不同方法縫合修復(fù)與修整成形半月板損傷的生物力學(xué)研究
發(fā)布時(shí)間：2018-09-07 12:38
【摘要】：目的 半月板在膝關(guān)節(jié)中的生物力學(xué)作用有：吸收震蕩、減輕負(fù)荷、維持膝關(guān)節(jié)的運(yùn)動(dòng)協(xié)調(diào)及膝關(guān)節(jié)穩(wěn)定等。外傷性或者退變性半月板損傷常引起膝關(guān)節(jié)的疼痛和退行性變,最終導(dǎo)致骨關(guān)節(jié)炎的發(fā)生。為最大可能保存半月板的功能,半月板縫合術(shù)常用來治療半月板撕裂,比較常用的縫合技術(shù)有水平、垂直及交叉縫合。本課題即通過生物力學(xué)實(shí)驗(yàn),探討不同縫合技術(shù)修復(fù)損傷半月板后脛股關(guān)節(jié)接觸應(yīng)力的變化,并與半月板部分切除術(shù)后相比較,為臨床手術(shù)提供力學(xué)依據(jù)。 方法 24具新鮮冷凍的混合品種的狗后肢膝關(guān)節(jié)標(biāo)本(雌雄各6只),排除原發(fā)的膝關(guān)節(jié)疾病。每具膝關(guān)節(jié)均記錄以下3種狀態(tài)：對(duì)照組(完整半月板)、桶柄樣撕裂和半月板修復(fù)術(shù)后。首先記錄對(duì)照組(完整半月板)的接觸圖,然后制備桶柄樣撕裂的半月板模型,最后用不同的手術(shù)方式處理桶柄樣半月板損傷：垂直縫合、水平縫合、交叉縫合及半月板切除。24具標(biāo)本隨機(jī)用上述辦法處理,所以最終每種手術(shù)方式均含有6具標(biāo)本。壓力傳感器記錄瞬時(shí)接觸面積(Instantaneous contact area, CA)、平均接觸壓力(mean contact pressure, MCP)及峰值接觸壓力(peak contact pressure, PCP)。膝關(guān)節(jié)置于正常站立角度,斯氏針平行于地面,對(duì)膝關(guān)節(jié)加壓、內(nèi)外翻、屈伸、內(nèi)外旋；包埋好的脛骨端固定于定制的滑動(dòng)平臺(tái)中,允許旋轉(zhuǎn)、頭尾和內(nèi)外平移。8具新鮮冷凍的混合品種的狗后肢膝關(guān)節(jié)標(biāo)本,序貫進(jìn)行以下半月板切除操作,采取百分比來計(jì)算每一樣本半月板切除的范圍：(1)內(nèi)30%的內(nèi)側(cè)半月板后角撕裂(Meniscectomy30,M30)；(2)內(nèi)75%的內(nèi)側(cè)半月板后角撕裂(Meniscectomy75, M75);(3)內(nèi)側(cè)半月板后角完全切除(CPH)。用MTS858進(jìn)行生物力學(xué)測(cè)試。統(tǒng)計(jì)學(xué)比較采用SPSS18.0軟件進(jìn)行組問比較。 結(jié)果 桶柄樣撕裂的半月板與對(duì)照組相比,CA顯著減少,MCP (P0.001)和PCP(P0.001)明顯升高。半月板縫合術(shù)后膝關(guān)節(jié)的接觸力學(xué)與對(duì)照組相比差異無統(tǒng)計(jì)學(xué)意義。水平、垂直及交叉縫合后CA的恢復(fù)差異無統(tǒng)計(jì)學(xué)意義。與半月板切除術(shù)相比,3種縫合方式導(dǎo)致的MCP及PCP改變更接近于對(duì)照組,MCP和PCP恢復(fù)百分比差異無統(tǒng)計(jì)學(xué)意義(P分別為0.851和0.987)。半月板組織切除越多,內(nèi)側(cè)和外側(cè)CA下降越明顯,M75和CPH后,內(nèi)側(cè)CA差異無統(tǒng)計(jì)學(xué)意義；內(nèi)側(cè)半月板后角完全切除(CPH)之后,外側(cè)CA顯著減少。M75和CPH之后,內(nèi)側(cè)間室的PCP顯著升高,與對(duì)照組相比差異有統(tǒng)計(jì)學(xué)意義(P0.05),外側(cè)間室CPH后PCP顯著降低(P0.05)。因?yàn)榘朐掳褰M織的切除,其相應(yīng)的應(yīng)變下降；但是各組間差異無統(tǒng)計(jì)學(xué)意義。 結(jié)論 半月板切除多少?zèng)Q定術(shù)后半月板的生物力學(xué)功能；水平、垂直及交叉縫合半月板后脛股關(guān)節(jié)的接觸力學(xué)優(yōu)于半月板部分切除術(shù),不同縫合方式間無明顯差異；因此,對(duì)于半月板的桶柄樣撕裂,尤其是紅區(qū)損傷,應(yīng)盡量選擇半月板縫合術(shù),以避免或者延緩膝關(guān)節(jié)的退行性變。
[Abstract]:Objective the biomechanical functions of meniscus in knee joint include absorption of concussion, lightening of load, coordination of knee motion and stability of knee joint. Traumatic or degenerative meniscus injury often causes knee joint pain and degenerative degeneration, and eventually causes osteoarthritis. In order to preserve the function of meniscus as far as possible, meniscus suture is often used to treat meniscus tear. The commonly used suture techniques are horizontal, vertical and cross suture. Through biomechanical experiments, this paper discusses the change of tibiofemoral joint contact stress after meniscus repair with different suture techniques, and compares it with partial meniscal excision, which provides a mechanical basis for clinical operation. Methods 24 fresh frozen dog hindlimb knee joints (6 male and 6 male) were collected and the primary knee diseases were excluded. The following three states were recorded in each knee joint: control group (complete meniscus), barrel shank tear and meniscus repair. The contact pictures of the control group (complete meniscus) were recorded first, then the meniscus model of barrel shank tear was made. Finally, different surgical methods were used to deal with the meniscus injury: vertical suture, horizontal suture. Cross-suture and meniscal excision. 