【摘要】：目的：肘關(guān)節(jié)側(cè)副韌帶在維持肘關(guān)節(jié)穩(wěn)定中發(fā)揮著重要的作用,韌帶重建是治療肘關(guān)節(jié)韌帶損傷的有效手段,了解側(cè)副韌帶的生物力學(xué)有著重要的意義。以往研究大多數(shù)基于尸體標(biāo)本實(shí)施進(jìn)行,且對(duì)肘關(guān)節(jié)周圍的韌帶附著點(diǎn)的足跡沒有明確的界定。本研究目的是在活體上應(yīng)用三維CT重建技術(shù),探討肘關(guān)節(jié)屈曲過程中,肘關(guān)節(jié)側(cè)副韌帶的生物力學(xué)變化情況；通過韌帶的虛擬重建,尋找韌帶等長(zhǎng)重建中心,為肘關(guān)節(jié)側(cè)副韌帶損傷、肘關(guān)節(jié)不穩(wěn)定修復(fù)提供理論基礎(chǔ)。 研究方法：選用6名健康成年志愿者,年齡20-32歲,男性4名,女性2名,對(duì)其右肘關(guān)節(jié)進(jìn)行CT掃描,獲取肘關(guān)節(jié)在伸直位(0°)、半屈曲位(50°、90°)及完全屈曲位(120°)時(shí)的斷層掃描圖像,選取肘關(guān)節(jié)內(nèi)側(cè)副韌帶前束(AMCL)、后束(PMCL)以及外側(cè)尺副韌帶(LUCL)作為研究對(duì)象,利用Mimics10.01、Geomagic Studio12.0和幾何畫板軟件進(jìn)行三維圖像重建并測(cè)量韌帶長(zhǎng)度,比較四種位置下的AMCL(包括內(nèi)上組、中間組和外下組)、PMCL(包括內(nèi)上組、中間組和外下組)及LUCL(包括外上組、中間組和內(nèi)下組)三束共9組韌帶長(zhǎng)度的變化。分別由兩名實(shí)驗(yàn)人員測(cè)量韌帶長(zhǎng)度,統(tǒng)計(jì)方法采用單因素重復(fù)測(cè)量方差分析,若差異有統(tǒng)計(jì)學(xué)意義,則采用配對(duì)t檢驗(yàn)法進(jìn)行兩兩比較。P0.05認(rèn)為差異有統(tǒng)計(jì)學(xué)意義。統(tǒng)計(jì)使用SPSS17.0軟件。 結(jié)果：1.肘關(guān)節(jié)從伸直0°到屈曲120°位時(shí),AMCL三個(gè)束組長(zhǎng)度均有不同程度的增加,其中以中間組長(zhǎng)度增加尤其顯著,分別增加了10%、13%和21%(p0.05)。2.,PMCL三組韌帶長(zhǎng)度從肘關(guān)節(jié)0°到屈曲50°位緩慢增加,從屈曲50°到90°及120°,增加極為明顯,在屈曲120°時(shí),三組韌帶長(zhǎng)度增加了約90%(p0.01)。3.,LUCL三組韌帶長(zhǎng)度從肘關(guān)節(jié)0°到屈曲50°緩慢增加(P0.05),從屈曲50°到90°,三組韌帶長(zhǎng)度增加極為明顯(p0.05),而從90°到120°,三組韌帶長(zhǎng)度又再緩慢增加(P0.05)。 結(jié)論：三維CT重建技術(shù)是活體研究肘關(guān)節(jié)運(yùn)動(dòng)生物力學(xué)的有效手段；肘關(guān)節(jié)在屈曲過程中,側(cè)副韌帶的張力與伸直位相比均有不同程度的增加,肘關(guān)節(jié)側(cè)副韌帶張力變化呈現(xiàn)一定的規(guī)律性；對(duì)AMCL進(jìn)行韌帶重建可以選取內(nèi)、外組束組做近似等長(zhǎng)的雙束重建；對(duì)PMCL及LUCL進(jìn)行韌帶重建,原解剖附著點(diǎn)不適合作為韌帶等長(zhǎng)重建中心。
[Abstract]:Objective: the collateral ligament of the elbow joint plays an important role in maintaining the stability of the elbow joint. Ligament reconstruction is an effective method for the treatment of ligament injury of the elbow joint. It is of great significance to understand the biomechanics of the collateral ligament of the elbow joint. Most previous studies were based on cadaveric specimens, and the footprint of ligaments attached to the elbow joint was not clearly defined. The purpose of this study was to investigate the biomechanical changes of the collateral ligament of the elbow joint during the flexion of the elbow joint by using three-dimensional CT reconstruction technique in vivo, and to find the center of the ligament reconstruction through virtual reconstruction of the ligament. To provide a theoretical basis for the collateral ligament injury and unstable repair of elbow joint. Methods: six healthy adult volunteers, aged 20-32 years, 4 males and 2 females, were selected to