人体股四头肌腱重建膝后交叉韧带的生物力学特性研究
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摘要
目的
探讨人体股四头肌腱的生物力学特性,为其应用于临床后交叉韧带(PCL)双束重建提供客观的实验依据以及为评价愈后长期疗效提供参考。
方法
取32例新鲜尸体的1cm宽股四头肌腱,按其解剖结构分为两束：股直肌,股内、外侧肌腱合为A束,股中间肌腱为B束,用游标卡尺测量两束的宽度及厚度,然后将两束置于电子万能试验机上分别测其生物力学指标。
结果
A束厚度为4.393±1.720mm,宽度为8.193±1.177 mm,生物力学强度为685.670±227.090N,抗拉强度为16.995±3.483Mpa；B束厚度为3.061±1.473mm,宽度为7.101±2.033mm,生物力学强度为435.035±205.800 N,抗拉强度为13.157±4.021Mpa。A束生物力学强度与PCL的前外束(AL束)比较,差异有统计学意义(p<0.05)；B束生物力学强度与PCL的后内束(PM束)比较,差异有统计学意义(p<0.05)。
结论
分层的人体股四头肌腱的生物力学强度较小,与PCL的生物力学强度差距明显,其在临床上应用于PCL双束重建的价值以及愈后的长期疗效还有待于进一步的深入研究。
Objective
To investigate the biomechanics of the human quadriceps tendon in order to provide the theory basis and evaluate the efficacy of double-bundle reconstruction of the posterior cruciate ligament(PCL) using the quadriceps tendon.
Metrhods
32 quadriceps tendons (width 1cm) taken from fresh cadaver were dissected into 2 bundles according to the anatomy, one bundle including rectus femoris, vastus medialis and vastus lateralis was named A bundle and the other was named B bundle. The width and thickness of the A and B bundle were detected respectively with a Vernier caliper and the biomechanics were determined by WDW-30 election universal testing machine.
Results
The thickness, width, ultimate strength and ultimate tensile strength of bundle A were 4.393±1.720 mm,8.193+1.177 mm,685.670±227.090N and 16.995±3.483Mpa respectively, while for bundle B. which were 3.061±1.473 mm.7.101±2.033 mm.435.035±205.800N and 13,157±4.021 Mpa. Differences were noted after compared between the ultimate strength of bundle A and the anterolateral bundle(AL) of the PCL (p<0.05) and the difference also noted between bundle B and the posteromedial bundle(PM) of the PCL (p<0.05).
Conclusion
The ultimate strength of the quadriceps tendon was much smaller than the PCL and then it needs further studies on whether the quadriceps tendon could be the graft as the reconstruction of the PCL
探讨人体股四头肌腱的生物力学特性,为其应用于临床后交叉韧带(PCL)双束重建提供客观的实验依据以及为评价愈后长期疗效提供参考。
方法
取32例新鲜尸体的1cm宽股四头肌腱,按其解剖结构分为两束：股直肌,股内、外侧肌腱合为A束,股中间肌腱为B束,用游标卡尺测量两束的宽度及厚度,然后将两束置于电子万能试验机上分别测其生物力学指标。
结果
A束厚度为4.393±1.720mm,宽度为8.193±1.177 mm,生物力学强度为685.670±227.090N,抗拉强度为16.995±3.483Mpa；B束厚度为3.061±1.473mm,宽度为7.101±2.033mm,生物力学强度为435.035±205.800 N,抗拉强度为13.157±4.021Mpa。A束生物力学强度与PCL的前外束(AL束)比较,差异有统计学意义(p<0.05)；B束生物力学强度与PCL的后内束(PM束)比较,差异有统计学意义(p<0.05)。
结论
分层的人体股四头肌腱的生物力学强度较小,与PCL的生物力学强度差距明显,其在临床上应用于PCL双束重建的价值以及愈后的长期疗效还有待于进一步的深入研究。
Objective
To investigate the biomechanics of the human quadriceps tendon in order to provide the theory basis and evaluate the efficacy of double-bundle reconstruction of the posterior cruciate ligament(PCL) using the quadriceps tendon.
Metrhods
32 quadriceps tendons (width 1cm) taken from fresh cadaver were dissected into 2 bundles according to the anatomy, one bundle including rectus femoris, vastus medialis and vastus lateralis was named A bundle and the other was named B bundle. The width and thickness of the A and B bundle were detected respectively with a Vernier caliper and the biomechanics were determined by WDW-30 election universal testing machine.
Results
The thickness, width, ultimate strength and ultimate tensile strength of bundle A were 4.393±1.720 mm,8.193+1.177 mm,685.670±227.090N and 16.995±3.483Mpa respectively, while for bundle B. which were 3.061±1.473 mm.7.101±2.033 mm.435.035±205.800N and 13,157±4.021 Mpa. Differences were noted after compared between the ultimate strength of bundle A and the anterolateral bundle(AL) of the PCL (p<0.05) and the difference also noted between bundle B and the posteromedial bundle(PM) of the PCL (p<0.05).
