机构地区:[1]烟台市烟台山医院 [2]烟台中法友谊医院创伤一科,山东烟台264001
出 处:《中国修复重建外科杂志》2010年第8期948-952,共5页Chinese Journal of Reparative and Reconstructive Surgery
摘 要:目的研究髌骨部分切除及延长对髌股关节接触面积及压强的影响,为髌骨下极粉碎性骨折的治疗提供理论依据。方法将大小为100mm×100mm的压敏胶片置于自制压力加载装置的受力平台上,施加垂直向下载荷(0~19.6N),采用SamplePCI图像分析系统进行图像分析,获得压敏反应曲线。取自愿捐赠的6个新鲜男性左膝关节标本,置于自制膝关节固定加载装置上,将双层压敏片置于髌股关节面处,于196N载荷下屈膝0、15、30、45、60、75、90、105、120、135°,持续2min后取出压敏片,作为对照组。对照组测定后,行髌骨中部横行截断后,原位克氏针及钢丝内固定,作为原位固定组;之后于对侧髌骨截取全长1/6、2/6的骨块,置于该侧截骨间,以克氏针及钢丝内固定,制备髌骨延长模型,作为延长1/6组及延长2/6组;再由近至远依次截取全长1/6、2/6、3/6的髌骨,制备髌骨下部缺损1/6、2/6、3/6髌骨缺损模型,以克氏针及钢丝内固定,作为缩短1/6组、缩短2/6组、缩短3/6组;分别重复对照组力学测试步骤。将压敏片进行图像分析,测量髌股关节接触面积;并根据压敏反应曲线,计算髌股关节接触压强和压强峰值。结果各缩短组于屈膝30~135°时实际接触面积小于对照组(P<0.05);缩短1/6组在0、15、60、75°时,缩短2/6组在0°及75~135°时,缩短3/6组在0~30°及75~135°时压强大于对照组(P<0.05);缩短1/6组在0、15°及60~105°时,缩短2/6组在0、15、75~105°时,缩短3/6组在0、30°及60~135°时压强峰值均大于对照组(P<0.05)。各延长组在屈膝15、60、90°时实际接触面积小于对照组(P<0.05),延长2/6组在105、135°时大于对照组(P<0.05);在15~75°时各延长组压强大于对照组(P<0.05),在105、135°时小于对照组(P<0.05),120°时延长2/6组小于对照组(P<0.05);延长1/6组在0、90、105°时压强峰值小于对照组(P<0.05),延长2/6组在0°时小于对照组(P<0.05)。各延长组实�Objective To explore the effects of changes in the length of the patella on patellofemoral contact areas and pressures, to provide a theoretical foundation for treatment of lower pole of patella fracture. Methods Using homemade-loading equipment, pressure sensitive films of 100 mm × 100 mm in size were placed on the force platform, vertically downward load (0-19.6 N) was given. The pressure-sensitive response curve was obtained by computer image analysis of the pressure-sensitive tablets and calculation. Six male left fresh knee specimens from voluntary donation were placed in homemade-test fixed load device, and the double-layer pressure sensitive film was placed on the patellofemoral joint surface; under loading of 196 N at flexion of 0, 15, 30, 45, 60, 75, 90, 105, 120, and 135° for 2 minutes, respectively, the pressure sensitive film was removed as the control group. Patellas were transected cut and in situ fixed by Kirschner wire and steel-wire as in situ fixation group. Bone fragments obtained from the corresponding 1/6 and 2/6 of contralateral patella, were embedded in the interspace between osteotomy with internal fixation with Kirschner wire and steel-wire respectively as lengthening group. Followed by the amputating patella length of 1/6, 2/6, 3/6 from proximal to distal and internal fixation with Kirschner wire and steel wire by turns as a shortening group. Repeat the above steps of each experiment. By image analysis the pressure sensitive film, the patella joint contact area were measured, and patellar contact pressure (including the peak pressure and average pressure) was calculated according to pressure-sensitive response curve. Results The actural contact area were significantly smaller in the shortening groups than in the control group at flexion of 30-135° (P〈0.05); the pressure was significantly bigger in shortening 1/6 group at flexion of 0, 15, 60, and 75°, in shortening 2/6 group at flexion of 0° and 75-135°, and in shortening 3/6 group at flexion of 0-30° and 75-135° th
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