应用三维CT重建研究活体肘关节侧副韧带生物力学

发布时间：2018-09-13 06:42

【摘要】：目的：肘关节侧副韧带在维持肘关节稳定中发挥着重要的作用,韧带重建是治疗肘关节韧带损伤的有效手段,了解侧副韧带的生物力学有着重要的意义。以往研究大多数基于尸体标本实施进行,且对肘关节周围的韧带附着点的足迹没有明确的界定。本研究目的是在活体上应用三维CT重建技术,探讨肘关节屈曲过程中,肘关节侧副韧带的生物力学变化情况；通过韧带的虚拟重建,寻找韧带等长重建中心,为肘关节侧副韧带损伤、肘关节不稳定修复提供理论基础。研究方法：选用6名健康成年志愿者,年龄20-32岁,男性4名,女性2名,对其右肘关节进行CT扫描,获取肘关节在伸直位(0°)、半屈曲位(50°、90°)及完全屈曲位(120°)时的断层扫描图像,选取肘关节内侧副韧带前束(AMCL)、后束(PMCL)以及外侧尺副韧带(LUCL)作为研究对象,利用Mimics10.01、Geomagic Studio12.0和几何画板软件进行三维图像重建并测量韧带长度,比较四种位置下的AMCL(包括内上组、中间组和外下组)、PMCL(包括内上组、中间组和外下组)及LUCL(包括外上组、中间组和内下组)三束共9组韧带长度的变化。分别由两名实验人员测量韧带长度,统计方法采用单因素重复测量方差分析,若差异有统计学意义,则采用配对t检验法进行两两比较。P0.05认为差异有统计学意义。统计使用SPSS17.0软件。结果：1.肘关节从伸直0°到屈曲120°位时,AMCL三个束组长度均有不同程度的增加,其中以中间组长度增加尤其显著,分别增加了10%、13%和21%(p0.05)。2.,PMCL三组韧带长度从肘关节0°到屈曲50°位缓慢增加,从屈曲50°到90°及120°,增加极为明显,在屈曲120°时,三组韧带长度增加了约90%(p0.01)。3.,LUCL三组韧带长度从肘关节0°到屈曲50°缓慢增加(P0.05),从屈曲50°到90°,三组韧带长度增加极为明显(p0.05),而从90°到120°,三组韧带长度又再缓慢增加(P0.05)。结论：三维CT重建技术是活体研究肘关节运动生物力学的有效手段；肘关节在屈曲过程中,侧副韧带的张力与伸直位相比均有不同程度的增加,肘关节侧副韧带张力变化呈现一定的规律性；对AMCL进行韧带重建可以选取内、外组束组做近似等长的双束重建；对PMCL及LUCL进行韧带重建,原解剖附着点不适合作为韧带等长重建中心。
[Abstract]:Objective: the collateral ligament of the elbow joint plays an important role in maintaining the stability of the elbow joint. Ligament reconstruction is an effective method for the treatment of ligament injury of the elbow joint. It is of great significance to understand the biomechanics of the collateral ligament of the elbow joint. Most previous studies were based on cadaveric specimens, and the footprint of ligaments attached to the elbow joint was not clearly defined. The purpose of this study was to investigate the biomechanical changes of the collateral ligament of the elbow joint during the flexion of the elbow joint by using three-dimensional CT reconstruction technique in vivo, and to find the center of the ligament reconstruction through virtual reconstruction of the ligament. To provide a theoretical basis for the collateral ligament injury and unstable repair of elbow joint. Methods: six healthy adult volunteers, aged 20-32 years, 4 males and 2 females, were selected to perform CT scanning of the right elbow joint, and to obtain the CT images of the elbow joint in the extension position (0 掳), the half flexion position (50 掳) and the complete flexion position (120 掳). The medial collateral ligament anterior bundle (AMCL), posterior bundle (PMCL) and lateral ulnar collateral ligament (LUCL) were selected as the research objects. The 3D images were reconstructed with Mimics10.01,Geomagic Studio12.0 and the length of the ligaments were measured by using the software of geometric drawing board. The AMCL in four positions (including the inner superior group) was compared. The changes of ligamentous length in 9 groups were observed in the middle group and the outer inferior group (including the upper group, the middle group and the inferior group) and the three bundle of LUCL (including the outer group, the middle group and the inner and lower group). The length of ligaments was measured by two experimenters respectively. The statistical method used single factor repeated measurement variance analysis. If the difference was statistically significant, the paired t test method was used to compare the length of ligaments. P05 showed that the difference was statistically significant. Statistics using SPSS17.0 software. The result is 1: 1. The length of AMCL increased in varying degrees from 0 掳to 120 掳flexion of elbow joint, especially in the middle group, which increased by 10% (p 0.05) and 21% (p 0.05). 2. The length of ligament increased slowly from 0 掳to 50 掳flexion of elbow joint in three groups. From 50 掳to 90 掳and 120 掳of flexion, the increase is very obvious, and when flexion is 120 掳, The length of ligamentum increased by 90% (p0.01). 3. The length of ligaments of LUCL increased slowly from 0 掳to 50 掳of elbow joint (P0.05), from 50 掳to 90 掳of flexion, the length of ligaments of three groups increased significantly (p0.05), but from 90 掳to 120 掳, and the length of ligaments of three groups increased slowly (P0.05). Conclusion: Three-dimensional CT reconstruction is an effective method to study the motion biomechanics of the elbow joint in vivo, and the tension of the collateral ligament increases in varying degrees during the flexion of the elbow joint compared with the extension position. The tension changes of collateral ligament of elbow joint showed certain regularity; ligament reconstruction of AMCL could be done in the inner and outer group, and the ligaments of PMCL and LUCL could be reconstructed. The primordial attachment is not suitable for the isometric reconstruction of ligaments.
【学位授予单位】：苏州大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R686.5

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