前交叉韧带与Ramp损伤修复的生物力学对比  

Biomechanical comparison of anterior cruciate ligament tear accompanied with Ramp injury and their repairs in cadaver knees

作　　者：李书振 王豪 覃志 朱圣旺 曾沣 秦煜 孙可[1] 尹东[1] LI Shu-zhen;WANG Hao;QIN Zhi;ZHU Sheng-wang;ZENG Feng;QIN Yu;SUN Ke;YIN Dong(Department of Arthrosco-Py and Sports Medicine,Guangxi Zhuang Autonomous Region People's Hospital,Nanning 530022,China;Graduate School of West Universiy of Chinese Medicine,Nanning 530001,China)

机构地区：[1]广西壮族自治区人民医院关节·运动医学外科,广西南宁530022 [2]广西中医药大学研究生院,广西南宁530001

出　　处：《中国矫形外科杂志》2022年第16期1492-1496,共5页Orthopedic Journal of China

基　　金：广西自然科学基金项目(编号:2017GXNSFAA198374)。

摘　　要：[目的]比较前交叉韧带与Ramp损伤不同修复的运动学改变。[方法]16个新鲜尸体膝,均依次进行以下模型建立与运动学测试,处理顺序为:正常对照(normal control,NC),ACL切断+Ramp损伤组(ACL cutting and Ramp injury,ACRI)、ACL重建+Ramp损伤组(ACL reconstruction and Ramp injury,ARRI)。将16个膝分为两组,每组8膝,分别为ACL重建+Ramp缝合钩修复组(ACL reconstruction and suture hock repair for Ramp injury,ARSH)和ACL重建+Ramp Fast-fix修复组(ACL reconstruction and fast-fix repair for Ramp injury,ARFF)。将标本固定于力学测试仪,于屈曲0°、30°、60°、90°,施加前向134 N恒定载荷,和内外旋5 N·m载荷,测量胫骨前移距离、内旋和外旋角度。[结果]各屈膝角度状态下,胫骨前移、内旋和外旋由低至高总体依次为,NC<ARSH<ARFF<ARRI<ACRI,总体差异均有统计学意义(P<0.05)。在各屈膝角度下,ARSH组与ARFF组胫骨前移距离的差异均无统计学意义(P>0.05)。在屈膝0°、30°和60°下ARSH组胫骨内旋均显著小于ARFF组(P<0.05),但在屈膝90°下ARSH组与ARFF胫骨内旋的差异无统计学意义(P>0.05)。在各屈膝角度下ARSH组与ARFF胫骨外旋的差异均无统计学意义(P>0.05)。[结论]在膝关节ACL合并Ramp损伤ACL重建中,缝合钩与Fast-fix缝合修复Ramp损伤均能提高膝关节的稳定性,但与Fast-fix缝合修复相比,缝合钩修复能更好地恢复膝关节内旋稳定性。[Objective]To compare the biomechanical variations of anterior cruciate ligament(ACL)tear accompanied with Ramp injury and different repairs for them.[Methods]A total of 16 fresh cadaver knees were treated and tested in the following order:normal control(NC),ACL cutting and Ramp injury(ACRI),ACL reconstruction and Ramp injury(ARRI)group.After that,the 16 knees were divided into two groups with 8 knees in each group,including ACL reconstruction and suture hook repair for Ramp injury(ARSH)and ACL reconstruction and Fast-fix repair for Ramp injury(ARFF).After the specimens were fixed in the mechanical tester,the tibial translation,internal rotation and external rotation were measured under constant anteroposterior 134 N load and 5 N·m internal and external rotation torque at0°,30°,60°,90°flexion of the knee.[Results]The total order of tibial anterior displacement,internal rotation and external rotation from low to high was of NC<ARSH<ARFF<ARRI<ACRI,with statistically significant differences among the 5 groups(P<0.05).In any degrees of knee flexion,there was no significant difference in the tibia anterior displacement between ARSH group and ARFF group(P>0.05).However,the ARSH group had significantly less tibial internal rotation than ARFF group at 0°,30°and 60°knee flexion(P<0.05),although there was no statistical significance between them at 90°knee flexion(P>0.05).In addition,there was no significant difference between ARSH group and ARFF group in tibial external rotation at any knee flexion angles(P>0.05).[Conclusion]Both suture hook and fast fix for repair of Ramp injury following ACL reconstruction are effective treatments for the complex injuries,by contrast,suture hook repair achieve better restoration of internal rotation stability of the knee.

关 键 词：膝关节 前交叉韧带断裂 Ramp损伤 缝合钩修复 Fast-fix修复 膝关节稳定性 

分 类 号：R687[医药卫生—骨科学]