不同方法缝合修复与修整成形半月板损伤的生物力学研究
发布时间：2018-09-07 12:38
【摘要】：目的 半月板在膝关节中的生物力学作用有：吸收震荡、减轻负荷、维持膝关节的运动协调及膝关节稳定等。外伤性或者退变性半月板损伤常引起膝关节的疼痛和退行性变,最终导致骨关节炎的发生。为最大可能保存半月板的功能,半月板缝合术常用来治疗半月板撕裂,比较常用的缝合技术有水平、垂直及交叉缝合。本课题即通过生物力学实验,探讨不同缝合技术修复损伤半月板后胫股关节接触应力的变化,并与半月板部分切除术后相比较,为临床手术提供力学依据。 方法 24具新鲜冷冻的混合品种的狗后肢膝关节标本(雌雄各6只),排除原发的膝关节疾病。每具膝关节均记录以下3种状态：对照组(完整半月板)、桶柄样撕裂和半月板修复术后。首先记录对照组(完整半月板)的接触图,然后制备桶柄样撕裂的半月板模型,最后用不同的手术方式处理桶柄样半月板损伤：垂直缝合、水平缝合、交叉缝合及半月板切除。24具标本随机用上述办法处理,所以最终每种手术方式均含有6具标本。压力传感器记录瞬时接触面积(Instantaneous contact area, CA)、平均接触压力(mean contact pressure, MCP)及峰值接触压力(peak contact pressure, PCP)。膝关节置于正常站立角度,斯氏针平行于地面,对膝关节加压、内外翻、屈伸、内外旋；包埋好的胫骨端固定于定制的滑动平台中,允许旋转、头尾和内外平移。8具新鲜冷冻的混合品种的狗后肢膝关节标本,序贯进行以下半月板切除操作,采取百分比来计算每一样本半月板切除的范围：(1)内30%的内侧半月板后角撕裂(Meniscectomy30,M30)；(2)内75%的内侧半月板后角撕裂(Meniscectomy75, M75);(3)内侧半月板后角完全切除(CPH)。用MTS858进行生物力学测试。统计学比较采用SPSS18.0软件进行组问比较。 结果 桶柄样撕裂的半月板与对照组相比,CA显著减少,MCP (P0.001)和PCP(P0.001)明显升高。半月板缝合术后膝关节的接触力学与对照组相比差异无统计学意义。水平、垂直及交叉缝合后CA的恢复差异无统计学意义。与半月板切除术相比,3种缝合方式导致的MCP及PCP改变更接近于对照组,MCP和PCP恢复百分比差异无统计学意义(P分别为0.851和0.987)。半月板组织切除越多,内侧和外侧CA下降越明显,M75和CPH后,内侧CA差异无统计学意义；内侧半月板后角完全切除(CPH)之后,外侧CA显著减少。M75和CPH之后,内侧间室的PCP显著升高,与对照组相比差异有统计学意义(P0.05),外侧间室CPH后PCP显著降低(P0.05)。因为半月板组织的切除,其相应的应变下降；但是各组间差异无统计学意义。 结论 半月板切除多少决定术后半月板的生物力学功能；水平、垂直及交叉缝合半月板后胫股关节的接触力学优于半月板部分切除术,不同缝合方式间无明显差异；因此,对于半月板的桶柄样撕裂,尤其是红区损伤,应尽量选择半月板缝合术,以避免或者延缓膝关节的退行性变。
[Abstract]:Objective the biomechanical functions of meniscus in knee joint include absorption of concussion, lightening of load, coordination of knee motion and stability of knee joint. Traumatic or degenerative meniscus injury often causes knee joint pain and degenerative degeneration, and eventually causes osteoarthritis. In order to preserve the function of meniscus as far as possible, meniscus suture is often used to treat meniscus tear. The commonly used suture techniques are horizontal, vertical and cross suture. Through biomechanical experiments, this paper discusses the change of tibiofemoral joint contact stress after meniscus repair with different suture techniques, and compares it with partial meniscal excision, which provides a mechanical basis for clinical operation. Methods 24 fresh frozen dog hindlimb knee joints (6 male and 6 male) were collected and the primary knee diseases were excluded. The following three states were recorded in each knee joint: control group (complete meniscus), barrel shank tear and meniscus repair. The contact pictures of the control group (complete meniscus) were recorded first, then the meniscus model of barrel shank tear was made. Finally, different surgical methods were used to deal with the meniscus injury: vertical suture, horizontal suture. Cross-suture and meniscal excision. 24 specimens were randomly treated with this method. Recording instantaneous contact area (Instantaneous contact area, CA), average contact pressure (mean contact pressure, MCP) and Peak contact pressure (peak contact pressure, PCP). By pressure Sensor The knee joint is placed at a normal standing angle, the Scotch needle is parallel to the ground, the knee joint is pressurized, varus, flexion, and internal and external rotation; the embedded tibial end is fixed in a custom sliding platform, allowing rotation, Head and tail and internal and external translation of 8 fresh frozen mixture of dog hind limbs and knee joint specimens, sequential meniscal excision operation, Take the percentage to calculate the range of meniscal excision for each sample: (1) in 30% of the medial meniscus posterior angle tear (Meniscectomy30,M30); (2) 75% of the medial meniscus posterior horn tear (Meniscectomy75, M75); (3) the medial meniscus posterior horn is completely removed (CPH). Biomechanical tests were carried out with MTS858. Statistical comparison was conducted by SPSS18.0 software. Results compared with the control group, the meniscus of bucket shank tear was significantly decreased in MCP (P0. 001) and PCP (P0. 001). The contact mechanics of knee joint after meniscus suture was not significantly different from that of control group. There was no significant difference in CA recovery after horizontal, vertical and cross suture. Compared with meniscal resection, the changes of MCP and PCP were similar to those of the control group (P = 0.851 and 0.987, respectively). The more the meniscal tissue was removed, the lower the medial and lateral CA were, the more significant the difference of CA was between M75 and CPH, the higher the PCP level in the medial interventricular was after the complete (CPH) resection of the medial meniscus, the decrease of CA in the medial meniscus was significantly lower than that in the M75 and CPH. Compared with the control group, the difference was statistically significant (P0.05), the PCP decreased significantly after CPH (P0.05). As meniscus tissue was removed, the corresponding strain decreased, but there was no significant difference among the groups. Conclusion how much meniscectomy determines the biomechanical function of meniscus, the contact mechanics of tibiofemoral joint after horizontal, vertical and cross suture of meniscus is superior to partial meniscal resection, and there is no significant difference between different suture methods. Therefore, meniscus suture should be chosen as far as possible to avoid or delay the degeneration of knee joint.
