本文選題：膝關(guān)節(jié) + 腓骨截骨�。� 參考：《河北北方學(xué)院》2017年碩士論文

【摘要】：我們?yōu)榱藴y(cè)量腓骨高位截骨前后膝關(guān)節(jié)內(nèi)外側(cè)間室接觸特征的改變情況,探討其對(duì)膝關(guān)節(jié)應(yīng)力改變的影響�，F(xiàn)收集膝關(guān)節(jié)上方10cm以上高位截肢帶足標(biāo)本6例,要求標(biāo)本關(guān)節(jié)完整,膝關(guān)節(jié)活動(dòng)正常,X線檢查無骨結(jié)構(gòu)異常。標(biāo)本離體2-4h內(nèi)于-80℃深低溫冰箱保存。實(shí)驗(yàn)前標(biāo)本于4℃冰箱中解凍24個(gè)小時(shí),之后于室溫下繼續(xù)解凍12小時(shí)。解凍完全后對(duì)標(biāo)本進(jìn)行膝關(guān)節(jié)屈伸活動(dòng)200次,以保證標(biāo)本接近正常膝關(guān)節(jié)生理狀態(tài)。固定標(biāo)本時(shí),使標(biāo)本在自然伸直狀態(tài)下置于生物力學(xué)試驗(yàn)機(jī)上,足部先固定于臺(tái)面上自制夾板中,調(diào)節(jié)下肢力線,使其下肢保持在額狀面和矢狀面的中立體位。股骨近端以自凝牙托粉固定在生物力學(xué)試驗(yàn)機(jī)頂端的固定槽中,在固定時(shí)始終保持下肢直立,可根據(jù)體位狀況適當(dāng)調(diào)整足內(nèi)旋或外旋位置,使之更接近自然體位。于髕韌帶兩側(cè)關(guān)節(jié)間隙處縱形切開皮膚,分離軟組織,切開關(guān)節(jié)囊,顯露關(guān)節(jié)間隙。模板測(cè)量獲得內(nèi)、外側(cè)脛骨平臺(tái)形狀及大小。電腦調(diào)節(jié)生物力學(xué)試驗(yàn)機(jī)所需實(shí)驗(yàn)條件,將內(nèi)、外側(cè)關(guān)節(jié)間隙所需使用的壓敏片剪成上述測(cè)試所得形狀,分別在壓敏片最長(zhǎng)軸兩端用細(xì)針打眼標(biāo)記,以兩點(diǎn)連線為壓敏片中軸線。作為腓骨截骨前后計(jì)算壓敏片壓強(qiáng)峰值中心位移改變的參照線。規(guī)定以中軸線為界,所測(cè)得壓敏片壓強(qiáng)峰值中心到中軸線的位移,靠近內(nèi)側(cè)副韌帶側(cè)為正值,遠(yuǎn)離內(nèi)側(cè)副韌帶側(cè)為負(fù)值。將制作好的壓敏片分別置于內(nèi)、外側(cè)關(guān)節(jié)間隙內(nèi)。利用生物力學(xué)實(shí)驗(yàn)機(jī)對(duì)標(biāo)本軸向加壓400N,持續(xù)60s,然后5s內(nèi)卸載壓力,取出壓敏片。相同實(shí)驗(yàn)條件,軸向加壓2次。同一標(biāo)本,相同狀態(tài)下,在腓骨頭下約7cm處使用擺鋸截除約2cm左右腓骨段。相同實(shí)驗(yàn)條件下重復(fù)上述操作2次。將受壓后的壓敏片按不同標(biāo)本的序號(hào)分組排列,用專用儀器和軟件轉(zhuǎn)換數(shù)據(jù),獲得的數(shù)據(jù)取其平均值。分別測(cè)算出在腓骨完整和高位截骨后兩種情況下膝關(guān)節(jié)內(nèi)外側(cè)間室壓強(qiáng)的大小及壓敏片的著色面積,推導(dǎo)出壓力值。同時(shí)標(biāo)記壓敏片上壓強(qiáng)最高值處的5個(gè)點(diǎn),電腦測(cè)量5點(diǎn)到中軸線距離取平均值,作為壓強(qiáng)峰值中心到中軸線的位移。實(shí)驗(yàn)后發(fā)現(xiàn),腓骨截骨前后,外側(cè)間室壓強(qiáng)分別為(1.194±0.285VS 1.607±0.296)×106Pa、接觸面積為(1.144±0.338 VS1.551±0.264)×10-4m2、接觸壓力為(1.328±0.383 VS·2.468±0.629)×102N。兩組間比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。而腓骨截骨前后內(nèi)側(cè)間室壓強(qiáng)分別為(1.966±0.173VS·1.572±0.267)×106 Pa,內(nèi)側(cè)間室壓力為(4.057±0.641 VS 2.699±0.610)×102 N,兩組間比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。而內(nèi)側(cè)間室接觸面積為(2.083±0.274VS·1.728±0.336)×10-4 m2。兩組間比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。腓骨截骨前后內(nèi)側(cè)脛骨平臺(tái)壓強(qiáng)峰值中心與中軸線的位移平均值分別為0.725±1.117mm和-1.412±1.131mm(P0.05),兩組相比具有統(tǒng)計(jì)學(xué)差異;而外側(cè)脛骨平臺(tái)壓強(qiáng)峰值中心與中軸線的位移平均值分別為0.945±1.003mm,-0.493±0.754mm(P0.05),同樣具有統(tǒng)計(jì)學(xué)差異。我們認(rèn)為,腓骨截骨后,外側(cè)脛骨平臺(tái)所承受的壓強(qiáng)、接觸面積及壓力均增加,內(nèi)側(cè)脛骨平臺(tái)壓強(qiáng)、壓力明顯減小,并且內(nèi)外側(cè)間室壓強(qiáng)峰值中心向膝關(guān)節(jié)外側(cè)偏移。表明腓骨截骨影響了膝關(guān)節(jié)內(nèi)外側(cè)間室的應(yīng)力分布,且使內(nèi)側(cè)間室的應(yīng)力中心向外發(fā)生了位移。驗(yàn)證了腓骨截骨治療內(nèi)側(cè)間室膝骨關(guān)節(jié)炎的有效性。為腓骨截骨治療內(nèi)側(cè)膝骨關(guān)節(jié)炎有效性提供了生物力學(xué)的理論基礎(chǔ)。
[Abstract]:In order to measure the changes of the internal and external ventricular contact characteristics of the knee joint before and after the high osteotomy of the fibula, the influence of the stress on the knee joint stress was investigated. 6 specimens of the foot amputation belt above the knee joint above 10cm were collected, and the specimen joints were complete, the knee joint activity was normal, and the X-ray examination had no bone structure abnormality. The specimens were in 2-4h in vitro. The specimens were thawing for 24 hours at 4 centigrade refrigerator for 24 hours, and then defrosting at room temperature for 12 hours. After thawing, the specimens were flexed and extended 200 times to the specimens to ensure that the specimens were close to the normal physiological state of the knee joint. When the specimen was fixed, the specimen was placed under the natural straightening state and placed in the biomechanical test machine. At first, Abe is fixed on the self-made splint on the table to adjust the lower limb force line to keep the lower extremities neutral position on the forehead and sagittal plane. The proximal femur is fixed in the fixed slot at the top of the biomechanics test machine at the proximal end of the femur, and keeps the lower extremities upright at the time of fixation. The internal rotation or external rotation of the foot can be adjusted according to the position condition. Make it closer to the