24 specimens were randomly treated with this method. Recording instantaneous contact area (Instantaneous contact area, CA), average contact pressure (mean contact pressure, MCP) and Peak contact pressure (peak contact pressure, PCP). By pressure Sensor The knee joint is placed at a normal standing angle, the Scotch needle is parallel to the ground, the knee joint is pressurized, varus, flexion, and internal and external rotation; the embedded tibial end is fixed in a custom sliding platform, allowing rotation, Head and tail and internal and external translation of 8 fresh frozen mixture of dog hind limbs and knee joint specimens, sequential meniscal excision operation, Take the percentage to calculate the range of meniscal excision for each sample: (1) in 30% of the medial meniscus posterior angle tear (Meniscectomy30,M30); (2) 75% of the medial meniscus posterior horn tear (Meniscectomy75, M75); (3) the medial meniscus posterior horn is completely removed (CPH). Biomechanical tests were carried out with MTS858. Statistical comparison was conducted by SPSS18.0 software. Results compared with the control group, the meniscus of bucket shank tear was significantly decreased in MCP (P0. 001) and PCP (P0. 001). The contact mechanics of knee joint after meniscus suture was not significantly different from that of control group. There was no significant difference in CA recovery after horizontal, vertical and cross suture. Compared with meniscal resection, the changes of MCP and PCP were similar to those of the control group (P = 0.851 and 0.987, respectively). The more the meniscal tissue was removed, the lower the medial and lateral CA were, the more significant the difference of CA was between M75 and CPH, the higher the PCP level in the medial interventricular was after the complete (CPH) resection of the medial meniscus, the decrease of CA in the medial meniscus was significantly lower than that in the M75 and CPH. Compared with the control group, the difference was statistically significant (P0.05), the PCP decreased significantly after CPH (P0.05). As meniscus tissue was removed, the corresponding strain decreased, but there was no significant difference among the groups. Conclusion how much meniscectomy determines the biomechanical function of meniscus, the contact mechanics of tibiofemoral joint after horizontal, vertical and cross suture of meniscus is superior to partial meniscal resection, and there is no significant difference between different suture methods. Therefore, meniscus suture should be chosen as far as possible to avoid or delay the degeneration of knee joint.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2013
【分類號(hào)】：R687.4;R318.01
本文編號(hào)：2228290
[Abstract]:Objective the biomechanical functions of meniscus in knee joint include absorption of concussion, lightening of load, coordination of knee motion and stability of knee joint. Traumatic or degenerative meniscus injury often causes knee joint pain and degenerative degeneration, and eventually causes osteoarthritis. In order to preserve the function of meniscus as far as possible, meniscus suture is often used to treat meniscus tear. The commonly used suture techniques are horizontal, vertical and cross suture. Through biomechanical experiments, this paper discusses the change of tibiofemoral joint contact stress after meniscus repair with different suture techniques, and