循環(huán)載荷對(duì)腓骨長(zhǎng)肌腱重建下脛腓聯(lián)合損傷的生物力學(xué)性能分析
發(fā)布時(shí)間：2018-10-12 17:09
【摘要】：目的下脛腓聯(lián)合韌帶的損傷在踝關(guān)節(jié)骨折中較常見(jiàn)。當(dāng)前,下脛腓聯(lián)合韌帶損傷的治療方法較多,主要以下脛腓螺釘固定為主,但螺釘治療的皮質(zhì)層數(shù)、螺釘數(shù)量、置入位置、取釘時(shí)間等仍無(wú)統(tǒng)一標(biāo)準(zhǔn)。由于下脛腓聯(lián)合關(guān)節(jié)的微動(dòng)生理特性,近年來(lái),越來(lái)越多的學(xué)者提倡彈性固定的方法。利用腓骨長(zhǎng)肌腱重建下脛腓聯(lián)合損傷,符合下脛腓的生理微動(dòng)特點(diǎn),本實(shí)驗(yàn)探討循環(huán)載荷對(duì)腓骨長(zhǎng)肌腱重建下脛腓聯(lián)合韌帶損傷的生物力學(xué)性能,為臨床選擇有效的彈性固定提供基礎(chǔ)理論依據(jù)。方法采集8具新鮮成人下肢尸體標(biāo)本,制成正常組(N),失穩(wěn)組(I)與腓骨長(zhǎng)肌腱重建組(B),用壓敏片技術(shù)分別測(cè)量8具正常標(biāo)本不同體位(中立位、背伸200、跖屈300)下的接觸面積S(cm2)、接觸壓PCP(N/cm2)。再對(duì)所有標(biāo)本用德國(guó)引進(jìn)的Zwik-100HFP 5100B低頻疲勞試驗(yàn)機(jī)進(jìn)行動(dòng)態(tài)力學(xué)測(cè)定,以1HZ頻率軸向加載750N,3000次,模擬患者術(shù)后功能鍛煉行走步態(tài)施加循環(huán)載荷,分別在不同體位(中立位、背伸200、跖屈300、旋后外旋250)下進(jìn)行動(dòng)態(tài)循環(huán)載荷實(shí)驗(yàn),測(cè)量下脛腓縱向位移(U)和水平位移(V)。然后切斷8具標(biāo)本的下脛腓聯(lián)合前韌帶,測(cè)量失穩(wěn)狀態(tài)下踝關(guān)節(jié)在不同體位下(中立位、背伸200、跖屈300、旋后外旋250)的循環(huán)載荷的脛腓骨縱向(U)和水平(V)位移值,再用腓骨長(zhǎng)肌腱經(jīng)下脛腓聯(lián)合前韌帶與骨間韌帶斜行平行下脛腓前韌帶重建,用8mm界面擠壓螺釘固定腓骨長(zhǎng)肌腱,用壓敏片技術(shù)測(cè)量其在不同體位、不同預(yù)張力下(20N、40N、60N、80N)脛距關(guān)節(jié)的接觸面積S(cm2)、接觸壓PCP(N/cm2)。進(jìn)行統(tǒng)計(jì)學(xué)分析,得出較適合的預(yù)張力,在此預(yù)張力下建立重建模型行循環(huán)載荷試驗(yàn),與正常標(biāo)本組循環(huán)載荷試驗(yàn)得出的數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析比較。結(jié)果下脛腓聯(lián)合韌帶損傷后,脛骨和腓骨的動(dòng)態(tài)位移性能發(fā)生明顯的異常變化,在與正常標(biāo)本組相比較時(shí)呈現(xiàn)出顯著性差異(P0.05);用腓骨長(zhǎng)肌腱重建下脛腓聯(lián)合韌帶損傷能達(dá)到彈性固定的目的,其動(dòng)態(tài)分離位移能達(dá)到或接近正常(P0.05);在不同預(yù)張力下用腓骨長(zhǎng)肌腱重建下脛腓聯(lián)合韌帶損傷對(duì)踝關(guān)節(jié)穩(wěn)定性有明顯影響,且以60N預(yù)張力重建為宜。結(jié)論在60N預(yù)張力下用腓骨長(zhǎng)肌腱重建下脛腓聯(lián)合韌帶損傷的循環(huán)載荷試驗(yàn)證明腓骨長(zhǎng)肌腱重建下脛腓聯(lián)合損傷動(dòng)態(tài)力學(xué)性能十分優(yōu)越,大大改善了踝關(guān)節(jié)的活動(dòng)度,能適應(yīng)距骨運(yùn)動(dòng)順應(yīng)性調(diào)節(jié),能達(dá)到并恢復(fù)踝關(guān)節(jié)的正常生理功能。腓骨長(zhǎng)肌腱彈性固定治療下脛腓聯(lián)合韌帶損傷符合下脛腓聯(lián)合的正常生理結(jié)構(gòu),避免了常規(guī)螺釘固定的松動(dòng)或發(fā)生疲勞斷裂,為臨床治療下脛腓聯(lián)合韌帶損傷提供理論依據(jù)。
[Abstract]:Objective the injury of inferior tibiofibular ligament is common in ankle fracture. At present, there are many treatment methods for the injury of the inferior tibiofibular ligament, mainly the following tibiofibular screw fixation, but the number of cortical layer, the number of screws, the position of the screw, the time of nailing still have no unified standard. In recent years, more and more scholars advocate elastic fixation because of the fretting physiological characteristics of the tibiofibular joint. Reconstruction of the injury of the tibiofibular syndesmosis using the long fibula tendon is in accordance with the physiological fretting characteristics of the inferior tibiofibular fibula. The biomechanical properties of cyclic loading on the reconstruction of the inferior tibiofibular syndesmosis ligament injury by the fibular long tendon were studied in this experiment. To provide a theoretical basis for clinical selection of effective elastic fixation. Methods eight fresh adult cadavers were collected and made into normal (N), unstable group (I) and peroneal long tendon reconstruction group (B), respectively measured by pressure sensitive film technique in different positions (neutral position) of 8 normal specimens. The contact area S (cm2) and the contact pressure PCP (N/cm2) were obtained under the condition of dorsal extension 200 and plantar flexion 300. The dynamic mechanics of all specimens was measured by Zwik-100HFP 5100B low frequency fatigue testing machine imported from Germany. 