(1.0±0.5)mm.结论 在腕关节尺桡偏运动时,桡舟头韧带、长桡月韧带、背侧腕间韧带于桡偏位缩短,尺头韧带、背侧桡腕韧带长度于尺偏位缩短.这些位置可能使不同腕韧带张力降低,有利于损伤韧带的修复.     

腕关节镜辅助下Kapandji技术整复桡骨远端Die-punch塌陷型骨折

目的探讨腕关节镜辅助下Kapandji技术整复桡骨远端Die-punch塌陷型骨折的治疗效果。方法自2012年1月至2018年12月,我们共收治31例桡骨远端Die-punch塌陷型骨折患者,骨折均经CT检查确诊,术中在腕关节镜视下用克氏针撬拨复位桡骨远端塌陷骨折块,达到关节软骨面基本平整,进一步检查腕关节内韧带,特别是舟月韧带、月三角韧带和三角纤维软骨复合体的损伤情况,并修复相应韧带损伤。本组骨折均用克氏针结合外固定支架固定。结果术中发现合并舟月韧带损伤5例、月三角韧带损伤2例、三角纤维软骨复合体损伤10例。术后患者伤口均Ⅰ期愈合,并获得随访,时间为6~24个月,平均11.3个月。骨折愈合时间为6?8周,平均7周。术后X线片测量掌倾角6°~17°,尺偏角15°~23°。腕关节功能按Gartland-Werley标准评定:优22例,良7例,可2例,优良率为93.5%。结论腕关节镜辅助下Kapandji技术整复桡骨远端Die-punch塌陷型骨折可准确复位塌陷的关节面,可减少创伤性骨关节炎并发症,又能明确腕关节内韧带和三角纤维软骨复合体等结构的损伤程度,便于早期处理,以防遗留慢性腕关节痛或不稳定。     

严重胸腰椎三柱损伤后路270°减压内固定术的数字三维可视化手术模型研究

目的胸腰椎爆裂性骨折节段（T12-L2）后路270°减压重建内固定术．以及前后路联合减压重建内同定术的虚拟手术模型构建。方法选取一名腰L1椎体爆裂性骨折志愿者,对其T12-L2部位行横断面CT扫描,应用Mimics软件作三维重建,并按后路2700减压重建内固定术和前后路联合减压重建内固定术,进行解剖复位、椎板减压、钛网植入、椎弓根螺钉同定等手术模拟。并通过数字模型与标本模型的对比验证其仿真精度。结果建立了胸腰椎爆裂性骨折节段（T12-L2）后路270°减压重建内固定术和前后路联合减压重建内固定术的三维可视化数字模型,虚拟手术设计均与标本模型,及术后CT扫描基本相符。结论后路270°减压重建内固定术的三维数字模型对胸腰椎爆裂性骨折术前计划制定有一定指导意义,并为该术式生物力学有限元分析提供了形态学基础。     

多源医学影像数据重构膝关节骨与韧带结构的三维工程化模型

目的利用多源医学影像数据重构人体活体膝关节骨与韧带结构的三维工程化模型,探索数字医学研究在临床应用的方法。方法采集无损伤膝关节CT和MRI影像数据,导入重构软件。提取骨与韧带结构分别构建三维工程化模型。以外部标记物为参照进行三维工程化模型的配准和融合。结果基于CT和MRI影像数据构建出膝关节骨与韧带结构的三维工程化模型,清楚显示了膝关节骨骼和韧带的空间立体位置关系。结论人体活体多源影像数据重构三维工程化模型技术不同于传统可视化三维重建技术,为数字医学研究的临床应用提供了可行的方法。     

Kinematic analysis of the distal radioulnar joint after a simulated progressive ulnar-sided wrist injury

A kinematic analysis of a progressive, ulnar-sided wrist injury was performed using a cadaver model to study the static and dynamic stabilizers of the distal radioulnar joint with a 3-dimensional motion tracking system. Anatomically based loads were applied to achieve pronation and supination and then the specimens were evaluated after serial transection of the triangular fibrocartilage, the extensor carpi ulnaris sheath, and the ulnocarpal ligaments. Statistically significant increases in translation of the radius relative to the ulna occurred with sectioning of both the triangular fibrocartilage proper and the extensor carpi ulnaris tendon sheath. No significant change in position of the forearm could be appreciated with subsequent sectioning of the ulnocarpal ligaments. Our observations support the idea that the ulnocarpal ligaments do not need to be surgically reconstructed when there are serious injuries to the triangular fibrocartilage complex.     

