CAJ | 학술논문

目的通过在尸体标本上模拟下胫腓联合韧带损伤,明确不同程度的下胫腓韧带损伤对踝关节稳定性的影响. 方法选取防腐尸体下肢标本10具,分别测量垂直加载500 N压力、7种体位下(中立位、背伸位、跖屈位、内翻位、外翻位、内旋位、外旋位)下胫腓联合韧带完整状态(A组)、单纯前韧带断裂(B组)、前韧带+后韧带断裂(C1组)、前韧带+骨间韧带断裂(C2组)、全部韧带断裂+切断骨间膜(＞5 cm)(D组)时,下胫腓联合的分离距离、胫距关节接触面积、平均接触压强及峰值压强的变化.结果在中立位、背伸位、跖屈位、内翻位、外翻位、内旋位、外旋位时,A组、B组标本的下胫腓分离距离、胫距关节接触面积、平均接触压强及峰值压强组内比较差异均无统计学意义(P＞0.05).C1组、C2组、D组在外旋及内翻应力位下,踝关节出现不稳定,下胫腓分离距离增宽均＞2mm,比其他5种体位均明显.与其他各体位比较,在外旋及内翻应力位下下胫腓分离距离、胫距关节接触面积、平均接触压强及峰值压强方面差异均有统计学意义(P＜0.05).随着损伤的加重,下胫腓韧带的分离距离增大,接触面积逐渐缩小,平均压强增大,峰值压强增大,外旋位及内翻位更明显.A、B、C1、C2、D组下胫腓分离距离、胫距关节接触面积、平均接触压强及峰值压强变化趋势基本一致. 结论不同程度的下胫腓联合韧带损伤在大部分体位下,踝关节能保持稳定,可满足普通人群的日常负重需求.但在外旋和内翻位下,会明显影响踝关节的稳定性.建议在中、重度韧带损伤时,需对下胫腓韧带修复固定,特别是对于踝关节要求更高的人群.
목적 통과재시체표본상모의하경비연합인대손상,명학불동정도적하경비인대손상대과관절은정성적영향. 방법 선취방부시체하지표본10구,분별측량수직가재500 N압력、7충체위하(중립위、배신위、척굴위、내번위、외번위、내선위、외선위)하경비연합인대완정상태(A조)、단순전인대단렬(B조)、전인대+후인대단렬(C1조)、전인대+골간인대단렬(C2조)、전부인대단렬+절단골간막(＞5 cm)(D조)시,하경비연합적분리거리、경거관절접촉면적、평균접촉압강급봉치압강적변화.결과 재중립위、배신위、척굴위、내번위、외번위、내선위、외선위시,A조、B조표본적하경비분리거리、경거관절접촉면적、평균접촉압강급봉치압강조내비교차이균무통계학의의(P＞0.05).C1조、C2조、D조재외선급내번응력위하,과관절출현불은정,하경비분리거리증관균＞2mm,비기타5충체위균명현.여기타각체위비교,재외선급내번응력위하하경비분리거리、경거관절접촉면적、평균접촉압강급봉치압강방면차이균유통계학의의(P＜0.05).수착손상적가중,하경비인대적분리거리증대,접촉면적축점축소,평균압강증대,봉치압강증대,외선위급내번위경명현.A、B、C1、C2、D조하경비분리거리、경거관절접촉면적、평균접촉압강급봉치압강변화추세기본일치. 결론 불동정도적하경비연합인대손상재대부분체위하,과관절능보지은정,가만족보통인군적일상부중수구.단재외선화내번위하,회명현영향과관절적은정성.건의재중、중도인대손상시,수대하경비인대수복고정,특별시대우과관절요구경고적인군.
Objective To investigate the effects of injuries of various degrees to the distal tibiofibular syndesmosis on the ankle stability in cadaveric specimens of distal tibiofibular syndesmosis injury.Methods We used 10 cadaveric specimens of lower limbs for this experiment.The specimens were set in 7 different positions (neutral position,dorsiflexion,plantar flexion,varus,valgus,internal rotation and external rotation) and then received axial force of 500 N.We measured separation distance of the distal tibiofibular syndesmosis (SD),contact area of the tibiotalar joint (CA),average contact pressure (CP) and peak pressure(PP) sequentially in all the specimens set at all the 7 positions in the following conditions:intact tibiofibular syndesmosis (group A),rupture of the anterior tibiofibular ligament (group B),rupture of the anterior and posterior tibiofibular ligaments (group C1),rupture of the anterior and interosseous ligaments (group C2),and rupture of all the ligaments and separation of interosseous membrane (＞ 5 cm) (group D).Results There were no significant differences in SD,CA,CP or PP within groups A and B between the 7 positions (P ＞0.05).At positions of external rotation and varus,ankle instability occurred in groups C1,C2 and D,with SD ＞ 2 mm,obviously larger than in the other 5 positions.SD,CA,CP and PP in positions of external rotation and varus were significantly different from those at the other 5 positions (P ＜ 0.05).With increased injury,SD increased,CA reduced,CP and PP increased,particularly at positions of external rotation and varus.The similar changes in SD,CA,CP and PP were observed in groups A,B,C1,C2 and D.Conclusions The ankle can remain stable and meet the requirements of daily weight bearing in general population when the syndesmosis ligaments are injured to various extents at most positions.However,ankle stability can be obviously affected at positions of external rotation and varus.We suggest that fixation of the tibiofibular ligaments should be necessary when the tibiofibular syndesmosis ligaments are injured to a moderate or severe extent,especially in those who require a high level of ankle activities.