三种sMCL和POL重建方法的生物力学对比性研究

发布时间：2018-08-06 16:00

【摘要】：目的:膝关节后内侧结构为膝关节内侧稳定结构的重要组成部分,而内侧副韧带浅层(medial collateral ligamen,s MCL)和后斜韧带(posterior oblique ligament,POL)是膝关节后内侧结构稳定结构中最重要的两部分,在维持膝关节外翻和旋转稳定作用中是相辅相成的作用。目前对膝关节后内侧结构损伤的患者治疗方法多为s MCL并POL解剖重建,术后结果与完整膝关节稳定性相比仍有差异。本研究目的是比较三种s MCL和POL重建方式的恢复效果。方法:以新鲜冷冻尸体为实验模型,比较正常膝关节与缺失s MCL及POL的膝关节及三种方法重建s MCL及POL后的膝关节的稳定性与生物力学差异。实验样本由本医院提供。第一种长力臂三角形重建s MCL和POL的定义为重建s MCL的股骨侧止点、胫骨侧远端止点及POL的股骨胫骨止点;第二种短力臂三角形重建s MCL与POL结构,重建s MCL股骨止点、胫骨近端止点及POL的股骨胫骨止点;第三种结合重建s MCL与POL结构,同时重建s MCL股骨止点、胫骨侧双止点及POL的股骨胫骨止点。模拟膝关节在0°~90°间被动性运动,首先测量完整膝关节外翻及旋转稳定性;然后在s MCL及POL股骨端切断,再次测量稳定性。依次进行长力臂三角形重建s MCL和POL,短力臂三角形重建s MCL和POL;结合三角形重建s MCL和POL后的膝关节及三种方法重建后的膝关节在各个屈膝角度(0°,30°,60°,90°)外翻及旋转角度变化。采集数据,进行统计学分析。结果:对比解剖完整的膝关节,切断s MCL和POL后膝关节外翻角度明显增大,增大范围(5.5°~8.6°)外旋角度在各个屈膝角度(0°,30°,60°,90°)也明显增大,增大范围(3.9°~10.0°);我们还发现在膝关节屈曲30°、60°时,膝关节内旋角与完整膝关节相比也明显增大。在三种重建方式重建后,膝关节的外翻及旋转稳定性均明显提高。但是与完整膝关节相比,长、短力臂重建各有优势,在膝关节屈曲60°、90°时,长力臂三角形重建后的膝关节与完整膝关节相比外旋结果没有差异,而短力臂三角形重建的膝关节与完整膝关节相比外旋结果有差异。所以长力臂三角形重建能更好的恢复膝关节外旋稳定性;在膝关节屈曲0°时,短力臂三角形重建与完整膝关节相比外旋结果没有差异;而长力臂三角形重建与完整膝关节相比外旋结果有差异,所以短力臂三角形重建法能更好的恢复膝关节外翻稳定性。结合重建方法重建后的膝关节与完整膝关节相比在各个屈膝角度外翻,旋转角度相比均无差异。结论:这三种重建s MCL和POL的方法均对恢复膝关节的生物力学跟稳定性有帮助,与完整膝关节相比,长、短力臂三角形重建方法各有优缺点,而结合重建方法重建后效果最佳。所以,治疗膝关节后内侧结构损伤时,同时重建s MCL胫骨近端、远端双止点能更好的恢复膝关节稳定性。
[Abstract]:Objective: the posterior medial structure of the knee joint is an important part of the medial stable structure of the knee. The superficial (medial collateral ligamens MCL and the posterior oblique ligament (posterior oblique ligaments are the two most important parts of the posterior medial structure of the knee. In the maintenance of knee varus and rotation stability role is complementary to each other. At present, most of the patients with posterior medial structure injury of knee joint are treated by s MCL and POL anatomical reconstruction, and the postoperative results are still different from that of intact knee joint. The aim of this study was to compare the effects of three s MCL and POL reconstruction methods. Methods: fresh frozen cadavers were used as experimental models to compare the stability and biomechanical differences of normal knee joints with those with missing s MCL and POL and with three methods of reconstruction of s MCL and POL. The experimental samples were provided by our hospital. The first type of long arm triangle reconstruction s MCL and POL is defined as the reconstruction of the femoral side of s MCL, the distal end of tibia and the femoral tibia of POL, and the second kind of short arm triangle reconstructs s MCL and POL structures to reconstruct s MCL femoral stop. The proximal tibial tibia and the femoral tibial stop of POL, the third combined with the reconstruction of s MCL and POL structures, the simultaneous reconstruction of s MCL femoral tibia, tibia bilateral tibia and POL tibia. In order to simulate passive motion of knee joint between 0 掳and 90 掳, the stability of complete varus and rotation of knee joint was measured first, then the femoral end of s MCL and POL were cut off and the stability was measured again. S MCL and Pol were reconstructed with long arm triangle, s MCL and Pol with short arm triangle, the knee joint with s MCL and POL were reconstructed with triangle and the knee joint with three methods were reconstructed at each flexion angle (0 掳30 掳60 掳60 掳/ 90 掳), and the angle of rotation and valgus were changed at each flexion angle (0 掳~ 30 掳~ 60 掳~ 60 掳~ 90 掳). Collect data and carry on statistical analysis. Results: compared with the anatomic intact knee joints, the valgus angle of the knee joint increased obviously after the dissection of s MCL and POL, and the range of increase (5.5 掳and 8.6 掳) was also obviously increased at each flexion angle (0 掳/ 30 掳/ 60 掳/ 90 掳), and the range was increased (3.9 掳/ 10.0 掳), and it was also found that when the knee joint's flexion was 30 掳(60 掳), the angle of external rotation also increased obviously (3.9 掳/ 10.0 掳). The internal rotation angle of the knee is also significantly larger than that of the complete knee. The stability of valgus and rotation of knee joint was improved obviously after the three reconstruction methods. However, compared with the complete knee joint, the long and short arm reconstruction had advantages. When the knee joint flexion was 60 掳to 90 掳, the knee joint after the long arm triangle reconstruction had no difference with the complete knee joint, and there was no difference between the external rotation results of the long arm triangle reconstruction and the complete knee joint. The results of external rotation of the knee with short arm triangle reconstruction were different from those of the complete knee joint. Therefore, the long arm triangle reconstruction can better restore the external rotation stability of the knee joint, and there is no difference between the short arm triangle reconstruction and the complete knee joint when the knee flexion is 0 掳. Compared with the complete knee joint, the long arm triangle reconstruction has different results, so the short arm triangle reconstruction method can better restore the stability of the knee joint valgus. Compared with the intact knee joint, the knee joint reconstructed by the combined reconstruction method had no difference in each flexion angle valgus and rotation angle. Conclusion: these three methods of reconstruction s MCL and POL are helpful to restore the biomechanics and stability of knee joint. Compared with the complete knee joint, the triangle reconstruction method of long and short arm has its own advantages and disadvantages, and the reconstruction method combined with the reconstruction method has the best effect. Therefore, in the treatment of posterior medial structure injury of knee joint, reconstruction of the proximal end of s MCL tibia at the same time and distal double stop point can better restore the stability of knee joint.
【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

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