The anatomy of the ligaments of the wrist and distal radioulnar joints

The ligaments of the wrist are responsible for guiding and constraining the complex motion of the carpal bones relative to the forearm bones, the metacarpals, and contiguous carpal bones. The majority of wrist ligaments are found within the joint capsule as organized thickenings composed of parallel collagen fascicles, small caliber nerves and blood vessels, and lined on their deep surfaces by synoviocytes. The palmar radiocarpal ligament complex is composed of the radioscaphocapitate, long radiolunate, radioscapholunate and short radiolunate ligaments. The ulnocarpal ligaments include the ulnolunate, ulnotriquetral and ulnocapitate ligaments. Dorsally, the radiocarpal joint is spanned by the dorsal radiocarpal ligament. Palmar ligaments connecting the proximal and distal carpal rows include the scaphotrapeziotrapezoid, scaphocapitate, triquetrocapitate and triquetrohamate ligaments. Within each row are interosseous ligaments connecting adjacent carpal bones, each divisible into dorsal and palmar components. There are unique regions within some of the ligaments, such as a zone of fibrocartilage in the proximal regions of the scapholunate and lunotriquetral interosseous ligaments, and strong deep regions connecting the trapezoid, capitate, and hamate. The distal radioulnar joint is connected by the triangular fibrocartilage complex, composed of a fibrocartilaginous disc and the palmar and dorsal radioulnar ligaments. The ulnocarpal ligaments attach to the palmar radioulnar ligament rather than directly to the ulna, allowing increased independence between wrist and forearm motion.     

基于CT数据的计算机辅助髋关节体素三维重建与应用

目的计算机辅助建立髋关节可视化三维解剖模型为影像诊断学和虚拟外科手术提供形态学资料。方法选取30例患者,对其髋关节进行螺旋CT扫描,扫描数据以Dicom3.0格式直接导入计算机图形图像工作站,进行精确勾画及三维体素重建。结果三维重建模型能清楚显示髋关节骨性结构的毗邻空间关系,完整显示了髋关节及骨髓腔等的轮廓及内部细节并能在三维空间内能够任意角度旋转观察。结论计算机辅助髋关节三维重建和可视化可全面准确重现髋关节三维立体形态和空间关系,为进一步研究有限元生物力学研究、髋关节假体设计及虚拟植入等提供基础。     

Three-dimensional analysis of the ligamentous attachments of the first carpometacarpal joint

PURPOSE: To show the ligamentous locations and attachments of the first carpometacarpal (CMC) joint on a 3-dimensional (3-D) surface model. METHODS: Ten fresh-frozen cadaver wrists were used to dissect and identify the first CMC ligaments. Their ligamentous attachments and whole bone surfaces were digitized 3-dimensionally and their areas were calculated. The attachments of each ligament were represented in a model combining 3-D computed tomography surfaces overlaid by a digitized 3-D surface and also were shown visually by a specific color on 3-D bone images. The superimposed outlines of the ligamentous attachments on both the radial and ulnar base of the first metacarpal (MC) also are described. RESULTS: Seven ligaments of the first CMC joint were identified: the dorsoradial ligament, the posterior oblique ligament, the superficial anterior oblique ligament, the deep anterior oblique ligament, the ulnar collateral ligament, the dorsal first MC ulnar base-second MC radial base intermetacarpal ligament, and the volar first MC ulnar base-second MC radial base intermetacarpal ligament. The detailed locations and areas of the ligamentous attachments of the first CMC joint were determined. The average locations of the centroid of the ligamentous attachments of the ulnar collateral and the dorsoradial ligaments were located ulnovolar and dorsoradial on the first MC base, respectively. CONCLUSIONS: The anatomic 3-D attachment sites of the first CMC ligaments were shown qualitatively and their areas were quantified. The results of this study improve the knowledge and understanding of the normal anatomy and its impact on the mechanics of the first CMC joint. This should help in making an accurate assessment of radiographic images and treating injuries and degenerative changes in the first CMC joint by ligament reconstruction, repair, and arthroscopy.     

