摘要
[目的]下胫腓联合韧带损伤如不及时治疗会导致踝关节不稳定,韧带重建是治疗下胫腓联合韧带损伤的重要方法,但韧带重建方法较多,且存在争议,本实验分析下胫腓联合韧带损伤在不同走向上进行重建的生物力学性能,为临床上下胫腓联合韧带的重建提供科学依据。[方法]采用成人新鲜尸体踝标本6具,韧带均采用腓骨长肌腱进行重建,将实验力学模型分为A、B两个大组,A组为在胫骨前结节位置水平走向上重建下胫腓联合韧带,B组为模拟下胫腓前韧带斜向走向重建下胫腓联合韧带,A、B两组再设置横截面上3个不同方向进行重建,方向1为下胫腓骨间韧带方向,方向2为下胫腓前韧带与骨间韧带之间方向,方向3为下胫腓骨间韧带与后韧带之间方向。运用生物力学分析方法和压敏片技术,测量不同走向韧带重建方式的远端胫腓骨的强度、刚度,胫距关节接触力学特征。实验力学模型需在结构、载荷、力学性质上尽量保持一致,以确保实验精度和受载均度。所有标本采用成人新鲜尸体标本,在标本上施加生理载荷500 N,实现分级加载,在加载过程中标本维持新鲜湿润状态,在试验前先进行小量程预载,以消除骨的时间效应、松弛、蠕变等影响,然后进行加载正式试验,并采集数据。运用优化理论的方法,用等效刚度指数来比较,以全面反映不同走向韧带重建固定方式、不同形状、不同载荷下总的力学特性,以此来综合各自的优点评定踝关节的稳定性。[结果]在下胫腓前韧带及骨间韧带之间并且斜行走向重建下胫腓韧带,在胫腓骨应力强度方面优于其他重建方式。在下胫腓前韧带及骨间韧带之间并且斜行走向重建下胫腓韧带,在胫腓骨三类刚度(轴向刚度,水平剪切刚度、扭转刚度)方面优于其他重建方式。并运用优化理论的方法,结果显示:B组等效刚度优于A组,在下胫腓前韧带及骨间韧带之间方向上重建优于横断面上其他方向重建,运用压敏片技术测量结果示:在下胫腓前韧带及骨间韧带之间并且斜行走向重建下胫腓韧带,胫距间接触面积最大,接触应力分布最均匀,且接触应力相对较小。总之,在下胫腓前韧带及骨间韧带之间并且斜行走向重建下胫腓韧带踝关节的力学性能最佳,关节最稳定,均优于其他重建方式,具有显著性差异(P<0.05)。[结论]在下胫腓前韧带及骨间韧带之间斜行走向重建下胫腓联合韧带,有利于改善踝关节的生物力学性能,且能有效地提高踝关节的承载能力,对韧带重建治疗下胫腓联合分离实现术后踝关节稳定性具有重要的应用价值。
[ Objective] The distal tibiofibular syndesmosis injuries have been correlated with poor functional outcomes and the development of osteoarthritis. Ligment ligment reconstruct has been shown to play a large part in the stability of the syndes- mosis joint. But the means to reconstruct are different and conflicting. The experiment is to analyze the biomechanical property of ligment reconstruct of distal tibiofibular syndesmosis in different directions, to guide ligment reconstruction in clinic. [ Method ] Six specimen of fresh adult ankle were used. We used the peroneus longus tendon for reconstruct of the distal tibiofibular liga- ments. The models were divided to two groups（ A and B）. group A was reconstructed in horizontal direction parallel to anterior tubercle of tibial. Group B was reconstructed in the oblique direction simulating the anterior inferior tibiofibular ligament. In cross section we set three direction in two groups. Direction 1 ：direction of in- terosseous ligament. Direction2： direction between the interosseous ligament and the distal anterior tibiofibular ligament. Direction 3 ： di- rection between the distal posterior tibiofibular ligament and the in- terosseous ligament. Biomechanical test and press sensitive film patch technique were used to measure the strength and rigidity of distal tibiofibular,load area and contact feature of tibiotalar joint in each reconstruct. Experimental mechanics models required structure ,load and mechanical properties as consistent as possible to ensure the accuracy of experiment and the average of load. All specimens was using fresh adult specimens. Physiological load （500 N）was imposed on the specimen in grade maintaining the specimen fresh moist state. Prior to the test small - scale load was imoposed to eliminate the time effect of the bone, relaxa- tion and creep change effect. Then we loaded the formal experiment and collected data. Optimization method was used to evaluate the stability of the ankle. [ Result] The test showed ligment reconstruct in the oblique direction between the distal anterior tibio- fibular ligament and the interosseous ligament was better than other ways of reconstruct in the aspect of strength and three differ- ent rigidity （axial stiffness, horizontal shear stiffness, torsional rigidity）of distal tibiofibular. We used Advantage Rigidity to eval- uate the total mechanical property in different reconstruct and different load with optimization method. The result showed group B was superior to group A,reconstruct between the distal anterior tibiofibular ligament and the interesseous ligament was superior to other direction. Press sensitive film patch test showed ligment reconstruct in the oblique direction between the distal anterior tibiofibular ligament and the interosseous ligament was better than other ways of reconstruct, the tibiotalar joint contact area was big, the contact stress was small and average. The difference was significant（ P 〈 0.05 ）o [ Condusion ] Ligment reconstruct in the obique direction between the distal anterior tibiofibular ligament and the interosseous ligament can improve the biomechani- cal property, it also can enhance the load bearing ability of ankle, it is the excellent method of ligment reconstruct of distal tibio- fibular syndesmosis.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2013年第24期2510-2514,共5页
Orthopedic Journal of China
基金
南京军区重点基金项目:踝关节镜监视下下胫腓联合损伤修复重建的应用解剖及相关生物力学研究(编号:09Z003)
关键词
下胫腓联合分离
韧带重建
生物力学
distal tibiofibular syndesmosis rupture, ligment reconstruct, biomechanical study