compares it with partial meniscal excision, which provides a mechanical basis for clinical operation. Methods 24 fresh frozen dog hindlimb knee joints (6 male and 6 male) were collected and the primary knee diseases were excluded. The following three states were recorded in each knee joint: control group (complete meniscus), barrel shank tear and meniscus repair. The contact pictures of the control group (complete meniscus) were recorded first, then the meniscus model of barrel shank tear was made. Finally, different surgical methods were used to deal with the meniscus injury: vertical suture, horizontal suture. Cross-suture and meniscal excision. 24 specimens were randomly treated with this method. Recording instantaneous contact area (Instantaneous contact area, CA), average contact pressure (mean contact pressure, MCP) and Peak contact pressure (peak contact pressure, PCP). By pressure Sensor The knee joint is placed at a normal standing angle, the Scotch needle is parallel to the ground, the knee joint is pressurized, varus, flexion, and internal and external rotation; the embedded tibial end is fixed in a custom sliding platform, allowing rotation, Head and tail and internal and external translation of 8 fresh frozen mixture of dog hind limbs and knee joint specimens, sequential meniscal excision operation, Take the percentage to calculate the range of meniscal excision for each sample: (1) in 30% of the medial meniscus posterior angle tear (Meniscectomy30,M30); (2) 75% of the medial meniscus posterior horn tear (Meniscectomy75, M75); (3) the medial meniscus posterior horn is completely removed (CPH). Biomechanical tests were carried out with MTS858. Statistical comparison was conducted by SPSS18.0 software. Results compared with the control group, the meniscus of bucket shank tear was significantly decreased in MCP (P0. 001) and PCP (P0. 001). The contact mechanics of knee joint after meniscus suture was not significantly different from that of control group. There was no significant difference in CA recovery after horizontal, vertical and cross suture. Compared with meniscal resection, the changes of MCP and PCP were similar to those of the control group (P = 0.851 and 0.987, respectively). The more the meniscal tissue was removed, the lower the medial and lateral CA were, the more significant the difference of CA was between M75 and CPH, the higher the PCP level in the medial interventricular was after the complete (CPH) resection of the medial meniscus, the decrease of CA in the medial meniscus was significantly lower than that in the M75 and CPH. Compared with the control group, the difference was statistically significant (P0.05), the PCP decreased significantly after CPH (P0.05). As meniscus tissue was removed, the corresponding strain decreased, but there was no significant difference among the groups. Conclusion how much meniscectomy determines the biomechanical function of meniscus, the contact mechanics of tibiofemoral joint after horizontal, vertical and cross suture of meniscus is superior to partial meniscal resection, and there is no significant difference between different suture methods. Therefore, meniscus suture should be chosen as far as possible to avoid or delay the degeneration of knee joint.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2013
【分類號(hào)】：R687.4;R318.01
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