perform CT scanning of the right elbow joint, and to obtain the CT images of the elbow joint in the extension position (0 擄), the half flexion position (50 擄) and the complete flexion position (120 擄). The medial collateral ligament anterior bundle (AMCL), posterior bundle (PMCL) and lateral ulnar collateral ligament (LUCL) were selected as the research objects. The 3D images were reconstructed with Mimics10.01,Geomagic Studio12.0 and the length of the ligaments were measured by using the software of geometric drawing board. The AMCL in four positions (including the inner superior group) was compared. The changes of ligamentous length in 9 groups were observed in the middle group and the outer inferior group (including the upper group, the middle group and the inferior group) and the three bundle of LUCL (including the outer group, the middle group and the inner and lower group). The length of ligaments was measured by two experimenters respectively. The statistical method used single factor repeated measurement variance analysis. If the difference was statistically significant, the paired t test method was used to compare the length of ligaments. P05 showed that the difference was statistically significant. Statistics using SPSS17.0 software. The result is 1: 1. The length of AMCL increased in varying degrees from 0 擄to 120 擄flexion of elbow joint, especially in the middle group, which increased by 10% (p 0.05) and 21% (p 0.05). 2. The length of ligament increased slowly from 0 擄to 50 擄flexion of elbow joint in three groups. From 50 擄to 90 擄and 120 擄of flexion, the increase is very obvious, and when flexion is 120 擄, The length of ligamentum increased by 90% (p0.01). 3. The length of ligaments of LUCL increased slowly from 0 擄to 50 擄of elbow joint (P0.05), from 50 擄to 90 擄of flexion, the length of ligaments of three groups increased significantly (p0.05), but from 90 擄to 120 擄, and the length of ligaments of three groups increased slowly (P0.05). Conclusion: Three-dimensional CT reconstruction is an effective method to study the motion biomechanics of the elbow joint in vivo, and the tension of the collateral ligament increases in varying degrees during the flexion of the elbow joint compared with the extension position. The tension changes of collateral ligament of elbow joint showed certain regularity; ligament reconstruction of AMCL could be done in the inner and outer group, and the ligaments of PMCL and LUCL could be reconstructed. The primordial attachment is not suitable for the isometric reconstruction of ligaments.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R686.5

