本文選題：膝內(nèi)翻　切入點(diǎn)：脛骨高位截骨　出處：《河北醫(yī)科大學(xué)》2015年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的:本課題通過(guò)采用壓敏片技術(shù)和正常尸體膝關(guān)節(jié),直接測(cè)定正常膝關(guān)節(jié)、脛骨高位截骨內(nèi)固定術(shù)后膝內(nèi)翻0度、2度、4度、6度,…,30度膝關(guān)節(jié)內(nèi)側(cè)間室的接觸應(yīng)力改變。分析膝內(nèi)翻角度的改變對(duì)內(nèi)側(cè)間室壓力的影響,并將采集到的數(shù)據(jù)進(jìn)行分析,找到隨著膝內(nèi)翻角度的增加內(nèi)側(cè)間室接觸應(yīng)力變化的相關(guān)性,為膝關(guān)節(jié)內(nèi)翻畸形的膝骨性關(guān)節(jié)炎的力學(xué)及臨床治療提供一些參考信息。方法:選取6例新鮮成年男性尸體下肢標(biāo)本(其中左側(cè)三例,右側(cè)三例,分別源自3具成年男性尸體),經(jīng)過(guò)提前嚴(yán)格測(cè)量下肢機(jī)械力線為0°,股骨脛骨角約為172度(此時(shí)膝關(guān)節(jié)無(wú)內(nèi)翻畸形)。實(shí)驗(yàn)前行X線檢查見(jiàn)每個(gè)膝關(guān)節(jié)間隙勻稱(chēng),關(guān)節(jié)軟骨完整,骨骼無(wú)明顯骨質(zhì)改變及解剖學(xué)變異。6例下肢標(biāo)本從尸體股骨上中段離斷后剔除軟組織,股骨保留25cm,脛骨及腓骨保留25cm。在剔除膝關(guān)節(jié)周?chē)浗M織時(shí),著重保留膝關(guān)節(jié)前、后交叉韌帶、內(nèi)外側(cè)副韌帶及內(nèi)、外側(cè)半月板的解剖學(xué)完整,以免影響正常脛股關(guān)節(jié)接觸應(yīng)力;保留上脛腓韌帶維持脛腓骨的連接;保護(hù)脛股關(guān)節(jié)、髕股關(guān)節(jié)處理過(guò)程中不被破壞,共組成6套膝關(guān)節(jié)骨標(biāo)本。透視下于脛骨關(guān)節(jié)面下2cm行近端截?cái)嗝劰?在腓側(cè)插入異形鋼板固定離斷的脛骨斷端。安裝固定異形鋼板,透視后再次測(cè)量脛股骨角為172度。調(diào)整異形鋼板的角度,軸向加壓(700N),利用壓敏片測(cè)量膝關(guān)節(jié)內(nèi)側(cè)間室的應(yīng)力變化。結(jié)果:6個(gè)標(biāo)本的數(shù)據(jù)均表明隨著膝內(nèi)翻角度的增大,膝關(guān)節(jié)內(nèi)側(cè)間室應(yīng)力逐漸增加,當(dāng)膝內(nèi)翻角度為0度時(shí),內(nèi)側(cè)間室應(yīng)力值為1.611±0.363 MPa,隨膝內(nèi)翻角度由0度逐漸增加至10度時(shí),其內(nèi)側(cè)間室應(yīng)力值顯著增加5.113±0.796 MPa,當(dāng)角度達(dá)到14度時(shí)達(dá)到了實(shí)驗(yàn)中的最高數(shù)據(jù):8.032±1.088 MPa;之后隨著角度的增加,膝關(guān)節(jié)內(nèi)側(cè)間室的應(yīng)力值開(kāi)始逐漸減小,到膝內(nèi)翻角度為30度時(shí)應(yīng)力值壓力為:2.009±0.386 MPa。各組數(shù)據(jù)用Bartlett法進(jìn)行方差齊性檢驗(yàn),證明方差齊有可比性。采用單因素方差分析得出隨著膝內(nèi)翻角度的變化,膝關(guān)節(jié)內(nèi)側(cè)間室的應(yīng)力而變化,其數(shù)據(jù)具有統(tǒng)計(jì)學(xué)意義(χ2=18.976,P0.01)。結(jié)論:隨膝內(nèi)翻角度的增大膝關(guān)節(jié)的內(nèi)側(cè)間室應(yīng)力值發(fā)生了顯著的變化,并在14度時(shí)達(dá)到高峰,那么膝Qg翻的角度越小,內(nèi)側(cè)間室接觸應(yīng)力越小,所以臨床上利用楔形截骨的術(shù)式,減輕膝關(guān)節(jié)內(nèi)側(cè)間室的負(fù)荷,改善伴膝內(nèi)翻畸形的膝骨性關(guān)節(jié)炎的癥狀及延緩病程。這就是脛骨高位截骨治療膝內(nèi)翻內(nèi)側(cè)間室骨性關(guān)節(jié)炎的機(jī)制。隨著膝關(guān)節(jié)內(nèi)翻角度的增加,膝關(guān)節(jié)內(nèi)側(cè)間室脛股關(guān)節(jié)接觸點(diǎn)內(nèi)移至膝關(guān)節(jié)內(nèi)側(cè)緣,壓力主要集中在內(nèi)側(cè)邊緣。很多因素的變化都會(huì)影響到膝關(guān)節(jié)內(nèi)側(cè)間室受力負(fù)荷,如承重量、承重時(shí)間、膝關(guān)節(jié)的姿勢(shì)、脛股關(guān)節(jié)接觸面大小、關(guān)節(jié)軟骨畸形退變程度、骨贅的形成和實(shí)驗(yàn)方法等,所以膝內(nèi)翻角度再度增加(14°-30°),膝關(guān)節(jié)所承受的應(yīng)力值會(huì)進(jìn)一步內(nèi)移至內(nèi)側(cè)間室內(nèi)側(cè)緣。
[Abstract]:Objective: the purpose of this study was to measure the normal knee joint directly by using the technique of pressure sensitive film and the normal cadaveric knee joint. The knee varus of 0 degrees and 4 degrees and 6 degrees after high tibial osteotomy were measured. ... The change of contact stress in the medial compartment of the knee joint at 30 degrees. The effect of the change of the knee varus angle on the pressure of the medial compartment was analyzed, and the collected data were analyzed. To find the correlation between the contact stress changes of the medial compartment with the increase of the genu varus angle, Methods: six fresh adult male cadavers (including 3 left and 3 right) were selected for mechanical and clinical treatment of knee osteoarthritis with varus knee deformity. The mechanical force line of lower extremity was 0 擄and the tibial angle of femur was about 172 degrees after strict measurement of mechanical force line of lower extremity in 3 adult male cadavers. Before the experiment, X-ray examination showed that the space of each knee joint was symmetrical and the articular cartilage was intact. There were no significant bone changes and anatomical variations in the bones. 