膝内翻角度变化对膝关节内侧间室接触应力影响的生物力学研究

发布时间：2018-03-18 12:14

本文选题：膝内翻　切入点：胫骨高位截骨　出处：《河北医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:本课题通过采用压敏片技术和正常尸体膝关节,直接测定正常膝关节、胫骨高位截骨内固定术后膝内翻0度、2度、4度、6度,…,30度膝关节内侧间室的接触应力改变。分析膝内翻角度的改变对内侧间室压力的影响,并将采集到的数据进行分析,找到随着膝内翻角度的增加内侧间室接触应力变化的相关性,为膝关节内翻畸形的膝骨性关节炎的力学及临床治疗提供一些参考信息。方法:选取6例新鲜成年男性尸体下肢标本(其中左侧三例,右侧三例,分别源自3具成年男性尸体),经过提前严格测量下肢机械力线为0°,股骨胫骨角约为172度(此时膝关节无内翻畸形)。实验前行X线检查见每个膝关节间隙匀称,关节软骨完整,骨骼无明显骨质改变及解剖学变异。6例下肢标本从尸体股骨上中段离断后剔除软组织,股骨保留25cm,胫骨及腓骨保留25cm。在剔除膝关节周围软组织时,着重保留膝关节前、后交叉韧带、内外侧副韧带及内、外侧半月板的解剖学完整,以免影响正常胫股关节接触应力;保留上胫腓韧带维持胫腓骨的连接;保护胫股关节、髌股关节处理过程中不被破坏,共组成6套膝关节骨标本。透视下于胫骨关节面下2cm行近端截断胫骨,在腓侧插入异形钢板固定离断的胫骨断端。安装固定异形钢板,透视后再次测量胫股骨角为172度。调整异形钢板的角度,轴向加压(700N),利用压敏片测量膝关节内侧间室的应力变化。结果:6个标本的数据均表明随着膝内翻角度的增大,膝关节内侧间室应力逐渐增加,当膝内翻角度为0度时,内侧间室应力值为1.611±0.363 MPa,随膝内翻角度由0度逐渐增加至10度时,其内侧间室应力值显著增加5.113±0.796 MPa,当角度达到14度时达到了实验中的最高数据:8.032±1.088 MPa;之后随着角度的增加,膝关节内侧间室的应力值开始逐渐减小,到膝内翻角度为30度时应力值压力为:2.009±0.386 MPa。各组数据用Bartlett法进行方差齐性检验,证明方差齐有可比性。采用单因素方差分析得出随着膝内翻角度的变化,膝关节内侧间室的应力而变化,其数据具有统计学意义(χ2=18.976,P0.01)。结论:随膝内翻角度的增大膝关节的内侧间室应力值发生了显著的变化,并在14度时达到高峰,那么膝Qg翻的角度越小,内侧间室接触应力越小,所以临床上利用楔形截骨的术式,减轻膝关节内侧间室的负荷,改善伴膝内翻畸形的膝骨性关节炎的症状及延缓病程。这就是胫骨高位截骨治疗膝内翻内侧间室骨性关节炎的机制。随着膝关节内翻角度的增加,膝关节内侧间室胫股关节接触点内移至膝关节内侧缘,压力主要集中在内侧边缘。很多因素的变化都会影响到膝关节内侧间室受力负荷,如承重量、承重时间、膝关节的姿势、胫股关节接触面大小、关节软骨畸形退变程度、骨赘的形成和实验方法等,所以膝内翻角度再度增加(14°-30°),膝关节所承受的应力值会进一步内移至内侧间室内侧缘。
[Abstract]:Objective: the purpose of this study was to measure the normal knee joint directly by using the technique of pressure sensitive film and the normal cadaveric knee joint. The knee varus of 0 degrees and 4 degrees and 6 degrees after high tibial osteotomy were measured. ... The change of contact stress in the medial compartment of the knee joint at 30 degrees. The effect of the change of the knee varus angle on the pressure of the medial compartment was analyzed, and the collected data were analyzed. To find the correlation between the contact stress changes of the medial compartment with the increase of the genu varus angle, Methods: six fresh adult male cadavers (including 3 left and 3 right) were selected for mechanical and clinical treatment of knee osteoarthritis with varus knee deformity. The mechanical force line of lower extremity was 0 掳and the tibial angle of femur was about 172 degrees after strict measurement of mechanical force line of lower extremity in 3 adult male cadavers. Before the experiment, X-ray examination showed that the space of each knee joint was symmetrical and the articular cartilage was intact. There were no significant bone changes and anatomical variations in the bones. 6 cases of lower extremity specimens were removed soft tissue from the upper and middle femur of cadaveric cadaver, the femur retained 25 cm, tibia and fibula preserved 25 cm. When removing soft tissue around the knee joint, the emphasis was placed on the preservation of the knee joint. The anatomical integrity of the posterior cruciate ligament, the internal and external collateral ligament and the medial and lateral meniscus so as not to affect the contact stress of the normal tibiofemoral joint; the preservation of the upper tibiofibular ligament to maintain the tibiofibular connection; and the protection of the tibiofemoral joint, During the treatment of patellofemoral joint, 6 sets of knee bone specimens were formed. The proximal tibia was amputated 2 cm below the articular surface of tibia under fluoroscopy, and the broken tibia was fixed with special-shaped plate in peroneal side. The angle of tibial femur was measured again after fluoroscopy to 172 degrees. Adjusting the angle of profiled plate, axial compression was used to measure the stress change of medial compartment of knee joint. Results: the data of 6 specimens showed that the angle of knee varus increased with the increase of knee varus angle. The stress of medial interventricular of knee joint increased gradually. When the angle of genu varus was 0 degrees, the stress value of medial interventricular was 1.611 卤0.363 MPa, and gradually increased from 0 degree to 10 degree with the angle of genu varus. The stress value of medial compartment increased 5.113 卤0.796 MPa, and reached the maximum value of 8.032 卤1.088 MPa when the angle reached 14 degrees, then the stress value of medial compartment of knee joint began to decrease with the increase of angle. When the knee varus angle is 30 degrees, the stress and pressure are: 2. 009 卤0. 386 MPa. The Bartlett method is used to test the homogeneity of variance, which proves that the variance is comparable. The single factor ANOVA is used to obtain the variation with the knee varus angle. The stress of the medial compartment of the knee joint changed with statistical significance (蠂 ~ (2) 18.976) (P < 0.01). Conclusion: the stress value of the medial compartment of the knee joint changed significantly with the increase of the knee varus angle, and reached the peak at 14 degrees. Then the smaller the angle of QG inversion of the knee, the smaller the contact stress of the medial compartment, so the wedge osteotomy is used clinically to reduce the load of the medial compartment of the knee joint. Improve the symptoms of knee osteoarthritis with varus genu deformity and delay the course. This is the mechanism of high tibial osteotomy in the treatment of osteoarthritis in the medial compartment of genu varus. The medial tibiofemoral joint contact point was moved to the medial edge of the knee joint, and the pressure was concentrated on the medial edge of the knee joint. The changes of many factors would affect the load of the medial compartment of the knee joint, such as bearing weight, bearing time, and the posture of the knee joint. Because of the size of tibiofemoral joint contact surface, degenerative degree of articular cartilage, formation of osteophyte and experimental methods, the knee varus angle was increased again by 14 掳-30 掳, and the stress value of knee joint would move further to the lateral edge of the medial interior.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4

【共引文献】