下胫腓韧带损伤解剖重建的研究

发布时间：2018-05-27 15:32

本文选题：下胫腓联合 + 韧带　；参考：《中国人民解放军医学院》2015年博士论文

【摘要】：目的:探讨下胫腓韧带解剖重建的方法及其对下胫腓联合稳定性的影响。方法:第一部分①解剖成年猪的新鲜踝关节标本10例,研究其下胫腓韧带的解剖特点和踝关节的运动特点,比较其与人体踝关节的解剖相似性,建立下胫腓联合损伤的实验动物模型。②研究下胫腓韧带解剖重建的骨道出入点,以及腓骨短肌腱的走行和固定方式。③研究下胫腓韧带解剖重建对下胫腓联合稳定性及其生理运动的影响。应用Instron8874生物力学试验机测量下胫腓韧带完整,完全切断,韧带解剖重建以及单枚3.5mm螺钉三皮质固定等四种状态下,腓骨远端相对于胫骨在横轴和矢状轴上的运动方向和距离。比较不同状态下的下胫腓联合稳定性和生理运动的变化。第二部分使用新鲜人体踝关节标本10例,研究下胫腓韧带解剖重建的方法,分别在踝关节背伸30°位垂直加压至200N,在踝关节0°中立位外旋加扭至10Nm,研究其对下胫腓联合稳定性的影响。比较下胫腓螺钉固定与韧带解剖重建后用腓骨相对于胫骨在横轴和矢状轴的位移方向及距离,及其对下胫腓联合稳定性与生理运动的影响。结果:①猪下胫腓联合韧带由下胫腓前韧带,后韧带和骨间韧带组成,与人踝关节结构相似,符合下胫腓联合损伤的动物模型要求。②使用腓骨短肌腱解剖重建下胫腓韧带的手术方式具有临床可行性和实用行。③腓骨相对于胫骨的移位距离和方向在下胫腓联合韧带完整与解剖重建状态下无显著性差异。④下胫腓韧带解剖重建恢复了下胫腓联合的稳定性,并允许其生理运动存在。结论①下胫腓联合韧带由下胫腓前韧带,后韧带和骨间韧带组成,与人踝关节结构相似,符合下胫腓联合损伤的动物模型要求。②使用腓骨短肌腱解剖重建下胫腓韧带技术可行实用。③下胫腓韧带解剖重建恢复了下胫腓联合的稳定性,并允许其生理运动存在。
[Abstract]:Objective: to investigate the anatomical reconstruction of the inferior tibiofibular ligament and its effect on the stability of the tibiofibular syndesmosis. Methods: in the first part, 10 fresh ankle specimens of adult pigs were dissected. The anatomical characteristics of the inferior tibiofibular ligament and the motion of the ankle joint were studied, and the anatomic similarity between the ankle joint and the human ankle joint was compared. Establishment of experimental animal model of injury of inferior tibiofibular syndesmosis To study the influence of anatomical reconstruction of inferior tibiofibular ligament on the stability and physiological movement of inferior tibiofibular syndesmosis. Instron8874 biomechanical testing machine was used to measure the movement direction and distance between distal fibula and tibia on the transverse axis and sagittal axis under the four conditions of complete tibiofibular ligament complete amputation anatomic reconstruction and tricortical fixation with single 3.5mm screw. To compare the stability and physiological movement of inferior tibiofibular syndesmosis in different states. In the second part, 10 fresh human ankle specimens were used to study the method of anatomical reconstruction of the lower tibiofibular ligament. The effects of lateral rotation and torsion to 10Nm on the stability of the tibiofibular syndesmosis were studied at 30 掳extension of the ankle and 10 nm in the 0 掳neutral position of the ankle respectively. To compare the displacement direction and distance between fibula and tibia in transverse axis and sagittal axis after fixation and anatomic reconstruction of the inferior tibiofibular screw and its influence on the stability and physiological movement of the tibiofibular syndesmosis. Results the inferior tibiofibular ligament was composed of anterior tibiofibular ligament, posterior ligament and interosseous ligament. In accordance with the animal model of inferior tibiofibular syndesmosis injury, .2 the surgical method of reconstruction of inferior tibiofibular ligament using fibula short tendon anatomy is feasible and practical. 3. 3 fibula displacement distance and direction from tibia to tibia. There was no significant difference between the integrity of the ligaments of the fibular syndesmosis and the anatomic reconstruction of the inferior tibiofibular ligament. 4. The stability of the tibiofibular syndesmosis was restored. And allows its physiological movement to exist. Conclusion 1the inferior tibiofibular ligament is composed of anterior tibiofibular ligament, posterior ligament and interosseous ligament, which is similar to the structure of human ankle joint. In accordance with the animal model of inferior tibiofibular syndesmosis injury, the technique of anatomical reconstruction of inferior tibiofibular ligament with tendon of fibula brevis is feasible and practical. The anatomical reconstruction of inferior tibiofibular ligament can restore the stability of the tibiofibular syndesmosis and allow its physiological movement to exist.
【学位授予单位】：中国人民解放军医学院
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R687.3;R322

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