不同术式重建第一腕掌关节稳定性的生物力学研究

发布时间：2018-09-10 19:41

【摘要】：目的研究不同术式重建第1腕掌关节稳定性的生物力学差异,为临床选择重建方式提供理论依据。方法以12个新鲜成人尸体上肢标本作为研究对象,所有标本均经正侧位X线片检查,排除骨折、骨病、腕部各关节脱位、畸形、退变及关节周围韧带损伤。实验分为5组,分别为正常组、损伤组、掌侧重建组、背侧重建组以及掌背侧重建组。随机取3个正常标本作为正常组进行生物力学测试后,制备第1腕掌关节脱位模型作为损伤组进行测试;剩余9个标本随机分为掌侧重建组、背侧重建组以及掌背侧重建组,每组各3个标本,制备第1腕掌关节脱位模型,分别采用Eaton-Little法、尹维田法以及联合两种方法修复重建韧带,并行生物力学测试。记录各组载荷-位移曲线,计算弹性模量并进行统计学分析。结果生物力学测试过程中,损伤组和掌侧韧带重建组各1例标本出现韧带断裂以及远端1.5 mm克氏针滑松,但标本未出现滑脱,其测量结果纳入研究。正常组、损伤组、掌侧重建组、背侧重建组、掌背侧重建组弹性模量分别为(11.61±0.20)、(5.39±0.12)、(6.33±0.10)、(7.12±0.08)、(8.30±0.10)MPa,各组间弹性模量比较差异均有统计学意义(P0.05)。结论掌侧韧带重建、背侧韧带重建及掌背侧韧带重建均能明显提高关节稳定性,其中掌背侧韧带重建效果最好,但仍不能恢复至正常水平。
[Abstract]:Objective To study the biomechanical differences of the stability of the first carpometacarpal joint after different surgical procedures and to provide theoretical basis for the clinical selection of reconstruction methods.Methods 12 fresh adult cadaver upper limb specimens were taken as the research object. The experiment was divided into five groups: normal group, injury group, palmar reconstruction group, dorsal reconstruction group and palmar-dorsal reconstruction group. The first dislocation model of carpometacarpal joint was made in the reconstruction group and the metacarpal dorsal reconstruction group. The reconstructed ligaments were repaired by Eaton-Little method, Yin Weitian method and the combination of the two methods, and the biomechanical tests were carried out. The load-displacement curves of each group were recorded, the elastic modulus was calculated and analyzed statistically. Normal group, injury group, palmar reconstruction group, dorsal reconstruction group, elastic modulus of the palmar-dorsal reconstruction group were (11.61 [0.20], (5.39 [0.12], (6.33 [0.10], (7.12 [0.08], respectively. Conclusion Volar ligament reconstruction, dorsal ligament reconstruction and dorsal metacarpal ligament reconstruction can significantly improve the stability of the joint, and the dorsal metacarpal ligament reconstruction is the best, but it can not return to the normal level.
【作者单位】：四川大学华西医院骨科;
【分类号】：R687.3;R318.01

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