腓骨高位截骨对膝关节内外侧间室应力改变影响的生物力学研究

发布时间：2018-06-20 14:27

本文选题：膝关节 + 腓骨截骨　；参考：《河北北方学院》2017年硕士论文

【摘要】：我们为了测量腓骨高位截骨前后膝关节内外侧间室接触特征的改变情况,探讨其对膝关节应力改变的影响。现收集膝关节上方10cm以上高位截肢带足标本6例,要求标本关节完整,膝关节活动正常,X线检查无骨结构异常。标本离体2-4h内于-80℃深低温冰箱保存。实验前标本于4℃冰箱中解冻24个小时,之后于室温下继续解冻12小时。解冻完全后对标本进行膝关节屈伸活动200次,以保证标本接近正常膝关节生理状态。固定标本时,使标本在自然伸直状态下置于生物力学试验机上,足部先固定于台面上自制夹板中,调节下肢力线,使其下肢保持在额状面和矢状面的中立体位。股骨近端以自凝牙托粉固定在生物力学试验机顶端的固定槽中,在固定时始终保持下肢直立,可根据体位状况适当调整足内旋或外旋位置,使之更接近自然体位。于髌韧带两侧关节间隙处纵形切开皮肤,分离软组织,切开关节囊,显露关节间隙。模板测量获得内、外侧胫骨平台形状及大小。电脑调节生物力学试验机所需实验条件,将内、外侧关节间隙所需使用的压敏片剪成上述测试所得形状,分别在压敏片最长轴两端用细针打眼标记,以两点连线为压敏片中轴线。作为腓骨截骨前后计算压敏片压强峰值中心位移改变的参照线。规定以中轴线为界,所测得压敏片压强峰值中心到中轴线的位移,靠近内侧副韧带侧为正值,远离内侧副韧带侧为负值。将制作好的压敏片分别置于内、外侧关节间隙内。利用生物力学实验机对标本轴向加压400N,持续60s,然后5s内卸载压力,取出压敏片。相同实验条件,轴向加压2次。同一标本,相同状态下,在腓骨头下约7cm处使用摆锯截除约2cm左右腓骨段。相同实验条件下重复上述操作2次。将受压后的压敏片按不同标本的序号分组排列,用专用仪器和软件转换数据,获得的数据取其平均值。分别测算出在腓骨完整和高位截骨后两种情况下膝关节内外侧间室压强的大小及压敏片的着色面积,推导出压力值。同时标记压敏片上压强最高值处的5个点,电脑测量5点到中轴线距离取平均值,作为压强峰值中心到中轴线的位移。实验后发现,腓骨截骨前后,外侧间室压强分别为(1.194±0.285VS 1.607±0.296)×106Pa、接触面积为(1.144±0.338 VS1.551±0.264)×10-4m2、接触压力为(1.328±0.383 VS·2.468±0.629)×102N。两组间比较差异有统计学意义(P0.05)。而腓骨截骨前后内侧间室压强分别为(1.966±0.173VS·1.572±0.267)×106 Pa,内侧间室压力为(4.057±0.641 VS 2.699±0.610)×102 N,两组间比较差异有统计学意义(P0.05)。而内侧间室接触面积为(2.083±0.274VS·1.728±0.336)×10-4 m2。两组间比较差异无统计学意义(P0.05)。腓骨截骨前后内侧胫骨平台压强峰值中心与中轴线的位移平均值分别为0.725±1.117mm和-1.412±1.131mm(P0.05),两组相比具有统计学差异;而外侧胫骨平台压强峰值中心与中轴线的位移平均值分别为0.945±1.003mm,-0.493±0.754mm(P0.05),同样具有统计学差异。我们认为,腓骨截骨后,外侧胫骨平台所承受的压强、接触面积及压力均增加,内侧胫骨平台压强、压力明显减小,并且内外侧间室压强峰值中心向膝关节外侧偏移。表明腓骨截骨影响了膝关节内外侧间室的应力分布,且使内侧间室的应力中心向外发生了位移。验证了腓骨截骨治疗内侧间室膝骨关节炎的有效性。为腓骨截骨治疗内侧膝骨关节炎有效性提供了生物力学的理论基础。
[Abstract]:In order to measure the changes of the internal and external ventricular contact characteristics of the knee joint before and after the high osteotomy of the fibula, the influence of the stress on the knee joint stress was investigated. 6 specimens of the foot amputation belt above the knee joint above 10cm were collected, and the specimen joints were complete, the knee joint activity was normal, and the X-ray examination had no bone structure abnormality. The specimens were in 2-4h in vitro. The specimens were thawing for 24 hours at 4 centigrade refrigerator for 24 hours, and then defrosting at room temperature for 12 hours. After thawing, the specimens were flexed and extended 200 times to the specimens to ensure that the specimens were close to the normal physiological state of the knee joint. When the specimen was fixed, the specimen was placed under the natural straightening state and placed in the biomechanical test machine. At first, Abe is fixed on the self-made splint on the table to adjust the lower limb force line to keep the lower extremities neutral position on the forehead and sagittal plane. The proximal femur is fixed in the fixed slot at the top of the biomechanics test machine at the proximal end of the femur, and keeps the lower extremities upright at the time of fixation. The internal rotation or external rotation of the foot can be adjusted according to the position condition. Make it closer to the natural position. Cut the skin in the gap between the patellar ligaments, separate the soft tissue, cut the joint capsule and expose the joint space. The shape and size of the internal and lateral tibial plateau are measured by the template. The experimental conditions required by the computer to adjust the biomechanics test machine are cut into the pressure sensitive film used in the internal and lateral joint space. The shape of the above test is marked with a fine needle at both ends of the most long