中华创伤骨科杂志
中華創傷骨科雜誌
중화창상골과잡지
CHINESE JOURNAL OF ORTHOPAEDIC TRAUMA
2011年
1期
60-63
,共4页
潘永谦%李健%赵卫东%赵洪普%张平%陈应超
潘永謙%李健%趙衛東%趙洪普%張平%陳應超
반영겸%리건%조위동%조홍보%장평%진응초
髌骨%关节不稳定性%生物力学
髕骨%關節不穩定性%生物力學
빈골%관절불은정성%생물역학
Patella%Joint instability%Biomechanics
目的 评价传统与改良Elmslie-Trillat术治疗髌骨不稳定的生物力学特性,为改良Elmslie-Trillat术治疗髌骨不稳定提供生物力学依据.方法 先对12具新鲜冰冻成人尸体膝关节完整标本(完整膝关节组,12具)进行生物力学测试测量髌骨移位距离,切断内侧髌股韧带制成髌骨不稳定模型(髌骨不稳定模型组,12具)后再测量髌骨移位距离,然后随机再分为2组(传统Elmslie-Trillat术组及改良Elmslie-Trillat术组,每组6具标本)分别采用传统和改良Elmslie-Trillat术矫正.膝关节屈曲30°位固定胫骨及股骨端,将标本安装在MTS-858实验机上,通过髌骨中心外侧施加20 N的载荷,测量髌骨移位距离.结果 完整膝关节组、髌骨不稳定模型组、传统Elmslie-Trillat术组及改良Elmslie-Trillat术组的髌骨外侧移位距离平均分别为(6.2±0.6)、(11.3±0.9)、(6.4±0.8)、(6.7±0.8)mm,4组外侧减内侧移位距离平均分别为(-1.5±0.5)、(3.5±0.4)、(-1.4±1.0)、(-1.3±1.0)mm.髌骨不稳定模型组的外侧移位距离和外侧减内侧移位距离分别与其他3组比较,差异均有统计学意义(P<0.05);完整膝关节组、传统Elmslie-Trillat术组及改良Elmslie-Trillat术组的外侧移位距离和外侧减内侧移位距离比较差异均无统计学意义(P>0.05).结论 内侧髌股韧带是髌骨的主要稳定因素.与传统Elmslie-Trillat术比较,改良Elmslie-Trillat术同样能改善髌骨异常力线,减少相同应力下的髌骨位移.
目的 評價傳統與改良Elmslie-Trillat術治療髕骨不穩定的生物力學特性,為改良Elmslie-Trillat術治療髕骨不穩定提供生物力學依據.方法 先對12具新鮮冰凍成人尸體膝關節完整標本(完整膝關節組,12具)進行生物力學測試測量髕骨移位距離,切斷內側髕股韌帶製成髕骨不穩定模型(髕骨不穩定模型組,12具)後再測量髕骨移位距離,然後隨機再分為2組(傳統Elmslie-Trillat術組及改良Elmslie-Trillat術組,每組6具標本)分彆採用傳統和改良Elmslie-Trillat術矯正.膝關節屈麯30°位固定脛骨及股骨耑,將標本安裝在MTS-858實驗機上,通過髕骨中心外側施加20 N的載荷,測量髕骨移位距離.結果 完整膝關節組、髕骨不穩定模型組、傳統Elmslie-Trillat術組及改良Elmslie-Trillat術組的髕骨外側移位距離平均分彆為(6.2±0.6)、(11.3±0.9)、(6.4±0.8)、(6.7±0.8)mm,4組外側減內側移位距離平均分彆為(-1.5±0.5)、(3.5±0.4)、(-1.4±1.0)、(-1.3±1.0)mm.髕骨不穩定模型組的外側移位距離和外側減內側移位距離分彆與其他3組比較,差異均有統計學意義(P<0.05);完整膝關節組、傳統Elmslie-Trillat術組及改良Elmslie-Trillat術組的外側移位距離和外側減內側移位距離比較差異均無統計學意義(P>0.05).結論 內側髕股韌帶是髕骨的主要穩定因素.與傳統Elmslie-Trillat術比較,改良Elmslie-Trillat術同樣能改善髕骨異常力線,減少相同應力下的髕骨位移.
목적 평개전통여개량Elmslie-Trillat술치료빈골불은정적생물역학특성,위개량Elmslie-Trillat술치료빈골불은정제공생물역학의거.방법 선대12구신선빙동성인시체슬관절완정표본(완정슬관절조,12구)진행생물역학측시측량빈골이위거리,절단내측빈고인대제성빈골불은정모형(빈골불은정모형조,12구)후재측량빈골이위거리,연후수궤재분위2조(전통Elmslie-Trillat술조급개량Elmslie-Trillat술조,매조6구표본)분별채용전통화개량Elmslie-Trillat술교정.슬관절굴곡30°위고정경골급고골단,장표본안장재MTS-858실험궤상,통과빈골중심외측시가20 N적재하,측량빈골이위거리.결과 완정슬관절조、빈골불은정모형조、전통Elmslie-Trillat술조급개량Elmslie-Trillat술조적빈골외측이위거리평균분별위(6.2±0.6)、(11.3±0.9)、(6.4±0.8)、(6.7±0.8)mm,4조외측감내측이위거리평균분별위(-1.5±0.5)、(3.5±0.4)、(-1.4±1.0)、(-1.3±1.0)mm.빈골불은정모형조적외측이위거리화외측감내측이위거리분별여기타3조비교,차이균유통계학의의(P<0.05);완정슬관절조、전통Elmslie-Trillat술조급개량Elmslie-Trillat술조적외측이위거리화외측감내측이위거리비교차이균무통계학의의(P>0.05).결론 내측빈고인대시빈골적주요은정인소.여전통Elmslie-Trillat술비교,개량Elmslie-Trillat술동양능개선빈골이상력선,감소상동응력하적빈골위이.
Objective To evaluate the biomechanical performance of the modified Elmslie-Trillat procedure in the treatment of patellar instability as compared with traditional Elmslie-Trillat procedure.Methods Twelve fresh frozen cadaveric specimens of intact knee joint were used in this study.First biomechanical measurements were performed to compare the patellar displacements between the intact knee joints and models of patellar instability which were made by cutting the medial patellofemoral ligaments.Next the models of patellar instability were randomized into 2 groups for treatments with traditional and modified Elmslie-Trillat procedures respectively.After the tibiofemoral joint was held at 30 degrees of flexion, a load of 20 N was applied to the lateral center of the patella.The patellar displacements were measured with transducers in an Instron Testing System.Results The lateral patellar displacement was respectively 6.2 ±0.6 mm, 11.3 ± 0.9 mm, 6.4 ± 0.8 mm and 6.7 ± 0.8 mm and the lateral minus medial patellar displacement was respectively - 1.5 ± 0.5 mm, 3.5 ± 0.4 mm, - 1.4 ± 1.0 mm and - 1.3 ± 1.0 mm for the 4 groups of intact knee joint, patellar instability, traditional Elmslie-Trillat procedure treatment and modified Elmslie-Trillat procedure treatment.There were significant differences in both of the patellar displacements between the patellar instability group and the other 3 groups ( P < 0.05).There was no significant difference in both of the patellar displacements among the 3 groups of intact knee joint, traditional Elmslie-Trillat procedure treatment and modified Elmslie-Trillat procedure treatment ( P > 0.05 ).Conclusion Since the medial patellofemoral ligament is a main stable factor for patella, patellar abnormal traction can be improved and patellar displacement can be reduced under the same loading by both modified and traditional Elmslie-Trillat procedures.