In Vivo Pilot Study Evaluating the Thumb Carpometacarpal Joint During Circumduction
Tóm tắt
Analysis of arthrokinematics may have clinical use in the diagnosis of dynamic instability of the thumb and wrist. Recent technological advances allow noninvasive, high-resolution imaging of skeletal (thumb and carpal bones) structures during motion. The primary purpose of this study is to define the arthrokinematics, estimated joint contact patterns, and distribution ratios of the carpometacarpal joint of the thumb using four-dimensional CT (three-dimensional CT + time) and registration algorithms. The second purpose is to validate the accuracy of the approach. Four-dimensional CT scans were obtained using a nongated sequential scanning technique. Eighteen image volumes were reconstructed over a 2-second cycle during thumb circumduction in one healthy volunteer. Using a registration algorithm, serial thumb motions as well as estimated joint contact areas were quantified. To evaluate the accuracy of our approach, one cadaveric hand was used. During circumduction, the ranges of motion of the thumb carpometacarpal joint were: flexion-extension, 27.3°; adduction-abduction, 66.9°; and pronation-supination, 10°. The magnitude of the translation of the center of the estimated joint contact area of the metacarpal was 4.1, 4.0, 1.0, and 1.5 mm when moving from the initial key pinch position to adduction, adduction to palmar abduction, palmar abduction to opposition, and opposition to the initial key pinch position, respectively. The maximum estimated contact area on the trapezium and on the metacarpal was in palmar abduction; the minimum was in adduction. Dominant central-volar contact patterns were observed on both the trapezium and the metacarpal bone except in adduction. This analysis approach had an average rotational error of less than 1°. During circumduction, the estimated joint contact area was concentrated on the central-volar regions of both the trapezium and the metacarpal bones except when the thumb was adducted. This tool provides quantification of estimated joint contact areas throughout joint motion under physiological dynamic loading conditions; this tool may, in future studies, help to clarify some of the ways that joint mechanics might or might not predispose patients to arthritis.
Tài liệu tham khảo
Adams R, Bischof L. Seeded region growing. IEEE Transactions on Pattern Analysis and Machine Intelligence. 1994;16:641–647.
Ateshian GA, Ark JW, Rosenwasser MP, Pawluk RJ, Soslowsky LJ, Mow VC. Contact areas in the thumb carpometacarpal joint. J Orthop Res. 1995;13:450–458.
Biswas D, Bible JE, Bohan M, Simpson AK, Whang PG, Grauer JN. Radiation exposure from musculoskeletal computerized tomographic scans. J Bone Joint Surg Am. 2009;91:1882–1889.
Carelsen B, Bakker NH, Strackee SD, Boon SN, Maas M, Sabczynski J, Grimbergen CA, Streekstra GJ. 4D rotational x-ray imaging of wrist joint dynamic motion. Med Phys. 2005;32:2771–2776.
Cooney WP 3rd, Lucca MJ, Chao EY, Linscheid RL. The kinesiology of the thumb trapeziometacarpal joint. J Bone Joint Surg Am. 1981;63:1371–1381.
Eaton RG, Littler JW. Ligament reconstruction for the painful thumb carpometacarpal joint. J Bone Joint Surg Am. 1973;55:1655–1666.
Hajnal JV, Saeed N, Soar EJ, Oatridge A, Young IR, Bydder GM. A registration and interpolation procedure for subvoxel matching of serially acquired MR images. J Comput Assist Tomogr. 1995;19:289–296.
Hill DL, Batchelor PG, Holden M, Hawkes DJ. Medical image registration. Phys Med Biol. 2001;46:R1–45.
Jonsson H, Valtysdottir ST, Kjartansson O, Brekkan A. Hypermobility associated with osteoarthritis of the thumb base: a clinical and radiological subset of hand osteoarthritis. Ann Rheum Dis. 1996;55:540–543.
Leng S, Zhao K, Qu M, An KN, Berger R, McCollough CH. Dynamic CT technique for assessment of wrist joint instabilities. Med Phys. 2011;38(Suppl 1):S50.
Lorensen WE, Cline HE. Marching cubes: a high resolution 3D surface construction algorithm. Comput Graph. 1987;21:163–170.
Mehnert A, Jackway P. An improved seeded region growing. Pattern Recognition Letters. 1997;18:1065–1071.
Napier JR. The form and function of the carpo-metacarpal joint of the thumb. J Anat. 1955;89:362–369.
Pellegrini VD Jr. Osteoarthritis of the trapeziometacarpal joint: the pathophysiology of articular cartilage degeneration. I. Anatomy and pathology of the aging joint. J Hand Surg Am. 1991;16:967–974.
Wu G, van der Helm FC, Veeger HE, Makhsous M, Van Roy P, Anglin C, Nagels J, Karduna AR, McQuade K, Wang X, Werner FW, Buchholz B. ISB recommendation on definitions of joint coordinate systems of various joints for the reporting of human joint motion—Part II: shoulder, elbow, wrist and hand. J Biomech. 2005;38:981–992.