骨盆前后压缩Ⅱ型损伤相关韧带损伤机制的生物力学研究  

A biomechanical study of ligament injury associated with anteroposterior compression ofYoung-Burgess type Ⅱ

作　　者：水小龙[1] 曹生鲁 冯永增[1] 林威[1] 郭晓山[1] 王钢[2] 

机构地区：[1]温州医科大学附属第二医院、育英儿童医院骨科,325027 [2]南方医科大学南方医院创伤骨科,广州510515

出　　处：《中华创伤骨科杂志》2017年第5期423-428,共6页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金面上项目（81272008）;温州市公益性科技计划项目（Y20160367）

摘　　要：目的探讨骨盆前后压缩（APC）Ⅱ型损伤时相关韧带损伤情况及耻骨联合、骶髂关节的分离程度等。方法取10具新鲜尸体标本，将标本随机分为2组（n=5），制造2种骨盆APC1I型损伤测试模型：半骨盆固定（限制组）和半骨盆不固定（非限制组）。模拟骨盆APCII型损伤，记录骶髂前韧带断裂时耻骨联合分离距离、骶髂关节前方分离距离及骶棘韧带、骶结节韧带损伤情况。极度外旋半骨盆，观察限制组与非限制组相关韧带损伤情况及骨盆的骨性改变。结果骶髂前韧带断裂时，耻骨联合分离距离和骶髂关节前方分离距离平均分别为（23．8±2．8）、（10．9±4．4）mm，限制组与非限制组之间比较差异均无统计学意义（P〉0．05）；外旋角度平均为40．1°±9．8°，外旋力平均为（646．7±131．5）N，限制组与非限制组之间比较差异均有统计学意义（P〈0．05）；非限制组骶棘韧带和骶结节韧带均未见明显损伤，而限制组骶结节韧带和骶棘韧带均有损伤。骶髂前韧带断裂后再极度外旋，非限制组仍未见骶棘韧带和骶结节韧带断裂，而限制组出现骶棘韧带和骶结节韧带断裂。当骶髂前韧带、骶棘韧带和骶结节韧带均断裂时，限制组耻骨联合分离距离平均为41．8mm，骶髂关节前方分离距离平均为16．8mm。结论骨盆APC1I型损伤可以有2种情况，即半骨盆限制和非限制，这2种情况的韧带损伤结果是不同的。当骶髂前韧带断裂时耻骨联合分离距离可以有较大波动。Objective To investigate the injury and disruption of anterior sacroiliac ligament （ASIL） and saerotuberous/saerospinous ligament complex（STL/SSL）, as well as the displacement of pubic symphysis （PS） and sacroiliac joint （SIJ）, associated with anterior-posterior compression （APC） of Young-Burgess type Ⅱ. Methods Test models of APC of Young-Burgess type Ⅱwere created in 10 fresh human pelvic ca- daveric specimens which were randomized into 2 equal groups （ n = 5 ）. The right hemipelvis in one group was fixed to a table （the limited group） while that in the other was not （the unlimited group）. At the disruption point of ASIL during external rotation of the hemipelvis, displacement of PS, separation distance between the anterior parts of the sacroiliac joint, and injury and disruption of STL/SSL were recorded. When STL/SSL was gradually made to breakdown and fracture with continuous external rotation of the hemipelvis, bony changes and injuries to the posterior pelvic ligaments were observed and recorded. Results At the failure point of ASIL, the mean displacement of PS was 23.8 ± 2. 8 mm and that of SIJ was 10.9 ± 4. 4 ram, showing no significant difference between the limited and unlimited groups （ P 〉 0. 05 ）; the mean external rotation angle was 40. 1± 9.8± and the mean torsion was 646.7 ± 131.5 N, showing significant differences between the limited and unlimited groups （ P 〈 0.05 ）. At the disruption point of ASIL, obvious injuries or disruptionof STL/SSL were not observed in the unlimited group but observed in the limited group. With extreme external rotation, obvious disruption of STL/SSL was not found in the unlimited group but observed in the limited group. When ASIL and STL/SSL were all fractured, the mean displacement of PS was 41.8 mm aml that of SIJ was 16.8 mm in the limited group. Conclusions Since APC injury can lead to 2 situations, limited or unlimited hemipelvis, external rotation injuries to the ligaments differ in the 2 different situations. W

关 键 词：骨盆 韧带 创伤和损伤 生物力学 

分 类 号：R683[医药卫生—骨科学]