单隧道双束和单束ACL重建的生物力学比较研究  

Biomechanical comparison of single-tunnel double-bundle and single-bundle reconstruction of anterior cruciate ligament

作　　者：王庆[1] 黄华扬[1] 张余[1] 郑小飞[1] 李凭跃[1] 王泽锦[1] 沈洪园[1] 

机构地区：[1]广州军区广州总医院骨病关节科,510010

出　　处：《中国骨科临床与基础研究杂志》2010年第4期271-276,共6页Chinese Orthopaedic Journal of Clinical and Basic Research

基　　金：广东省科技计划攻关项目(2010B031100016)

摘　　要：目的比较单隧道双束和单隧道单束ACL重建膝关节稳定性的差异。方法选用6侧人体膝关节标本,保留完整的关节囊及周围韧带,行单隧道双束和单束ACL重建,在MTS-858生物材料试验系统上测试膝关节在胫前加载(134N)和旋转加载(5N·m内旋胫骨)下屈曲0°、15°、30°、60°、90°位时的运动学反应。每个膝关节在4个不同条件下进行测试:ACL完整、ACL损伤、单隧道双束重建ACL以及单隧道单束重建ACL,其中单隧道双束及单束ACL均采用双股腘绳肌腱。结果 (1)胫前加载:双束组在屈曲30°、60°和90°位,单束组在屈曲90°位时关节前后稳定性获得良好恢复(P>0.05);在屈曲60°位时双束组的胫前位移明显低于单束组,差异有统计学意义(P<0.05)。(2)旋转加载:与ACL完整组相比较,双束组的胫骨内旋角度在屈曲0°、60°位时无明显变化(P>0.05),屈曲90°位时明显减少(P<0.05);单束组在屈曲0°时无明显变化(P>0.05)。屈曲60°和90°位时双束组的胫骨内旋角度明显小于单束组,差异有统计学意义(P<0.05)。结论与单隧道单束ACL重建相比,单隧道双束ACL重建能够更好地恢复膝关节前后稳定性及旋转稳定性。Objective To compare the difference in stability of the knee joint after single-tunnel double-bundle and single-bundle anterior cruciate liagament （ACL） reconstruction. Methods Six formalin-soaked specimens of the human knee with retained joint capsule and surrounding ligaments underwent the single-tunnel double-dundle and single-bundle ACL reconstruction. The kinematic response of the knee joint under anterior tibial load （134 N） and rotational load （internal rotation of tibia, 5 N·m） when the knee flexion was 0°, 15°, 30°, 60° and 90° were investigated using the MTS-858 biomaterial test system. Each knee was tested sequentially under 4 conditions： intact ACL, deficient ACL, single-tunnel double-bundle ACL reconstruction as well as single-tunnel single-bundle ACL reconstruction. All ACL reconstructions utilized double quadrupled hamstring tendon grafts. Results （1） Anterior tibial load condition： the anterior-posterior stability of knee joint restored when the knee was flexed at 30° , 60° and 90° in double-bundle group and 90° in single-bundle group （P 0.05）, the anterior tibial translations in double-bundle group were smaller than those after single-bundle ACL reconstruction when knee flexion at 60° （P 0.05）. （2） Rotational load condition： compared with the internal rotation degrees under the condition of intact ACL, those in double-bundle group had no statistical difference with knee flexion at 0° and 60° （P 0.05）, but decreased at 90° flexion （P 0.05）; those in single-bundle group changed slightly with knee flextion at 0°（P 0.05）. There was statistical significance between double-bundle and single-bundle group whenknee flexion at 60° and 90° （P 0.05）. Conclusion The single-tunnel double-bundle ACL construction can effectively provide more anterior-posterior and rotational stability than single-bundle ACL reconstruction.

关 键 词：前交叉韧带 移植 同种 生物力学 

分 类 号：R687.4[医药卫生—骨科学] R336[医药卫生—外科学]