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 陳宏;王欣;李學(xué)淵;章偉文;;應(yīng)用微型骨錨重建手指?jìng)?cè)副韌帶—附7例報(bào)告[J];中華手外科雜志;2006年06期

2 竇慶寅,劉金慕,張弩,劉世清,鐘俊,唐新宇,李家元;近節(jié)指間關(guān)節(jié)側(cè)副韌帶斷裂三種治療方法的療效比較[J];中華手外科雜志;1998年03期

3 任逸眾;李文琪;劉曉民;;血小板源性生長(zhǎng)因子對(duì)大鼠內(nèi)側(cè)側(cè)副韌帶愈合的影響[J];中國(guó)修復(fù)重建外科雜志;2006年06期

4 張長(zhǎng)杰;膝關(guān)節(jié)制動(dòng)對(duì)外側(cè)副韌帶膠原轉(zhuǎn)化影響的觀察[J];中華理療雜志;2001年04期

5 馬學(xué)東,劉衛(wèi)民,王軍,何少波,賴嘉第;近節(jié)指間關(guān)節(jié)側(cè)副韌帶斷裂手術(shù)與非手術(shù)治療的療效比較[J];寧夏醫(yī)學(xué)雜志;2002年02期

6 李峻;王平;周禮榮;王偉;朱誠(chéng);;應(yīng)用微型骨錨亞急診修復(fù)指關(guān)節(jié)側(cè)副韌帶撕脫傷[J];中國(guó)骨與關(guān)節(jié)損傷雜志;2007年07期

7 張強(qiáng);張抒;李瑞;劉立峰;張永先;;軍事訓(xùn)練致膝關(guān)節(jié)側(cè)副韌帶Ⅲ度損傷的手術(shù)治療[J];解放軍醫(yī)學(xué)雜志;2011年08期

8 賈義軍;岳楓;;肘關(guān)節(jié)側(cè)副韌帶的解剖結(jié)構(gòu)研究及臨床意義[J];四川解剖學(xué)雜志;2013年02期

9 竇慶寅,劉金慕,胡榮,劉世清,明江華;近指間關(guān)節(jié)側(cè)副韌帶完全斷裂治療方法的比較[J];湖北醫(yī)科大學(xué)學(xué)報(bào);1998年02期

10 張長(zhǎng)杰,吳宗耀;膝關(guān)節(jié)制動(dòng)對(duì)兔膝外側(cè)副韌帶影響的實(shí)驗(yàn)觀察[J];現(xiàn)代康復(fù);2000年02期

相關(guān)會(huì)議論文 前4條

1 劉林海;滕曉峰;陳宏;;微型骨錨重建手指近側(cè)指間關(guān)節(jié)側(cè)副韌帶[A];2009年浙江省顯微外科、手外科學(xué)術(shù)年會(huì)論文匯編[C];2009年

2 王欣;魏鵬;徐吉海;陳宏;;微型骨錨修復(fù)急性拇指掌指關(guān)節(jié)尺側(cè)副韌帶損傷[A];2009年浙江省顯微外科、手外科學(xué)術(shù)年會(huì)論文匯編[C];2009年

3 王欣;魏鵬;徐吉海;陳宏;;微型骨錨修復(fù)急性拇指掌指關(guān)節(jié)尺側(cè)副韌帶損傷[A];浙江省醫(yī)學(xué)會(huì)創(chuàng)傷學(xué)分會(huì)成立大會(huì)暨2009年浙江省創(chuàng)傷學(xué)術(shù)年會(huì)論文匯編[C];2009年

4 周曉波;陳忠義;梁軍波;馮興兵;;Müller法行外側(cè)副韌帶和胭肌腱重建臨床初步報(bào)道[A];2007年浙江省醫(yī)學(xué)會(huì)骨科學(xué)學(xué)術(shù)會(huì)議暨浙江省抗癌協(xié)會(huì)骨軟腫瘤學(xué)術(shù)會(huì)議論文匯編[C];2007年

相關(guān)博士學(xué)位論文 前1條

1 譚軍;應(yīng)用三維CT重建研究活體肘關(guān)節(jié)側(cè)副韌帶生物力學(xué)[D];蘇州大學(xué);2014年

相關(guān)碩士學(xué)位論文 前2條

1 張義群;微型骨錨在急性近指間關(guān)節(jié)側(cè)副韌帶起點(diǎn)或止點(diǎn)損傷治療中的應(yīng)用[D];吉林大學(xué);2014年

2 李鵬;人膝前交叉韌帶損傷對(duì)外側(cè)副韌帶影響的生物力學(xué)研究[D];中南大學(xué);2009年

，

本文編號(hào)：2240380