750NV 3000 times of axial loading with 1HZ frequency were used to simulate the patients' walking gait and applied cyclic load in different positions (neutral position). Dynamic cyclic loading experiments were carried out under the conditions of dorsal extension 200, metatarsal flexion 300, circumflex rotation 250). The longitudinal displacement (U) and horizontal displacement (V). Of the tibiofibular were measured. The tibiofibular longitudinal (U) and horizontal (V) displacement of ankle under different positions (neutral position, dorsal extension 200, metatarsal flexion 300, circumflex 250) were measured by transecting the anterior tibiofibular ligament of 8 specimens. The anterior tibiofibular ligament was reconstructed through the anterior ligament of inferior tibiofibular syndesmosis and the oblique interosseous ligament. The tendon of the long fibula was fixed with 8mm interface compression screw, and its position was measured by pressure sensitive film technique. The contact area S (cm2) and the contact pressure PCP (N/cm2) of the tibiotalar joint were observed under different pretension (20 NV 40 NV 60 NV 80 N). Through statistical analysis, a more suitable pretension was obtained, under which the reconstruction model was established and the cyclic load test was carried out, and the data obtained from the cyclic load test of the normal specimen group were statistically analyzed and compared. Results the dynamic displacement of the tibia and fibula showed obvious abnormal changes after the injury of the tibiofibular syndesmosis ligament. Compared with the normal group, there was significant difference (P0.05). The injury of the inferior tibiofibular syndesmosis ligament with the long fibula tendon could achieve the purpose of elastic fixation. The dynamic separation displacement could reach or close to normal (P0.05); the reconstruction of inferior tibiofibular syndesmosis ligament with long fibula tendon under different pretension had a significant effect on the stability of ankle joint, and 60N pretension reconstruction was appropriate. Conclusion the cyclic loading test of reconstruction of tibiofibular syndesmous ligament injury with fibula long tendon under 60 N pretension proves that the dynamic mechanical properties of reconstruction of tibiofibular syndesmosis injury with fibula long tendon are superior, and the motion of ankle joint is greatly improved. It can adapt to the compliance regulation of talus motion and achieve and restore the normal physiological function of ankle joint. The treatment of ligamentous injury of inferior tibiofibular syndesmosis with elastic fixation of long tendon of fibula accords with the normal physiological structure of inferior tibiofibular syndesmosis and avoids loosening of conventional screw fixation or fatigue rupture, which provides theoretical basis for clinical treatment of ligamentous injury of inferior tibiofibular syndesmosis.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3
本文編號(hào)：2266912
[Abstract]:Objective the injury of inferior tibiofibular ligament is common in ankle fracture. At present, there are many treatment methods for the injury of the inferior tibiofibular ligament, mainly the following tibiofibular screw fixation, but the number of cortical layer, the number of screws, the position of the screw, the time of nailing still have no unified standard. In recent years, more and more scholars advocate elastic fixation because of the fretting physiological characteristics of the tibiofibular joint. Reconstruction of the injury of the tibiofibular syndesmosis using the long fibula tendon is in accordance with the physiological fretting characteristics of the inferior tibiofibular fibula. The biomechanical properties of cyclic loading on the reconstruction of the inferior tibiofibular syndesmosis ligament injury by the fibular long tendon were studied in this experiment. To provide a theoretical basis for clinical selection of effective elastic fixation. Methods eight fresh adult cadavers were collected and made into normal (N), unstable group (I) and peroneal long tendon reconstruction group (B), respectively measured by pressure sensitive film technique in different positions (neutral position) of 8 normal specimens. The contact area S (cm2) and the contact pressure PCP (N/cm2) were obtained under the condition of dorsal extension 200 and plantar flexion 300. The dynamic mechanics of all specimens was measured by Zwik-100HFP 5100B low frequency fatigue testing machine imported from Germany. 