循环载荷对腓骨长肌腱重建下胫腓联合损伤的生物力学性能分析
发布时间：2018-10-12 17:09
【摘要】：目的下胫腓联合韧带的损伤在踝关节骨折中较常见。当前,下胫腓联合韧带损伤的治疗方法较多,主要以下胫腓螺钉固定为主,但螺钉治疗的皮质层数、螺钉数量、置入位置、取钉时间等仍无统一标准。由于下胫腓联合关节的微动生理特性,近年来,越来越多的学者提倡弹性固定的方法。利用腓骨长肌腱重建下胫腓联合损伤,符合下胫腓的生理微动特点,本实验探讨循环载荷对腓骨长肌腱重建下胫腓联合韧带损伤的生物力学性能,为临床选择有效的弹性固定提供基础理论依据。方法采集8具新鲜成人下肢尸体标本,制成正常组(N),失稳组(I)与腓骨长肌腱重建组(B),用压敏片技术分别测量8具正常标本不同体位(中立位、背伸200、跖屈300)下的接触面积S(cm2)、接触压PCP(N/cm2)。再对所有标本用德国引进的Zwik-100HFP 5100B低频疲劳试验机进行动态力学测定,以1HZ频率轴向加载750N,3000次,模拟患者术后功能锻炼行走步态施加循环载荷,分别在不同体位(中立位、背伸200、跖屈300、旋后外旋250)下进行动态循环载荷实验,测量下胫腓纵向位移(U)和水平位移(V)。然后切断8具标本的下胫腓联合前韧带,测量失稳状态下踝关节在不同体位下(中立位、背伸200、跖屈300、旋后外旋250)的循环载荷的胫腓骨纵向(U)和水平(V)位移值,再用腓骨长肌腱经下胫腓联合前韧带与骨间韧带斜行平行下胫腓前韧带重建,用8mm界面挤压螺钉固定腓骨长肌腱,用压敏片技术测量其在不同体位、不同预张力下(20N、40N、60N、80N)胫距关节的接触面积S(cm2)、接触压PCP(N/cm2)。进行统计学分析,得出较适合的预张力,在此预张力下建立重建模型行循环载荷试验,与正常标本组循环载荷试验得出的数据进行统计学分析比较。结果下胫腓联合韧带损伤后,胫骨和腓骨的动态位移性能发生明显的异常变化,在与正常标本组相比较时呈现出显著性差异(P0.05);用腓骨长肌腱重建下胫腓联合韧带损伤能达到弹性固定的目的,其动态分离位移能达到或接近正常(P0.05);在不同预张力下用腓骨长肌腱重建下胫腓联合韧带损伤对踝关节稳定性有明显影响,且以60N预张力重建为宜。结论在60N预张力下用腓骨长肌腱重建下胫腓联合韧带损伤的循环载荷试验证明腓骨长肌腱重建下胫腓联合损伤动态力学性能十分优越,大大改善了踝关节的活动度,能适应距骨运动顺应性调节,能达到并恢复踝关节的正常生理功能。腓骨长肌腱弹性固定治疗下胫腓联合韧带损伤符合下胫腓联合的正常生理结构,避免了常规螺钉固定的松动或发生疲劳断裂,为临床治疗下胫腓联合韧带损伤提供理论依据。
[Abstract]:Objective the injury of inferior tibiofibular ligament is common in ankle fracture. At present, there are many treatment methods for the injury of the inferior tibiofibular ligament, mainly the following tibiofibular screw fixation, but the number of cortical layer, the number of screws, the position of the screw, the time of nailing still have no unified standard. In recent years, more and more scholars advocate elastic fixation because of the fretting physiological characteristics of the tibiofibular joint. Reconstruction of the injury of the tibiofibular syndesmosis using the long fibula tendon is in accordance with the physiological fretting characteristics of the inferior tibiofibular fibula. The biomechanical properties of cyclic loading on the reconstruction of the inferior tibiofibular syndesmosis ligament injury by the fibular long tendon were studied in this experiment. To provide a theoretical basis for clinical selection of effective elastic fixation. Methods eight fresh adult cadavers were collected and made into normal (N), unstable group (I) and peroneal long tendon reconstruction group (B), respectively measured by pressure sensitive film technique in different positions (neutral position) of 8 normal specimens. The contact area S (cm2) and the contact pressure PCP (N/cm2) were obtained under the condition of dorsal extension 200 and plantar flexion 300. The dynamic mechanics of all specimens was measured by Zwik-100HFP 5100B low frequency fatigue testing machine imported from Germany. 750NV 3000 times of axial loading with 1HZ frequency were used to simulate the patients' walking gait and applied cyclic load in different positions (neutral position). Dynamic cyclic loading experiments were carried out under the conditions of dorsal extension 200, metatarsal flexion 300, circumflex rotation 250). The longitudinal displacement (U) and horizontal displacement (V). Of the tibiofibular were measured. The tibiofibular longitudinal (U) and horizontal (V) displacement of ankle under different positions (neutral position, dorsal extension 200, metatarsal flexion 300, circumflex 250) were measured by transecting the anterior tibiofibular ligament of 8 specimens. The anterior tibiofibular ligament was reconstructed through the anterior ligament of inferior tibiofibular syndesmosis and the oblique interosseous ligament. The tendon of the long fibula was fixed with 8mm interface compression screw, and its position was measured by pressure sensitive film technique. The contact area S (cm2) and the contact pressure PCP (N/cm2) of the tibiotalar joint were observed under different pretension (20 NV 40 NV 60 NV 80 N). Through statistical analysis, a more suitable pretension was obtained, under which the reconstruction model was established and the cyclic load test was carried out, and the data obtained from the cyclic load test of the normal specimen group were statistically analyzed and compared. Results the dynamic displacement of the tibia and fibula showed obvious abnormal changes after the injury of the tibiofibular syndesmosis ligament. Compared with the normal group, there was significant difference (P0.05). The injury of the inferior tibiofibular syndesmosis ligament with the long fibula tendon could achieve the purpose of elastic fixation. The dynamic separation displacement could reach or close to normal (P0.05); the reconstruction of inferior tibiofibular syndesmosis ligament with long fibula tendon under different pretension had a significant effect on the stability of ankle joint, and 60N pretension reconstruction was appropriate. Conclusion the cyclic loading test of reconstruction of tibiofibular syndesmous ligament injury with fibula long tendon under 60 N pretension proves that the dynamic mechanical properties of reconstruction of tibiofibular syndesmosis injury with fibula long tendon are superior, and the motion of ankle joint is greatly improved. It can adapt to the compliance regulation of talus motion and achieve and restore the normal physiological function of ankle joint. The treatment of ligamentous injury of inferior tibiofibular syndesmosis with elastic fixation of long tendon of fibula accords with the normal physiological structure of inferior tibiofibular syndesmosis and avoids loosening of conventional screw fixation or fatigue rupture, which provides theoretical basis for clinical treatment of ligamentous injury of inferior tibiofibular syndesmosis.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