Attritional lesions of the wrist joint

One hundred anatomic specimens of wrists were dissected to assess the incidence of perforations in the ligaments and triangular fibrocartilage of the wrist. The age of the specimen appeared to have a positive correlation with the incidence of perforations. There were no identifiable lesions in the wrists of specimens that were 45 years of age or younger. The incidence of perforations increased in specimens 60 years of age or older to 33% for the scapholunate interosseous ligaments, 27.6% for the lunotriquetral interosseous ligaments, and 27.6% for the disk of the triangular fibrocartilage of the wrist.     

The relevance of ligament tears or perforations in the diagnosis of wrist pain: An arthrographic study

This study was designed to assess the clinical significance of arthrographic abnormalities in the ligaments of a painful wrist. This was accomplished by means of comparison arthrography of the asymptomatic wrist. Fifty-six consecutive patients with unilateral wrist pain underwent selective bilateral arthrography to assess interruptions of continuity of the triangular fibrocartilage, lunotriquetral, and scapholunate ligaments. The prevalence of bilaterally symmetric lesions was high. In patients with ligament defects in the symptomatic wrist, 88% of defects near the radial attachment of the triangular fibrocartilage, 59% of lunotriquetral defects, and 57% of scapholunate defects were bilateral. Furthermore, physical examination was not predictive of specific ligament defects. This study raises questions concerning the relevance of interrupted ligaments in the diagnosis of wrist pain.     

The virtual nose: a 3-dimensional virtual reality model of the human nose

BACKGROUND: The 3-dimensionally complex interplay of soft tissue, cartilaginous, and bony elements makes the mastery of nasal anatomy difficult. Conventional methods of learning nasal anatomy exist, but they often involve a steep learning curve. Computerized models and virtual reality applications have been used to facilitate teaching in a number of other complex anatomical regions, such as the human temporal bone and pelvic floor. We present a 3-dimensional (3-D) virtual reality model of the human nose. METHODS: Human cadaveric axial cross-sectional (0.33-mm cuts) photographic data of the head and neck were used. With 460 digitized images, individual structures were traced and programmed to create a computerized polygonal model of the nose. Further refinements to this model were made using a number of specialized computer programs. This 3-D computer model of the nose was then programmed to operate as a virtual reality model. RESULTS: Anatomically correct 3-D model of the nose was produced. High-resolution images of the "virtual nose" demonstrate the nasal septum, lower lateral cartilages, middle vault, bony dorsum, and other structural details of the nose. Also, the model can be combined with a separate virtual reality model of the face and its skin cover as well as the skull. The user can manipulate the model in space, examine 3-D anatomical relationships, and fade superficial structures to reveal deeper ones. CONCLUSIONS: The virtual nose is a 3-D virtual reality model of the nose that is accurate and easy to use. It can be run on a personal computer or in a specialized virtual reality environment. It can serve as an effective teaching tool. As the first virtual reality model of the nose, it establishes a virtual reality platform from which future applications can be launched.     

Three-dimensional description of ligamentous attachments around the lunate

PURPOSE: To detail the location and area of specific ligament attachments on the 3-dimensional (3-D) surface morphology of the individual carpal bones. METHODS: We describe the attachment regions of both extrinsic and intrinsic intercarpal ligaments by using a combination of detailed dissection, computed tomography imaging, and a 3-D digitization technique and provide detailed information about ligament attachments around the lunate. RESULTS: The length, width, and thickness of each ligament are described in millimeters and its area of attachment is given in square millimeters and as a percentage of the bone surface and/or total ligament attachment area. The attachment sites of the ligaments also are shown visually on 3-D images of the bones. CONCLUSIONS: This study improves the knowledge and understanding of carpal ligament anatomy, which can result in better intraoperative assessment of ligament integrity/disruption and allow more accurate and anatomic repair, reattachment, and/or reconstruction of carpal ligaments for the treatment of carpal instability.