natural position. Cut the skin in the gap between the patellar ligaments, separate the soft tissue, cut the joint capsule and expose the joint space. The shape and size of the internal and lateral tibial plateau are measured by the template. The experimental conditions required by the computer to adjust the biomechanics test machine are cut into the pressure sensitive film used in the internal and lateral joint space. The shape of the above test is marked with a fine needle at both ends of the most long axis of the pressure sensitive plate, and the two lines are used as the central axis of the pressure sensitive plate. As the reference line to calculate the change of the central displacement of the pressure peak value of the pressure sensitive plate before and after the osteotomy of the fibula, the displacement of the pressure peak center to the central axis is measured with the central axis as the boundary, and it is close to the inner side. The ligament side was positive, and the side of the medial collateral ligament was negative. The prepared pressure sensitive tablets were placed in the internal and lateral joint space respectively. The specimen was subjected to the axial compression of 400N with a biomechanical experimental machine and sustained 60s, then the pressure was unloaded in 5S, and the pressure sensitive tablets were removed. The same experimental condition, 2 times of axial compression. Under the same condition, under the fibula head, the same specimen, under the same state, under the fibula About 7cm was used to remove about 2cm around the fibula segment at about 7cm. Under the same experimental conditions, the above operation was repeated. The pressure sensitive tablets were arranged in groups according to the number of different specimens. The data obtained by the special instrument and software were used to obtain the average value. The knee joint was calculated in two cases of the knee joint after the fibula finishing and the high osteotomy. The pressure of the lateral interventricular pressure and the color area of the pressure sensitive film was deduced. At the same time, the 5 points at the highest pressure of the pressure sensitive plate were marked. The distance between the 5 points and the central axis was measured by the computer as the displacement of the center of the pressure peak to the central axis. After the experiment, the pressure of the lateral interventricular chamber was (1.194 + 0.285VS 1), respectively. .607 + 0.296) * 106Pa, the contact area was (1.144 + 0.338 VS1.551 + 0.264) x 10-4m2, and the contact pressure was (1.328 + 0.383 VS 2.468 + 0.629) x 102N. two groups, and there were significant differences (P0.05). The pressure of medial compartment was (1.966 + 0.173VS. 1.572 + 0.267) * 106 Pa respectively. .699 + 0.610) x 102 N, the difference between the two groups was statistically significant (P0.05), but the medial compartment contact area was (2.083 + 0.274VS 1.728 + 0.336) x 10-4 m2. two groups, and there was no statistical difference (P0.05). The average displacement of the peak value center of the medial tibial Plateau and the central axis were 0.725 + 1.117mm and -1.41, respectively. 2 + 1.131mm (P0.05), compared with the two groups, the average value of the lateral tibial plateau pressure peak center and the central axis was 0.945 + 1.003mm, -0.493 + 0.754mm (P0.05), respectively. We think that the pressure, contact area and pressure of the lateral tibial plateau increased after the osteotomy of the fibula. The pressure of the tibial plateau decreased, and the pressure of the internal and external ventricular pressure peak shifted to the lateral of the knee joint. It showed that the fibula osteotomy affected the stress distribution in the inner and outer compartment of the knee joint, and the stress center of the medial compartment was displaced outward. Osteotomy provides a biomechanical theoretical basis for the effectiveness of medial knee osteoarthritis.
【學(xué)位授予單位】：河北北方學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 李健;姚玉龍;張磊磊;程細(xì)高;;雌激素在軟骨中作用機(jī)制研究進(jìn)展[J];中國矯形外科雜志;2016年23期

2 王天，

本文編號(hào)：2044576