Designing Trajectory-driven Program of Passive Rehabilitation for Ankle Fracture
-
摘要: 并联外固定技术是一种面向踝关节骨折的新型治疗方法,亟需研究该治疗模式下的骨折术后康复理论。结合临床上连续被动运动康复理念,提出了通过正常运动轨迹驱动并联外固定器械运动的新型踝关节骨折被动康复方案。该方案设计了踝关节运动规律测定实验,通过Optotrak Certus三维测量系统捕捉正常运动状态下的标记物位置,在MATLAB中计算踝关节运动轨迹与运动范围。选取符合正常踝关节运动规律的康复轨迹,使外固定器械动平台按该轨迹运动,通过并联机构运动学逆解计算各支链杆长,形成被动康复方案。该方案可为采用并联外固定器械的踝关节骨折提供一种有效的术后康复方法。Abstract: Parallel external fixation is a new treatment method for ankle fracture, which is an essential problem to study the fracture rehabilitation theory with this treatment method. Based on the clinical rehabilitation concept of continuous passive motion, we design a new passive rehabilitation program for ankle fracture, which drives a parallel external fixator' s movement with the normal motion trajectory. With this program, the experiment for measuring the law of ankle movement is designed. The positions of markers under normal motion state were captured by the three-dimensional measurement system called Optotrak Certus. The motion trajectory of an ankle and its range were calculated with the MATLAB software. The rehabilitation trajectory which conforms with the normal ankle motion law is selected to drive the external fixator' s moving platform move according to the trajectory. The length of each branch chain was calculated with the inverse kinematics of parallel mechanism; thus the complete passive rehabilitation program was formed, effectively rehabilitating ankle fracture with a parallel external fixator.
-
表 1 不同被测者踝关节运动统计
mm 被测者 实验
序号${\bar x_1}$ ${\bar y_1}$ ${\bar {\textit{z}}_1}$ ${\sigma _{{x_1}}}$ ${\sigma _{ {y_1} } }$ ${\sigma _{{{\textit{z}}_1}}}$ 1 1 575.07 171.94 519.15 35.93 51.91 31.54 2 576.58 165.23 525.94 38.30 50.41 32.74 3 578.31 160.69 528.46 37.10 52.88 33.75 2 1 663.78 211.82 562.68 34.48 48.41 33.69 2 676.09 199.90 571.36 32.90 46.45 34.07 3 652.47 213.10 566.66 36.14 47.88 32.20 3 1 599.38 223.58 546.87 31.84 45.14 29.30 2 589.30 234.59 546.12 34.26 49.08 30.29 3 596.05 220.47 545.59 33.98 46.56 29.17 表 2 离散化康复轨迹
mm 序号 x y z 1 470.9 300 567.74 2 471.5 300 567.08 $\vdots$ $\vdots$ $\vdots$ $\vdots$ 79 549.3 300 468.71 80 550.2 300 464.66 -
[1] Goost H, Wimmer M D, Barg A, et al. Fractures of the ankle joint: investigation and treatment options[J]. Deutsches Ärzteblatt International, 2014, 111(21): 377-388 [2] Pakarinen H J, Flinkkila T E, Ohtonen P P, et al. Stability criteria for nonoperative ankle fracture management[J]. Foot & Ankle International, 2011, 32(2): 141-147 [3] 王国利, 李成才. 踝关节骨折手术治疗进展[J]. 国际骨科学杂志, 2013, 34(2): 97-100 doi: 10.3969/j.issn.1673-7083.2013.02.007Wang G L, Li C C. Progress in surgical treatment of ankle fracture[J]. International Journal of Orthopaedics, 2013, 34(2): 97-100 (in Chinese) doi: 10.3969/j.issn.1673-7083.2013.02.007 [4] Thordarson D B, Motamed S, Hedman T, et al. The effect of fibular malreduction on contact pressures in an ankle fracture malunion model[J]. The Journal of Bone and Joint Surgery, 1997, 79(12): 1809-1815 [5] Ramsey P L, Hamilton W. Changes in tibiotalar area of contact caused by lateral talar shift[J]. The Journal of Bone and Joint Surgery, 1976, 58(3): 356-357 [6] 秦泗河, 孙磊. Ilizarov技术在矫形外科的应用进展[J]. 