前交叉韧带重建术后关节粘连患者在体胫股关节运动学分析  

In-vivo Kinematics of the Tibiofemoral Joint in Patients with Arthrofibrosis after Anterior Cruciate Ligament Reconstruction

作　　者：范帅[1] 张玲 蔡斌[1] FAN Shuai;ZHANG Ling;CAI Bin(Department of Rehabilitation Medicine,Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China;School of Exercise and Health,Shanghai University of Sport,Shanghai 200438,China)

机构地区：[1]上海交通大学医学院附属第九人民医院康复医学科,上海200011 [2]上海体育大学运动健康学院,上海200438

出　　处：《医用生物力学》2023年第6期1134-1138,1145,共6页Journal of Medical Biomechanics

基　　金：上海市科委项医学创新研究项目(21Y11903400);上海交通大学数字医学教育部工程研究中心医工交叉研究种子基金(20210403)。

摘　　要：目的定量分析前交叉韧带重建(anterior cruciate ligament reconstruction,ACLR)术后关节粘连患者在体胫股关节6自由度的运动学特征。方法纳入15例ACLR术后关节粘连患者和15例健康受试者,运用便携式膝关节三维运动分析系统采集受试者负重屈膝和非负重屈膝时胫股相对于股骨的运动轨迹,获取胫股关节6自由度的运动学数据。结果与健康人相比,负重屈膝30°、45°、60°和75°时,膝关节粘连患者患侧胫骨内旋角度明显减少(P<0.001);负重屈膝30°和45°时,膝关节粘连患者患侧胫骨相对于股骨的外翻角度较健康人明显减小(P<0.05)。非负重屈膝75°时,膝关节粘连患者患侧胫骨内移距离较健康人明显减少(P<0.05)。结论关节粘连限制了胫骨相对于股骨的旋转和内外移,对于胫骨相对于股骨的前后移动影响不大。因此,临床上应该利用各种治疗手段松解股骨内外侧沟的粘连和外侧副韧带挛缩,解决旋转和内外移动受限的问题,以最大程度恢复膝关节功能。Objective To quantitatively analyze the in-vivo kinematics of the tibiofemoral joint in patients with arthrofibrosis after anterior cruciate ligament reconstruction(ACLR)surgery.Methods Fifteen patients with arthrofibrosis after ACLR and 15 healthy subjects were included in the study.The tibiofemoral motion trajectories relative to the femur during weightbearing and non-weightbearing knee flexion of the subjects were collected by using a portable three-dimensional(3D)knee motion analysis system,and kinematic data of the tibiofemoral joint with 6 degrees of freedom(6 DOF)were obtained.Results Compared with healthy subjects,the internal tibial rotation was significantly decreased in patients with arthrofibrosis under 30°,45°,60°and 75°weightbearing knee flexion(P<0.001),and the tibial valgus was significantly decreased in patients with arthrofibrosis under 30°and 45°weightbearing knee flexion(P<0.05).The internal tibial displacement in patients with arthrofibrosis was significantly smaller than that in healthy subjects under 75°non-weightbearing knee flexion(P<0.05).Conclusions Knee arthrofibrosis limits the rotation and internal displacement of the tibia,but has little impact on the anterior and posterior displacement of the tibia relative to the femur.Therefore,in clinical practice,various treatments should be used to release the adhesion in the medial and lateral femoral grooves and the contracture of the lateral collateral ligaments,address the limitation in rotation and displacement movement,so as to restore knee function to the fullest extent.

关 键 词：膝关节 关节粘连 运动捕捉 胫股关节 运动学 

分 类 号：R318.01[医药卫生—生物医学工程]