本文選題：下脛腓聯(lián)合 + 韌帶　； 參考：《中國人民解放軍醫(yī)學(xué)院》2015年博士論文

【摘要】：目的:探討下脛腓韌帶解剖重建的方法及其對下脛腓聯(lián)合穩(wěn)定性的影響。方法:第一部分①解剖成年豬的新鮮踝關(guān)節(jié)標(biāo)本10例,研究其下脛腓韌帶的解剖特點(diǎn)和踝關(guān)節(jié)的運(yùn)動特點(diǎn),比較其與人體踝關(guān)節(jié)的解剖相似性,建立下脛腓聯(lián)合損傷的實(shí)驗(yàn)動物模型。②研究下脛腓韌帶解剖重建的骨道出入點(diǎn),以及腓骨短肌腱的走行和固定方式。③研究下脛腓韌帶解剖重建對下脛腓聯(lián)合穩(wěn)定性及其生理運(yùn)動的影響。應(yīng)用Instron8874生物力學(xué)試驗(yàn)機(jī)測量下脛腓韌帶完整,完全切斷,韌帶解剖重建以及單枚3.5mm螺釘三皮質(zhì)固定等四種狀態(tài)下,腓骨遠(yuǎn)端相對于脛骨在橫軸和矢狀軸上的運(yùn)動方向和距離。比較不同狀態(tài)下的下脛腓聯(lián)合穩(wěn)定性和生理運(yùn)動的變化。第二部分使用新鮮人體踝關(guān)節(jié)標(biāo)本10例,研究下脛腓韌帶解剖重建的方法,分別在踝關(guān)節(jié)背伸30°位垂直加壓至200N,在踝關(guān)節(jié)0°中立位外旋加扭至10Nm,研究其對下脛腓聯(lián)合穩(wěn)定性的影響。比較下脛腓螺釘固定與韌帶解剖重建后用腓骨相對于脛骨在橫軸和矢狀軸的位移方向及距離,及其對下脛腓聯(lián)合穩(wěn)定性與生理運(yùn)動的影響。結(jié)果:①豬下脛腓聯(lián)合韌帶由下脛腓前韌帶,后韌帶和骨間韌帶組成,與人踝關(guān)節(jié)結(jié)構(gòu)相似,符合下脛腓聯(lián)合損傷的動物模型要求。②使用腓骨短肌腱解剖重建下脛腓韌帶的手術(shù)方式具有臨床可行性和實(shí)用行。③腓骨相對于脛骨的移位距離和方向在下脛腓聯(lián)合韌帶完整與解剖重建狀態(tài)下無顯著性差異。④下脛腓韌帶解剖重建恢復(fù)了下脛腓聯(lián)合的穩(wěn)定性,并允許其生理運(yùn)動存在。結(jié)論①下脛腓聯(lián)合韌帶由下脛腓前韌帶,后韌帶和骨間韌帶組成,與人踝關(guān)節(jié)結(jié)構(gòu)相似,符合下脛腓聯(lián)合損傷的動物模型要求。②使用腓骨短肌腱解剖重建下脛腓韌帶技術(shù)可行實(shí)用。③下脛腓韌帶解剖重建恢復(fù)了下脛腓聯(lián)合的穩(wěn)定性,并允許其生理運(yùn)動存在。
[Abstract]:Objective: to investigate the anatomical reconstruction of the inferior tibiofibular ligament and its effect on the stability of the tibiofibular syndesmosis. Methods: in the first part, 10 fresh ankle specimens of adult pigs were dissected. The anatomical characteristics of the inferior tibiofibular ligament and the motion of the ankle joint were studied, and the anatomic similarity between the ankle joint and the human ankle joint was compared. Establishment of experimental animal model of injury of inferior tibiofibular syndesmosis To study the influence of anatomical reconstruction of inferior tibiofibular ligament on the stability and physiological movement of inferior tibiofibular syndesmosis. Instron8874 biomechanical testing machine was used to measure the movement direction and distance between distal fibula and tibia on the transverse axis and sagittal axis under the four conditions of complete tibiofibular ligament complete amputation anatomic reconstruction and tricortical fixation with single 3.5mm screw. To compare the stability and physiological movement of inferior tibiofibular syndesmosis in different states. In the second part, 10 fresh human ankle specimens were used to study the method of anatomical reconstruction of the lower tibiofibular ligament. The effects of lateral rotation and torsion to 10Nm on the stability of the tibiofibular syndesmosis were studied at 30 擄extension of the ankle and 10 nm in the 0 擄neutral position of the ankle respectively. To compare the displacement direction and distance between fibula and tibia in transverse axis and sagittal axis after fixation and anatomic reconstruction of the inferior tibiofibular screw and its influence on the stability and physiological movement of the tibiofibular syndesmosis. Results the inferior tibiofibular ligament was composed of anterior tibiofibular ligament, posterior ligament and interosseous ligament. In accordance with the animal model of inferior tibiofibular syndesmosis injury, .2 the surgical method of reconstruction of inferior tibiofibular ligament using fibula short tendon anatomy is feasible and practical. 3. 3 fibula displacement distance and direction from tibia to tibia. There was no significant difference between the integrity of the ligaments of the fibular syndesmosis and the anatomic reconstruction of the inferior tibiofibular ligament. 4. The stability of the tibiofibular syndesmosis was restored. And allows its physiological movement to exist. Conclusion 1the inferior tibiofibular ligament is composed of anterior tibiofibular ligament, posterior ligament and interosseous ligament, which is similar to the structure of human ankle joint. In accordance with the animal model of inferior tibiofibular syndesmosis injury, the technique of anatomical reconstruction of inferior tibiofibular ligament with tendon of fibula brevis is feasible and practical. The anatomical reconstruction of inferior tibiofibular ligament can restore the stability of the tibiofibular syndesmosis and allow its physiological movement to exist.
【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級別】：博士
【學(xué)位授予年份】：2015
【分類號】：R687.3;R322

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