中国矫形外科杂志, 2002, 9(3): 295-298 doi: 10.3969/j.issn.1005-8478.2002.03.028Qin S H, Sun L. Progress of Ilizarov technique in orthopaedic surgery[J]. The Orthopedic Journal of China, 2002, 9(3): 295-298 (in Chinese) doi: 10.3969/j.issn.1005-8478.2002.03.028 [7] Tellisi N, Deland J T, Rozbruch S R. Gradual reduction of chronic fracture dislocation of the ankle using Ilizarov/Taylor spatial frame[J]. HSS Journal, 2011, 7(1): 85-88 [8] Riganti S, Coppa V, Nasto L A, et al. Treatment of complex foot deformities with hexapod external fixator in growing children and young adult patients[J]. Foot and Ankle Surgery, 2019, 25(5): 623-629 [9] 成永忠, 温建民, 赵勇, 等. 改良Ilizarov外固定器治疗复杂踝关节骨折脱位[J]. 中国矫形外科杂志, 2004, 12(10): 742-744 doi: 10.3969/j.issn.1005-8478.2004.10.006Cheng Y Z, Wen J M, Zhao Y, et al. Treatment of complex malleolar fracture-dislocation with the improved Ilizarov fixator[J]. The Orthopedic Journal of China, 2004, 12(10): 742-744 (in Chinese) doi: 10.3969/j.issn.1005-8478.2004.10.006 [10] 陈道维. 外固定支架在内外踝开放性骨折并踝关节脱位中应用探讨[J]. 中外医学研究, 2016, 14(8): 143-145Chen D W. Application of external fixator in open fracture of internal and external malleolus with dislocation of ankle joint[J]. Chinese and Foreign Medical Research, 2016, 14(8): 143-145 (in Chinese) [11] Swart E, Bezhani H, Greisberg J, et al. How long should patients be kept non-weight bearing after ankle fracture fixation? A survey of OTA and AOFAS members[J]. Injury, 2015, 46(6): 1127-1130 [12] 徐龙, 何仕诚. 踝关节骨折的手术治疗与功能康复研究[J]. 中国医药导报, 2013, 10(35): 56-58Xu L, He S C. Research of ankle fractures and functional rehabilitation[J]. China Medical Herald, 2013, 10(35): 56-58 (in Chinese) [13] 陈强, 张建明, 罗振东, 等. 快速康复外科理念在踝关节骨折治疗中的应用[J]. 中国中西医结合外科杂志, 2019, 25(1): 71-74 doi: 10.3969/j.issn.1007-6948.2019.01.015Chen Q, Zhang J M, Luo Z D, et al. Application of fast rehabilitation surgery in the treatment of ankle fracture[J]. Chinese Journal of Surgery of Integrated Traditional and Western Medicine, 2019, 25(1): 71-74 (in Chinese) doi: 10.3969/j.issn.1007-6948.2019.01.015 [14] Nugent-Derfus G E, Takara T, O′Neill J K, et al. Continuous passive motion applied to whole joints stimulates chondrocyte biosynthesis of PRG4[J]. Osteoarthritis and Cartilage, 2007, 15(5): 566-574 [15] Farsetti P, Caterini R, Potenza V, et al. Immediate continuous passive motion after internal fixation of an ankle fracture[J]. Journal of Orthopaedics and Traumatology, 2009, 10(2): 63-69 [16] 段秀丽, 张珍珍, 孙银梅, 等. 功能康复训练对踝关节骨折术后关节功能恢复影响分析[J]. 中国医学前沿杂志, 2018, 10(3): 44-47Duan X L, Zhang Z Z, Sun Y M, et al. Analysis of the effect of functional rehabilitation training on postoperative joint function recovery after ankle fracture surgery[J]. Chinese Journal of the Frontiers of Medical Science, 2018, 10(3): 44-47 (in Chinese) [17] Dario P, Mazzoleni S, Ciuti G, et al. Precision orthopaedic surgery and precision orthopaedic rehabilitation: a novel integrated approach[C]//17th Annual Meeting of the International Society for Computer Assisted Orthopaedic Surgery. Aachen, Germany, 2017: 244-247