6 cases of lower extremity specimens were removed soft tissue from the upper and middle femur of cadaveric cadaver, the femur retained 25 cm, tibia and fibula preserved 25 cm. When removing soft tissue around the knee joint, the emphasis was placed on the preservation of the knee joint. The anatomical integrity of the posterior cruciate ligament, the internal and external collateral ligament and the medial and lateral meniscus so as not to affect the contact stress of the normal tibiofemoral joint; the preservation of the upper tibiofibular ligament to maintain the tibiofibular connection; and the protection of the tibiofemoral joint, During the treatment of patellofemoral joint, 6 sets of knee bone specimens were formed. The proximal tibia was amputated 2 cm below the articular surface of tibia under fluoroscopy, and the broken tibia was fixed with special-shaped plate in peroneal side. The angle of tibial femur was measured again after fluoroscopy to 172 degrees. Adjusting the angle of profiled plate, axial compression was used to measure the stress change of medial compartment of knee joint. Results: the data of 6 specimens showed that the angle of knee varus increased with the increase of knee varus angle. The stress of medial interventricular of knee joint increased gradually. When the angle of genu varus was 0 degrees, the stress value of medial interventricular was 1.611 鹵0.363 MPa, and gradually increased from 0 degree to 10 degree with the angle of genu varus. The stress value of medial compartment increased 5.113 鹵0.796 MPa, and reached the maximum value of 8.032 鹵1.088 MPa when the angle reached 14 degrees, then the stress value of medial compartment of knee joint began to decrease with the increase of angle. When the knee varus angle is 30 degrees, the stress and pressure are: 2. 009 鹵0. 386 MPa. The Bartlett method is used to test the homogeneity of variance, which proves that the variance is comparable. The single factor ANOVA is used to obtain the variation with the knee varus angle. The stress of the medial compartment of the knee joint changed with statistical significance (蠂 ~ (2) 18.976) (P < 0.01). Conclusion: the stress value of the medial compartment of the knee joint changed significantly with the increase of the knee varus angle, and reached the peak at 14 degrees. Then the smaller the angle of QG inversion of the knee, the smaller the contact stress of the medial compartment, so the wedge osteotomy is used clinically to reduce the load of the medial compartment of the knee joint. Improve the symptoms of knee osteoarthritis with varus genu deformity and delay the course. This is the mechanism of high tibial osteotomy in the treatment of osteoarthritis in the medial compartment of genu varus. The medial tibiofemoral joint contact point was moved to the medial edge of the knee joint, and the pressure was concentrated on the medial edge of the knee joint. The changes of many factors would affect the load of the medial compartment of the knee joint, such as bearing weight, bearing time, and the posture of the knee joint. Because of the size of tibiofemoral joint contact surface, degenerative degree of articular cartilage, formation of osteophyte and experimental methods, the knee varus angle was increased again by 14 擄-30 擄, and the stress value of knee joint would move further to the lateral edge of the medial interior.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R687.4

【共引文獻(xiàn)】

相關(guān)博士學(xué)位論文 前10條

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