本文编号：2266912
[Abstract]:Objective the injury of inferior tibiofibular ligament is common in ankle fracture. At present, there are many treatment methods for the injury of the inferior tibiofibular ligament, mainly the following tibiofibular screw fixation, but the number of cortical layer, the number of screws, the position of the screw, the time of nailing still have no unified standard. In recent years, more and more scholars advocate elastic fixation because of the fretting physiological characteristics of the tibiofibular joint. Reconstruction of the injury of the tibiofibular syndesmosis using the long fibula tendon is in accordance with the physiological fretting characteristics of the inferior tibiofibular fibula. The biomechanical properties of cyclic loading on the reconstruction of the inferior tibiofibular syndesmosis ligament injury by the fibular long tendon were studied in this experiment. To provide a theoretical basis for clinical selection of effective elastic fixation. Methods eight fresh adult cadavers were collected and made into normal (N), unstable group (I) and peroneal long tendon reconstruction group (B), respectively measured by pressure sensitive film technique in different positions (neutral position) of 8 normal specimens. The contact area S (cm2) and the contact pressure PCP (N/cm2) were obtained under the condition of dorsal extension 200 and plantar flexion 300. The dynamic mechanics of all specimens was measured by Zwik-100HFP 5100B low frequency fatigue testing machine imported from Germany. 750NV 3000 times of axial loading with 1HZ frequency were used to simulate the patients' walking gait and applied cyclic load in different positions (neutral position). Dynamic cyclic loading experiments were carried out under the conditions of dorsal extension 200, metatarsal flexion 300, circumflex rotation 250). The longitudinal displacement (U) and horizontal displacement (V). Of the tibiofibular were measured. The tibiofibular longitudinal (U) and horizontal (V) displacement of ankle under different positions (neutral position, dorsal extension 200, metatarsal flexion 300, circumflex 250) were measured by transecting the anterior tibiofibular ligament of 8 specimens. The anterior tibiofibular ligament was reconstructed through the anterior ligament of inferior tibiofibular syndesmosis and the oblique interosseous ligament. The tendon of the long fibula was fixed with 8mm interface compression screw, and its position was measured by pressure sensitive film technique. The contact area S (cm2) and the contact pressure PCP (N/cm2) of the tibiotalar joint were observed under different pretension (20 NV 40 NV 60 NV 80 N). Through statistical analysis, a more suitable pretension was obtained, under which the reconstruction model was established and the cyclic load test was carried out, and the data obtained from the cyclic load test of the normal specimen group were statistically analyzed and compared. Results the dynamic displacement of the tibia and fibula showed obvious abnormal changes after the injury of the tibiofibular syndesmosis ligament. Compared with the normal group, there was significant difference (P0.05). The injury of the inferior tibiofibular syndesmosis ligament with the long fibula tendon could achieve the purpose of elastic fixation. The dynamic separation displacement could reach or close to normal (P0.05); the reconstruction of inferior tibiofibular syndesmosis ligament with long fibula tendon under different pretension had a significant effect on the stability of ankle joint, and 60N pretension reconstruction was appropriate. Conclusion the cyclic loading test of reconstruction of tibiofibular syndesmous ligament injury with fibula long tendon under 60 N pretension proves that the dynamic mechanical properties of reconstruction of tibiofibular syndesmosis injury with fibula long tendon are superior, and the motion of ankle joint is greatly improved. It can adapt to the compliance regulation of talus motion and achieve and restore the normal physiological function of ankle joint. The treatment of ligamentous injury of inferior tibiofibular syndesmosis with elastic fixation of long tendon of fibula accords with the normal physiological structure of inferior tibiofibular syndesmosis and avoids loosening of conventional screw fixation or fatigue rupture, which provides theoretical basis for clinical treatment of ligamentous injury of inferior tibiofibular syndesmosis.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
【参考文献】
相关期刊论文 前1条
1 吴伟峰;骆宇春;刘云鹏;张焱;华国军;陈斌;柏广富;王诗波;;下胫腓联合不同走向韧带重建的生物力学性能比较[J];中国矫形外科杂志;2013年24期
，本文编号：2266912
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