不同术式重建第一腕掌关节稳定性的生物力学研究  

Biomechanical evaluation of the first carpometacarpal joint stability by using different reconstruction methods

作　　者：何树坤[1] 徐龙[1] 赵思淳 黄富国[1] 

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中国修复重建外科杂志》2017年第2期171-175,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的研究不同术式重建第1腕掌关节稳定性的生物力学差异,为临床选择重建方式提供理论依据。方法以12个新鲜成人尸体上肢标本作为研究对象,所有标本均经正侧位X线片检查,排除骨折、骨病、腕部各关节脱位、畸形、退变及关节周围韧带损伤。实验分为5组,分别为正常组、损伤组、掌侧重建组、背侧重建组以及掌背侧重建组。随机取3个正常标本作为正常组进行生物力学测试后,制备第1腕掌关节脱位模型作为损伤组进行测试;剩余9个标本随机分为掌侧重建组、背侧重建组以及掌背侧重建组,每组各3个标本,制备第1腕掌关节脱位模型,分别采用Eaton-Little法、尹维田法以及联合两种方法修复重建韧带,并行生物力学测试。记录各组载荷-位移曲线,计算弹性模量并进行统计学分析。结果生物力学测试过程中,损伤组和掌侧韧带重建组各1例标本出现韧带断裂以及远端1.5 mm克氏针滑松,但标本未出现滑脱,其测量结果纳入研究。正常组、损伤组、掌侧重建组、背侧重建组、掌背侧重建组弹性模量分别为(11.61±0.20)、(5.39±0.12)、(6.33±0.10)、(7.12±0.08)、(8.30±0.10)MPa,各组间弹性模量比较差异均有统计学意义(P<0.05)。结论掌侧韧带重建、背侧韧带重建及掌背侧韧带重建均能明显提高关节稳定性,其中掌背侧韧带重建效果最好,但仍不能恢复至正常水平。Objective To study the biomechanical differences of the first carpometacarpal joint stability by using different reconstruction methods so as to provide theoretical basis for the clinical choice of reconstruction method. Methods The upper limb specimens were selected from 12 fresh adult cadavers, which had no fracture, bone disease, dislocation of wrist joint, deformity, degeneration, or ligament injury on the anteroposterior and lateral X-ray films. The specimens were randomly divided into 5 groups： normal group, injury group, palmar carpometacarpal ligaments reconstruction group, dorsal carpometacarpal ligaments reconstruction group, and palmar and dorsal carpometacarpal ligaments reconstruction group. Three normal specimens were used as normal group, and then were made of the first carpometacarpal joint dislocation models （injury group）; after the first carpometacarpal joint dislocation was established in the other 9 specimens; the volar ligament, dorsal ligament, and volar-dorsal ligaments were reconstructed with Eaton- Little method, Yin Weitian method, and the above two methods in 3 construction groups. The biomechanical test was done to obtain the load-displacement curve and to calculate the elastic modulus. Results During biomechanical test, ligament rupture and loosening of Kirschner wire occurred in 1 case of injury group and palmar carpometacarpal ligaments reconstruction group; no slipping was observed. The elastic modulus values were （11.61±0.20）, （5.39±0.12）, （6.33±0.10）, （7.12±0.08）, and （8.30±0.10） MPa in normal group, injury group, palmar carpometacarpal ligaments reconstruction group, dorsal carpometacarpal ligaments reconstruction group, and palmar and dorsal carpometacarpal ligaments reconstruction group respectively, showing significant differences among groups （P〈0.05）. Conclusion Volar ligament reconstruction, dorsal ligament reconstruction, and volar-dorsal ligament reconstruction all can greatly improve the stability of the first carpometacarpal joint.

关 键 词：第1腕掌关节 肌腱转位 韧带重建 生物力学 

分 类 号：R687.3[医药卫生—骨科学] R318.01[医药卫生—外科学]