【学位授予单位】：天津医科大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R687.4;R318.01
本文编号：2228290
[Abstract]:Objective the biomechanical functions of meniscus in knee joint include absorption of concussion, lightening of load, coordination of knee motion and stability of knee joint. Traumatic or degenerative meniscus injury often causes knee joint pain and degenerative degeneration, and eventually causes osteoarthritis. In order to preserve the function of meniscus as far as possible, meniscus suture is often used to treat meniscus tear. The commonly used suture techniques are horizontal, vertical and cross suture. Through biomechanical experiments, this paper discusses the change of tibiofemoral joint contact stress after meniscus repair with different suture techniques, and compares it with partial meniscal excision, which provides a mechanical basis for clinical operation. Methods 24 fresh frozen dog hindlimb knee joints (6 male and 6 male) were collected and the primary knee diseases were excluded. The following three states were recorded in each knee joint: control group (complete meniscus), barrel shank tear and meniscus repair. The contact pictures of the control group (complete meniscus) were recorded first, then the meniscus model of barrel shank tear was made. Finally, different surgical methods were used to deal with the meniscus injury: vertical suture, horizontal suture. Cross-suture and meniscal excision. 24 specimens were randomly treated with this method. Recording instantaneous contact area (Instantaneous contact area, CA), average contact pressure (mean contact pressure, MCP) and Peak contact pressure (peak contact pressure, PCP). By pressure Sensor The knee joint is placed at a normal standing angle, the Scotch needle is parallel to the ground, the knee joint is pressurized, varus, flexion, and internal and external rotation; the embedded tibial end is fixed in a custom sliding platform, allowing rotation, Head and tail and internal and external translation of 8 fresh frozen mixture of dog hind limbs and knee joint specimens, sequential meniscal excision operation, Take the percentage to calculate the range of meniscal excision for each sample: (1) in 30% of the medial meniscus posterior angle tear (Meniscectomy30,M30); (2) 75% of the medial meniscus posterior horn tear (Meniscectomy75, M75); (3) the medial meniscus posterior horn is completely removed (CPH). Biomechanical tests were carried out with MTS858. Statistical comparison was conducted by SPSS18.0 software. Results compared with the control group, the meniscus of bucket shank tear was significantly decreased in MCP (P0. 001) and PCP (P0. 001). The contact mechanics of knee joint after meniscus suture was not significantly different from that of control group. There was no significant difference in CA recovery after horizontal, vertical and cross suture. Compared with meniscal resection, the changes of MCP and PCP were similar to those of the control group (P = 0.851 and 0.987, respectively). The more the meniscal tissue was removed, the lower the medial and lateral CA were, the more significant the difference of CA was between M75 and CPH, the higher the PCP level in the medial interventricular was after the complete (CPH) resection of the medial meniscus, the decrease of CA in the medial meniscus was significantly lower than that in the M75 and CPH. Compared with the control group, the difference was statistically significant (P0.05), the PCP decreased significantly after CPH (P0.05). As meniscus tissue was removed, the corresponding strain decreased, but there was no significant difference among the groups. Conclusion how much meniscectomy determines the biomechanical function of meniscus, the contact mechanics of tibiofemoral joint after horizontal, vertical and cross suture of meniscus is superior to partial meniscal resection, and there is no significant difference between different suture methods. Therefore, meniscus suture should be chosen as far as possible to avoid or delay the degeneration of knee joint.
【学位授予单位】：天津医科大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R687.4;R318.01
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