CAJ | 학술논문

背景:关节镜下前交叉韧带重建可以有效地解决前交叉韧带损伤引起的膝关节不稳症状,而双骨道(胫骨单骨道-股骨单骨道)与三骨道(胫骨单骨道-股骨双骨道)前交叉韧带重建是目前较为常用的重建方式. 目的:探讨双骨道与三骨道前交叉韧带双束重建对膝关节稳定性的影响. 方法:选用8具新鲜正常成人尸体膝关节标本,分别进行双骨道与三骨道前交叉韧带双束重建,然后在MTS-809生物力学测试系统上测试膝关节在胫前加载(134 N)以及胫骨旋转加载(5 N?m内旋)下屈曲0°,15°,30°,60°,90°时的膝关节稳定性. 结果与结论:①胫前加载:在所测的5个角度下,两重建组的胫前位移较前交叉韧带完整组均增大,但差异无显著性意义(P>0.05);双骨道重建组较三骨道重建组胫前位移增大,但差异无显著性意义(P>0.05).②旋转加载:在所测的5个角度下,前交叉韧带完整组的胫前位移最小,双骨道重建组与三骨道重建组比较,在膝关节屈曲0°,15°和90°时,差异无显著性意义(P>0.05),在膝关节屈曲30°和60°时,三骨道重建组胫前位移小于双骨道重建组,差异有显著性意义(P<0.05);三骨道重建组与前交叉韧带完整组比较,差异无显著性意义(P>0.05).提示双骨道与三骨道前交叉韧带双束重建均可促进膝关节前后及旋转稳定性的恢复,三骨道前交叉韧带双束重建与双骨道前交叉韧带双束重建相比,显示了更好恢复膝关节旋转稳定性的作用.
배경:관절경하전교차인대중건가이유효지해결전교차인대손상인기적슬관절불은증상,이쌍골도(경골단골도-고골단골도)여삼골도(경골단골도-고골쌍골도)전교차인대중건시목전교위상용적중건방식. 목적:탐토쌍골도여삼골도전교차인대쌍속중건대슬관절은정성적영향. 방법:선용8구신선정상성인시체슬관절표본,분별진행쌍골도여삼골도전교차인대쌍속중건,연후재MTS-809생물역학측시계통상측시슬관절재경전가재(134 N)이급경골선전가재(5 N?m내선)하굴곡0°,15°,30°,60°,90°시적슬관절은정성. 결과여결론:①경전가재:재소측적5개각도하,량중건조적경전위이교전교차인대완정조균증대,단차이무현저성의의(P>0.05);쌍골도중건조교삼골도중건조경전위이증대,단차이무현저성의의(P>0.05).②선전가재:재소측적5개각도하,전교차인대완정조적경전위이최소,쌍골도중건조여삼골도중건조비교,재슬관절굴곡0°,15°화90°시,차이무현저성의의(P>0.05),재슬관절굴곡30°화60°시,삼골도중건조경전위이소우쌍골도중건조,차이유현저성의의(P<0.05);삼골도중건조여전교차인대완정조비교,차이무현저성의의(P>0.05).제시쌍골도여삼골도전교차인대쌍속중건균가촉진슬관절전후급선전은정성적회복,삼골도전교차인대쌍속중건여쌍골도전교차인대쌍속중건상비,현시료경호회복슬관절선전은정성적작용.
BACKGROUND:Arthroscopic anterior cruciate ligament reconstruction can effectively solve the symptoms of knee instability caused by anterior cruciate ligament injury, while double-tunnel double-bundle (single tibia tunnel-single femoral tunnel) and three-tunnel double-bundle (single tibia tunnel-double femoral tunnel) anterior cruciate ligament reconstruction are common repairing methods in clinic. @@@@OBJECTIVE:To investigate the effect of double-tunnel double-bundle and three-tunnel double-bundle anterior cruciate ligament reconstructions on the instability of knee joint. @@@@METHODS:Eight fresh-frozen human cadaveric knee specimens were selected and treated with double-tunnel double-bundle and three-tunnel double-bundle anterior cruciate ligament reconstructions respectively, and the instability of knee joint under an anterior tibial load (134 N) and internal tibial torques load (5 N?m) at 0°, 15°, 30°, 60 ° and 90 °of flexion were tested using MTS-809 biomechanics test system. @@@@RESULTS AND CONCLUSION: ①Anterior tibial load:the displacement of two reconstruction groups under five angles stated above were larger than that of anterior cruciate ligament intact group, and the difference was not significant (P>0.05);while the anterior tibial replacement in double-tunnel double-bundle anterior cruciate ligament reconstruction group was larger than that in the three-tunnel double-bundle anterior cruciate ligament reconstruction group, and the difference was not significant (P>0.05). ②Tibial torques load:under five angles stated above, the anterior tibial replacement of anterior cruciate ligament intact group was smal est, and there was no significant difference of anterior tibial replacement under 0°, 15° and 90° flexion between double-tunnel double-bundle anterior cruciate ligament reconstruction group and three-tunnel double-bundle anterior cruciate ligament reconstruction group (P>0.05), while the anterior tibial replacement under 30° and 60° flexion in the three-tunnel double-bundle anterior cruciate ligament reconstruction group was smal er than that in the double-tunnel double-bundle anterior cruciate ligament reconstruction group, and the difference was significant (P<0.05);there was no significant difference of anterior tibial replacement between three-tunnel double-bundle anterior cruciate ligament reconstruction group and anterior cruciate ligament intact group (P>0.05). The anterior-posterior and rotational stability of knee joint could be improved by double-tunnel double-bundle and three-tunnel double-bundle anterior cruciate ligament reconstructions. But compared with double-tunnel double-bundle anterior cruciate ligament reconstruction, three-tunnel double-bundle anterior cruciate ligament reconstruction can effectively provide more rotational stability of knee joint.