摘要目的 通过MRI技术对体内近排腕骨间的三维运动进行分析,明确近排腕骨在不同运动模式下适应性运动的特点和规律.方法 对12名健康志愿者的右腕分别在投掷平面(dart throwing motion,DTM)、屈伸平面(extension-flexion motion,EFM)和桡尺偏平面(radioulnar deviation,RUD)共15个体位进行MRI检查,获得的图像数据输入自行研发的腕关节运动学测量平台软件.以桡骨远端为坐标,对舟骨、月骨和三角骨在空间中横断面、矢状面和冠状面的相对运动规律进行分析.结果 舟骨相对于月骨的运动幅度较大,主要出现在矢状面.在DTM运动模式中,二者间于矢状面相对旋转23°(t=-4.521,P=0.001);在EFM运动模式中,二者间于矢状面相对旋转48°,于冠状面相对旋转15°(t=-9.206,P=0.000;t=5.697,P=0.000);在RUD运动模式中,二者间于矢状面相对旋转15°(t=3.180,P=0.009).三角骨相对于月骨在各个平面的运动幅度较小,均小于15°.在DTM运动模式中,二者间于矢状面相对旋转8°,于冠状面相对旋转8°(t=-4.439,P=0.001;t=-3.078,P=0.011);在EFM运动模式中,二者间于矢状面相对旋转15°(t=-3.547,P=0.005);在RUD运动模式中,二者间于冠状面相对旋转7°(t=-2.236,P=0.047).结论 在不同运动模式下,近排腕骨间均会出现明显的适应性运动.近排腕骨的适应性运动主要表现为在矢状面的相对运动,而在横断面和冠状面上近排腕骨间表现为同步运动.舟骨与月骨间的适应性运动幅度远大于月骨与三角骨间的运动幅度.在EFM运动模式下的适应性运动幅度大于DTM和RUD.近排腕骨间的适应性运动有助于保持腕关节整体运动的协调.

abstractsObjective To analyze the in vivo three-dimensional kinematics of the proximal carpal row by magnetic resonance imaging (MRI) and to delineate the characteristics of the adaptive kinematics of the proximal carpal row in different movement patterns.Methods We studied the in vivo threedimensional kinematics of the proximal carpal row with a markefless bone registration technique.Magnetic resonance images of 12 healthy volunteers' wrist were acquired during motion patterns of dart throwing motion (DTM),extension-flexion motion (EFM),and radioulnar deviation (RUD).A total of 15 different wrist positions were performed and recorded from each volunteer.Image data were entered into the software designated for carpal kinematics measurement.The respective motions of the scaphoid and triquetrum relative to the lunate in cross-sectional,sagittal and coronal planes were analyzed.Results In DTM,rotation of the scaphoid relative to the lunate was 0 ° in the cross-sectional plane,23° in the sagittal plane,and 0° in the coronal plane.In cross-sectional and coronal planes,the range of rotation was not statistically significant (t=-0.039,P=0.970;t=0.163,P=0.873),whereas rotation in the sagittal plane was significant (t=-4.521,P=0.001).In EFM,rotation of the scaphoid relative to the lunate was 2 ° in the cross-sectional plane,48° in the sagittal plane and 15 °in the coronal plane.In the cross-sectional plane,the movement was not significant (t=0.312,P=0.761),whereas rotation in the sagittal and coronal planes showed statistically significant differences (t=-9.206,P=0.000;t=5.697,P=0.000).In RUD,rotation of the scaphoid relative to the lunate was 7° in the cross-sectional plane,15° in the sagittal plane and 6° in the coronal plane.Data in the cross-sectional and coronal planes were not significant (t=-1.402,P=0.188;t=-1.410,P=0.186),whereas rotation in the sagittal plane showed statistically significant difference (t=3.180,P=0.009).In DTM,rotation of the triquetrum relative to the lunate was 8° in the cross-sectional plane,8° in the sagittal plane and 8 °in the coronal plane.Data in the cross-sectional plane were not significant (t=2.128,P=0.057),whereas rotation in the sagittal and coronal planes showed statistically significant difference (t=-4.439,P=0.001;t=-3.078,P=0.011).In EFM,rotation of the triquetrum relative to the lunate was 2 ° in the cross-sectional plane,15° in the sagittal plane and 3 ° in the coronal plane.Data in cross-sectional and coronal planes were not significant (t=0.487,P=0.636;t=-1.455,P=0.174),whereas rotation in the sagittal plane showed significant difference (t=-3.547,P=0.005).In RUD,rotation of the triquetrum relative to the lunate was 4 °in cross-sectional plane,4° in the sagittal plane and 7° in the coronal plane.Data in the cross-sectional and sagittal planes were not significant (t=1.006,P=0.336;t=1.015,P=0.332),whereas rotation in the coronal plane showed significant differences (t=-2.236,P=0.047).Conclusion In different movement pattems,the proximal carpal row adapts accordingly.The adaptive motion in the sagittal plane is the most significant,yet the intercarpal motion of proximal carpal row in the cross-sectional and coronal planes are synchronous.Adaptive range of motion between the scaphoid and lunate is much more than that between the lunate and triquetrum.Adaptive range of motion in the EFM is greater than that in the DTM and RUD.The adaptive motion of the proximal carpal row maintains the overall harmonious motion of the wrist.