axis of the pressure sensitive plate, and the two lines are used as the central axis of the pressure sensitive plate. As the reference line to calculate the change of the central displacement of the pressure peak value of the pressure sensitive plate before and after the osteotomy of the fibula, the displacement of the pressure peak center to the central axis is measured with the central axis as the boundary, and it is close to the inner side. The ligament side was positive, and the side of the medial collateral ligament was negative. The prepared pressure sensitive tablets were placed in the internal and lateral joint space respectively. The specimen was subjected to the axial compression of 400N with a biomechanical experimental machine and sustained 60s, then the pressure was unloaded in 5S, and the pressure sensitive tablets were removed. The same experimental condition, 2 times of axial compression. Under the same condition, under the fibula head, the same specimen, under the same state, under the fibula About 7cm was used to remove about 2cm around the fibula segment at about 7cm. Under the same experimental conditions, the above operation was repeated. The pressure sensitive tablets were arranged in groups according to the number of different specimens. The data obtained by the special instrument and software were used to obtain the average value. The knee joint was calculated in two cases of the knee joint after the fibula finishing and the high osteotomy. The pressure of the lateral interventricular pressure and the color area of the pressure sensitive film was deduced. At the same time, the 5 points at the highest pressure of the pressure sensitive plate were marked. The distance between the 5 points and the central axis was measured by the computer as the displacement of the center of the pressure peak to the central axis. After the experiment, the pressure of the lateral interventricular chamber was (1.194 + 0.285VS 1), respectively. .607 + 0.296) * 106Pa, the contact area was (1.144 + 0.338 VS1.551 + 0.264) x 10-4m2, and the contact pressure was (1.328 + 0.383 VS 2.468 + 0.629) x 102N. two groups, and there were significant differences (P0.05). The pressure of medial compartment was (1.966 + 0.173VS. 1.572 + 0.267) * 106 Pa respectively. .699 + 0.610) x 102 N, the difference between the two groups was statistically significant (P0.05), but the medial compartment contact area was (2.083 + 0.274VS 1.728 + 0.336) x 10-4 m2. two groups, and there was no statistical difference (P0.05). The average displacement of the peak value center of the medial tibial Plateau and the central axis were 0.725 + 1.117mm and -1.41, respectively. 2 + 1.131mm (P0.05), compared with the two groups, the average value of the lateral tibial plateau pressure peak center and the central axis was 0.945 + 1.003mm, -0.493 + 0.754mm (P0.05), respectively. We think that the pressure, contact area and pressure of the lateral tibial plateau increased after the osteotomy of the fibula. The pressure of the tibial plateau decreased, and the pressure of the internal and external ventricular pressure peak shifted to the lateral of the knee joint. It showed that the fibula osteotomy affected the stress distribution in the inner and outer compartment of the knee joint, and the stress center of the medial compartment was displaced outward. Osteotomy provides a biomechanical theoretical basis for the effectiveness of medial knee osteoarthritis.
【学位授予单位】：河北北方学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

【参考文献】