750NV 3000 times of axial loading with 1HZ frequency were used to simulate the patients' walking gait and applied cyclic load in different positions (neutral position). Dynamic cyclic loading experiments were carried out under the conditions of dorsal extension 200, metatarsal flexion 300, circumflex rotation 250). The longitudinal displacement (U) and horizontal displacement (V). Of the tibiofibular were measured. The tibiofibular longitudinal (U) and horizontal (V) displacement of ankle under different positions (neutral position, dorsal extension 200, metatarsal flexion 300, circumflex 250) were measured by transecting the anterior tibiofibular ligament of 8 specimens. The anterior tibiofibular ligament was reconstructed through the anterior ligament of inferior tibiofibular syndesmosis and the oblique interosseous ligament. The tendon of the long fibula was fixed with 8mm interface compression screw, and its position was measured by pressure sensitive film technique. The contact area S (cm2) and the contact pressure PCP (N/cm2) of the tibiotalar joint were observed under different pretension (20 NV 40 NV 60 NV 80 N). Through statistical analysis, a more suitable pretension was obtained, under which the reconstruction model was established and the cyclic load test was carried out, and the data obtained from the cyclic load test of the normal specimen group were statistically analyzed and compared. Results the dynamic displacement of the tibia and fibula showed obvious abnormal changes after the injury of the tibiofibular syndesmosis ligament. Compared with the normal group, there was significant difference (P0.05). The injury of the inferior tibiofibular syndesmosis ligament with the long fibula tendon could achieve the purpose of elastic fixation. The dynamic separation displacement could reach or close to normal (P0.05); the reconstruction of inferior tibiofibular syndesmosis ligament with long fibula tendon under different pretension had a significant effect on the stability of ankle joint, and 60N pretension reconstruction was appropriate. Conclusion the cyclic loading test of reconstruction of tibiofibular syndesmous ligament injury with fibula long tendon under 60 N pretension proves that the dynamic mechanical properties of reconstruction of tibiofibular syndesmosis injury with fibula long tendon are superior, and the motion of ankle joint is greatly improved. It can adapt to the compliance regulation of talus motion and achieve and restore the normal physiological function of ankle joint. The treatment of ligamentous injury of inferior tibiofibular syndesmosis with elastic fixation of long tendon of fibula accords with the normal physiological structure of inferior tibiofibular syndesmosis and avoids loosening of conventional screw fixation or fatigue rupture, which provides theoretical basis for clinical treatment of ligamentous injury of inferior tibiofibular syndesmosis.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3
【參考文獻(xiàn)】
相關(guān)期刊論文 前1條
1 吳偉峰;駱宇春;劉云鵬;張焱;華國(guó)軍;陳斌;柏廣富;王詩(shī)波;;下脛腓聯(lián)合不同走向韌帶重建的生物力學(xué)性能比較[J];中國(guó)矯形外科雜志;2013年24期
，本文編號(hào)：2266912
本文鏈接：http://sikaile.net/yixuelunwen/waikelunwen/2266912.html
最近更新
教材專著
