腕关节镜下带线微型骨锚钉重建舟月骨间韧带的三维影像动力学研究  

3D imaging kinematic analysis of arthroscopic scapholunate ligament reconstruction with suture anchors

作　　者：任汉儒 谢仁国[1] 刘佳佳[1] 邢树国[1] 王古衡[1] 茅天[1] 

机构地区：[1]南通大学附属医院手外科,江苏226001

出　　处：《中华手外科杂志》2015年第4期253-256,共4页Chinese Journal of Hand Surgery

基　　金：国家自然科学基金（81371948）;江苏省卫生厅“科教兴卫工程”重点人才基金（RC201101）

摘　　要：目的 探讨腕关节镜下带线锚钉修复舟月骨间韧带损伤的方法,通过三维重建及三维坐标系统分析其效果.方法 对6例新鲜冰冻的腕关节标本分别在舟月骨间韧带切断前、后和锚钉修复重建韧带后,CT扫描,收集数据.每个实验阶段的CT扫描共分7个体位,分别为腕关节中立位,掌屈20°、40°、60°,背伸20°、40°、6°.根据CT扫描的数据对腕关节舟月骨进行三维重建并运用三维坐标系统分析,比较舟月骨质心的距离变化和舟骨不同位置时相对于其中立位的位移变化.结果 切断舟月韧带后舟月骨质心的距离在腕关节中立位,背伸20°及背伸60°时比切断前增宽,但通过修复重建舟月骨质心间距离缩小.切断舟月骨间韧带后,舟骨在背伸时有明显的背侧移位缺失.结论 尸体研究表明腕关节镜下运用带线锚钉修复舟月韧带损伤操作可行,达到动力学重建效果.Objective To introduce the technique of arthroscopic scapholunate ligament reconstruction with suture anchors,and evaluate the treatment results using 3-D reconstruction and 3-D coordinates analysis.Methods Six fresh frozen cadaver wrist specimens were used.CT scans were performed at 3 different experimental stages of the scapholunate interosseous ligament：intact,cut and reconstructed.Each stage included 7 positions：flexion （60°,40°,20°）,neutral position,and extension （20°,40°,60°）.The ligaments were cut and reconstructed under the wrist arthroscopy.Three-dimensional reconstruction of the scaphoid and lunate was done using CT scan data.Through Mimics and Geonagic studio,we constructed a three-dimensional coordinate system to calculate and to compare the centroid distance of scapholunate in different positions and the changes of the scaphoid positions.Results The scapholunate centroid distance was significantly wider at the neutral position,20° of extension and 60° of extension when the scapholunate ligament was cut.This change could be reversed with the scapholunate interosseous;ligament reconstructed.Meanwhile,there was obvious scaphoid dorsal displacement loss at wrist extension when the scapholunate ligament was cut.This change could also be recovered with the scapholunate interosseous ligament reconstructed.Conclusion Wrist arthroscopic reconstruction of the scapholunate interosseous ligament with suture anchors is technically feasible and kinematically effective.

关 键 词：腕关节 关节镜 舟月骨间韧带 带线锚钉 三维重建 

分 类 号：R683.41[医药卫生—骨科学]