前交叉韧带与Ramp损伤修复的生物力学对比△

Biomechanical comparison of anterior cruciate ligament tear accompanied with Ramp injury and their repairs in cadaver knees

摘要:

[目的]比较前交叉韧带与 Ramp 损伤不同修复的运动学改变。[方法]16 个新鲜尸体膝，均依次进行以下模型建立与运动学测试，处理顺序为：正常对照 (normal control, NC)，ACL 切断+Ramp 损伤组 (ACL cutting and Ramp injury, ACRI)、 ACL 重建+Ramp 损伤组(ACL reconstruction and Ramp injury, ARRI)。将 16 个膝分为两组，每组 8 膝，分别为 ACL 重建+Ramp 缝合钩修复组 (ACL reconstruction and suture hock repair for Ramp injury, ARSH) 和 ACL 重建+Ramp Fast-fix 修复组 (ACL recon- struction and fast-fix repair for Ramp injury, ARFF)。将标本固定于力学测试仪，于屈曲 0°、30°、60°、90°，施加前向 134 N 恒定载荷，和内外旋 5 N · m 载荷，测量胫骨前移距离、内旋和外旋角度。[结果]各屈膝角度状态下，胫骨前移、内旋和外旋由低至高总体依次为，NC＜ ARSH 0.05)。在屈膝 0°、30°和 60°下 ARSH 组胫骨内旋均显著小于 ARFF 组(P＜0.05)，但在屈膝 90°下 ARSH 组与 ARFF 胫骨内旋的差异无统计学意义(P＞0.05)。在各屈膝角度下 ARSH 组与 ARFF 胫骨外旋的差异均无统计学意义(P＞0.05)。[结论]在膝关节 ACL 合并 Ramp 损伤 ACL 重建中，缝合钩与 Fast-fix 缝合修复 Ramp 损伤均能提高膝关节的稳定性，但与 Fast-fix 缝合修复相比，缝合钩修复能更好地恢复膝关节内旋稳定性。

Abstract:

[Objective] To compare the biomechanical variations of anterior cruciate ligament (ACL) tear accompanied with Ramp inju- ry and different repairs for them. [Methods] A total of 16 fresh cadaver knees were treated and tested in the following order: normal control (NC) , ACL cutting and Ramp injury (ACRI) , ACL reconstruction and Ramp injury (ARRI) group. After that, the 16 knees were divided in- to two groups with 8 knees in each group, including ACL reconstruction and suture hook repair for Ramp injury (ARSH) and ACL recon- struction and Fast-fix repair for Ramp injury (ARFF) . After the specimens were fixed in the mechanical tester, the tibial translation, inter- nal rotation and external rotation were measured under constant anteroposterior 134 N load and 5 N · m internal and external rotation torque at 0°, 30°, 60°, 90° flexion of the knee. [Results] The total order of tibial anterior displacement, internal rotation and external rota- tion from low to high was of NC ＜ ARSH ＜ ARFF ＜ ARRI ＜ ACRI, with statistically significant differences among the 5 groups (P＜0.05) . In any degrees of knee flexion, there was no significant difference in the tibia anterior displacement between ARSH group and ARFF group (P＞0.05) . However, the ARSH group had significantly less tibial internal rotation than ARFF group at 0°, 30° and 60° knee flexion (P＜ 0.05) , although there was no statistical significance between them at 90° knee flexion (P＞0.05) . In addition, there was no significant differ- ence between ARSH group and ARFF group in tibial external rotation at any knee flexion angles (P＞0.05) . [Conclusion] Both suture hook and fast fix for repair of Ramp injury following ACL reconstruction are effective treatments for the complex injuries, by contrast, suture hook repair achieve better restoration of internal rotation stability of the knee.