单隧道双束前交叉韧带重建不同移植物固定角度的生物力学研究  

Biomechanics of graft fixation at different knee flexion angles in single-tunnel double-bundle anterior cruciate ligament reconstruction

作　　者：区永亮[1] 黄华扬[1] 郑小飞[1] 李凭跃[1] 张涛[1] 陈帅[1] 沈洪园[1] 王庆[1] 

机构地区：[1]广州军区广州总医院骨科医院骨病关节科,510010

出　　处：《中华关节外科杂志（电子版）》2013年第1期57-61,共5页Chinese Journal of Joint Surgery(Electronic Edition)

基　　金：广东省科技计划攻关项目(2010B031100016)

摘　　要：目的探讨在何种初始张力及屈膝角度下进行移植物固定能够使单隧道双束前交叉韧带(ACL)重建术后的膝关节更好地恢复原有的运动学功能。方法将16具新鲜冰冻尸体膝关节随机分为四组,每四个膝关节为一组,分别为T20A20(在20N的初始张力下屈膝20°固定)、T20A45、T40A20及T40A45。使用BOSE-Electro Force材料生物力学性能测试仪定量测量上述四组膝关节在屈曲30°及90°时胫前载荷(134N)下的胫前位移和旋转载荷(5N×m胫骨内旋)下胫骨内旋角度。所有组均采用直径相等的自体腘绳肌腱、相同的隧道定位方法及固定装置进行韧带重建。结果 (1)胫前载荷(134N)下的胫前位移:T20A20、T20A45与完整组比较无统计学差异(F=0.56,P>0.05),T40A20、T40A45与完整组比较有统计学差异(F=85.35,P<0.05);(2)旋转载荷(5N×m胫骨内旋)下的胫骨内旋角度:T20A20、T40A20与完整组比较无统计学差异(F=0.74,P>0.05),T20A45、T40A45与完整组比较有统计学差异(F=145.24,P<0.05)。40N初始张力下进行韧带固定会使重建术后膝关节伸屈约束过度,而屈膝45°进行韧带固定则使重建术后膝关节内旋约束过度。在20N的初始张力下屈膝20°进行韧带固定能使重建术后膝关节的前后及旋转稳定性更接近于正常。结论单隧道双束ACL重建术中,两束韧带分别在20N的初始张力下屈膝20°进行固定能够恢复膝关节的前后及旋转稳定性,从而更好地恢复原有的运动学功能。Objective To investigate at what knee flexion angle and initial tension that the graft can better restore intact knee kinematics after single-tunnel double-bundle reconstruction of anterior cruciate ligament （ACL）. Methods 16 fresh-frozen human cadaverie knees were randomly divided into four groups, four knees for each group： group T20A20 （20 N initial tension, fixed at flexion angle 20°） , group T20A45 （20 N initial tension, fixed at flexion angle 45°） , group T40A20（40 N initial tension, fixed at flexion angle 20°） and group T40A45 （40 N initial tension, fixed at flexion angle 45°）. A BOSE- ElectroForce testing system was used to investigate the kinematic response of the knee under an anterior tibial load （134 N ） and internal tibial torques （5 N x m ） at 30° and 90° knee flexion. The same quadrupled hamstring tenden graft with identical diameter,the same tunnel location and fixation methods in the ACL reconstruction were applied in all groups. Results （ 1 ） Under the anterior tibial load （ 134 N）, group T20A20 and group T20Ad5 had no significant difference compared with ACL intact group （ F = 0. 56, P 〉 0. 05 ）, while group T40A20 and T40A45 had significant difference compared with ACL intact group at each flexion angles （ F = 85.35, P 〈 0. 05 ）. （ 2 ） Under the internal tibial torques （ 5 N·m ） , group T20A20 and T20A20 had no significant difference compared with ACL intact group （ F=0. 74, P 〉 0. 05 ）, while group T20A45 and T40A45 had significant difference compared with ACL intact group at each flexion angles （ F = 145.24, P 〈 0. 05 ）. Under 40 N initial tension or at 45° flexion, the fixation will result in an over-constrained after knee reconstruction ; under 20 N initial tension at 20° flexion, the fixation can restore the anterior-posterior and rotating stability more close to normal. Conclusions In single-tunnel double-bundle ACL reconstruction, that fixing the double-bundle ligaments respectively under 20 N initial tension

关 键 词：前交叉韧带 生物力学 固定角度 修复外科手术 

分 类 号：R687.2[医药卫生—骨科学]