臺灣博碩士論文加值系統

手腕骨外固定器已廣泛地使用於治療遠端橈骨骨折，在治療過程中使得骨折部位整復(reduction)讓骨骼得到完全的復位，再加上骨外固定器充分的穩定性，將使得骨折斷端得以快速癒合，因此本文的研究主要利用齊次轉換矩陣的運動鏈分析Orthofix、Trauma-Fix及新型手腕骨外固定器之調整範圍，並探討影響調整範圍的設計因素，再以田口方法找出手腕骨外固定器設計參數之貢獻度，且針對Trauma-Fix與新型手腕骨外固定器進行一系列之生物力學測試，評估其是否有足夠的強度與穩定度。
調整範圍分析結果得知，Orthofix、Trauma-Fix兩種手腕骨外固定器調整範圍可
利用齊次轉換矩陣的運動鏈分析，再由三角幾何模型及電腦模擬方式得以驗證。使用手腕骨外固定器作調整骨折，外固定器施打方式將以在臨界初始伸長量( )的位置為最佳，骨折位置應在手腕骨外固定器中間而外固定器夾鉗中心軸與骨頭中心軸距離要短則將有最大的調整空間，利用運動鏈方程式參數化分析可獲得手腕外固定器較大之可調整範圍，其中較大的球關節、伸縮臂、中間體、伸縮臂放置兩球關節之間、骨釘夾鉗不離球軸中心會有較佳的結果，手腕骨外固定器設計參數之重要性依順序為(1)球關節、(2)伸縮臂放置兩球關節之間、(3)中間體、(4)骨釘夾鉗不離球軸中心、(5)伸縮臂。
機械強度測試實驗結果顯示，新型骨外固定器已有足夠的穩定度，此骨外固定器之球關節可利用螺絲(set screws)加以固定，將可提高手腕骨外固定器之抗扭能力。
本研究結果可以提供醫師在手術過程中有效的操作模式，另一方面也可以作為將來設計新型手腕骨外固定器之參考依據。

External fixators have been widely used for distal radial fractures. The purposes of this study were to analyze the adjustable ranges for wrist external fixators, including Orthofix, Trauma-Fix and a new external fixator designed in National Taiwan University Hospital. The external fixator was assumed to be fixed to two cylinders. The relative motion between these two cylinders, which represent the adjustable range of motion was analyzed by kinematic equations. Each link and joint of the external fixator was described by a 4×4 homogenous transformation matrix. The kinematic equations were established by concatenating these homogenous transformation matrices. Z-X-Z representation was used to describe the sequence of the motion of the components. The contribution for each design parameter of external fixator was thus investigated by the Taguchi method. In addition, strength and stability of Trauma-fix and the new external fixators were tested by the biomechanical experiment.
The present study showed that the adjustable range of motion could be increased as follows: 1. increasing the range of motion of the ball joints; 2. increasing the length of the central body; 3. putting the telescoping joint between the ball joints; 4. increasing the length of the telescoping joint; 5. putting the position of the pins lined up with the axis of the ball joints. During surgery, the surgeons had better keep the elongation length of the telescoping joint as close to a critical level as possible. Beyond and below this level may decrease the range of adjustability. Furthermore, decreasing the pin length and keep the fracture at the middle of the external fixator may also increase the adjustable range of motion. The results of the kinematic studies could be verified by trigonometric models and computer simulation. The mechanical studies showed that the new external fixator had equivalent fixation stability with the Trauma-Fix in bending tests. However, the torsional stability of the new external fixator was much stronger than that of the Trauma-Fix. The stability of the new external fixator could be maintained by set screws.
The results of this study can help the engineer in designing a new external fixator and orthopedic surgeons handle the fixators during operation.

頁次
中文摘要………………………………………………………... I
英文摘要………………………………………………………... II
誌謝……………………………………………………………... III
目錄……………………………………………………………... IV
符號索引………………………………………….…………….. VII
圖表索引…………………………………………….………….. IX
第一章 緒論………………………………..…………………... 1
1.1研究動機與目的 …..……………………….………….. 1
1.2手部之解剖……………………….….….……………... 2
1.3骨折與治療方式………………….………..…………… 3
1.4文獻回顧….…………………………………..………… 4
1.5本文架構……………………….……………...………… 6
第二章 調整範圍分析……………………..…………………... 10
2.1機器人運動學介紹………………………………………… 10
2.1.1空間作描述與轉換…………………………………… 10
2.1.2順向運動學…………………………………………… 12
2.2.3逆向運動學…………………………………………… 12
2.2.4球關節之描述………………………………………… 13
2.2手腕骨外固定器介紹……………………………………… 14
2.3運動鏈分析………………………………………………… 16
2.3.1骨折與骨外固定器之自由度分析…………………. 16
2.3.2骨折偏移量之描述…………………………………… 17
2.3.3骨外固定器之齊次轉換矩陣與運動鏈方程式……… 18
2.3.4計算調整範圍與參數化……………………………… 23
2.3.5求解運動鏈方程式…………………………………… 24
2.4三角幾何模型……………………………………………… 24
2.4.1方向定義……………………………………………. 24
2.4.2旋轉計算……………………………………………… 25
2.5電腦模擬…………………………………………………… 25
2.6田口方法…………………………………………………… 25
第三章 機械強度測試實驗………………..…………………... 36
3.1材料……………………………………………………... 36
3.2測試儀器………....……………………………………… 36
3.3測試方法..……………………………………….……… 37
3.3.1彎曲勁度測試………………………………………… 37
3.3.2扭轉強度測試………………………………………… 38
3.4生物統計學………………………………………………… 39
第四章 調整範圍分析與機械強度測試實驗之結果………….… 44
4.1調整範圍分析…………………………………………... 44
4.1.1骨折斷面三軸向調整範圍…………………...……. 44
4.1.2參數化分析…………………………………..….…. 47
4.2機械強度測試實驗………………………………..….… 49
4.2.1彎曲勁度測試……………………………..……..… 49
4.2.2扭轉強度測試…………………………..………..… 50
第五章 討論……..……….…………………………………….. 86
5.1調整範圍結果討論……………………………..………. 86
5.2機械強度測試實驗結果討論…...……………..…..… 89
第六章 結論與未來展望…..…………………………………... 94
6.1結論…………………………………..…………………. 94
6.2未來展望……………………………..……………….… 95
參考文獻…………………….………………………………….. 96
附錄……………………………………………………………... 99
作者簡介……………………………………………………...… 119

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