Conclusion
The ultimate strength of the quadriceps tendon was much smaller than the PCL and then it needs further studies on whether the quadriceps tendon could be the graft as the reconstruction of the PCL
引文
1.潘不春,刘金钊,孙康.γ射线照射与非照射人肌腱生物力学的比较研究[J].中国矫形外科杂志.2009,17(13)：1010-1012.
2. Strobel MJ. Arthroskopische chirurgie [M].1st ed. Berlin Heidelberg: Springer-Verlag,1998, 571-659
3. Girgis FG, Marshall JL, Monajem A. The cruciate ligaments of the knee joint:anatomical, functional and experimental analysis. Clin Orthop 1975;106:216-31
4. Van Dommelen BA, Fowler PJ. Anatomy of the posterior cruciate ligament: a review. Am J Sports Med 1989;17:24-9
5. Harner CD, Livesay GA, Kashiwaguchi S, et al. Comparative study of the size and shape of human anterior and posterior cruciate ligaments. J Orthop Res 1995;13:429-34
6. Harner CD, Xerogeanes JW, Livesay GA, et al. The human posterior cruciate ligament complex: an interdisciplinary study:ligament morphology and biomechanical evaluation. Am J Sports Med 1995; 23:736-45
7. Harner CD. Baek GH, Vogrin TM,et al. Quantitative analysis of human cruciate ligament insertions. Arthroscopy 1999; 15:741-9
8. Hefzy MS. Grood ES. Lindenfield TL. The posterior cruciate ligament:a new look at length patterns [J]. Trans Orthop Res Soc 1986; 11:128
9. Ahmad CS, Cohen ZA, Levine WN, et al:Codominance of the individual posterior cruciate ligament bundles. An analysis of bundle lengths and orientation. Am J Sports Med 31:221-225, 2003
10. AmisAA, Gup te CM, Bull AM, et al. Anatomy of the posterior cruciate ligament and the meniscofemoral ligaments [J]. Knee Surg Sports Traumatol Arthrosc.2006,14(3):257-263. Epub 2005 Oct 14.
11. Race A, Amis A A. Loading of the two bundles of the posterior cruciate ligament:an analysis of bundle function in A-P drawer [J]. J Biomech,1996,29 (7):873-879.
12. TakahashiM. Matsubara T. DoiM, et al. Anatomical study of the femoral and tibial insertions of the anterolateral and posteromedial bundles of human posterior cruciate ligament [J]. Knee Surg Sports Traumatol Arthrosc,2006,14 (11):1055-1059. Epub 2006 Aug 4.
13. Carofalo R, Jolles BM, Moretti B, et al. Double-bundle transtibial posterior cruciate ligament reconstruction with a tendon-patellar bone-semitendinosus tendon autograft:clinical results with a minimum of 2 years'follow-up[J].Arthroscopy,2006,22(12):1331-1338.
14. Stahelin AC.Sudkamp NP,Weiler A.Anatomic double-bundle posterior cruciate ligament reconstruction using hamstring tendons[J].Arthroscopy.2001,17(1):88.
15. Fanelli GC.Giannotti BF,Edson CJ.Arthroscopically asscombined anterior and posterior cruciate ligament reconstruction[J].Arthroscopy,1996.12(1):5-14.
16. Markolf KL, Feeley BT, Jackson SR, et al. Biomechanical Studies of Double—Bundle Posterior Cruciate Ligament Reconstructions. J Bone Joint Surg(Am),2006,88:1788-1794.
17.Keller PM, Shelbourne K D, McCarroll JR. et al. Nonoperatively treated isolated posterior cruciate ligament injuries [J]. Am J Sports Med,1993,21 (1):132-136.
18.Chuang TY, Chen CH, Chou SW, et al. Tibial inlay technique with quadriceps tendon-bone autograft for posterior cruciate ligament reconstruction [J]. Arthroscopy,2004,20 (3):331-335.
19.Wang CJ, Chen HS, Huang TW. Outcome of arthroscopic single bundle reconstruction for complete posterior cruciate ligament tear[J]. Injury,2003,34 (10):747-751.
20.Mckernan DJ, Paulos LE. Craft selection[A].In:Fu FH, Harner CD, Vince KG. Knee surgery [M]. Baltimore:Williams & Winkins,1994.667-678.
21.Morgan CD, Leitman EH. Quadriceps tendon autograft harvesting [A]. In:Jackson DW, ed. Reconstructive knee surgery [M]. Philadelphia: Lippincott Williams & Wilkins,2003.151-158.
22.孙康,汤继文,王立德,等.关节镜下股四头肌腱-骨双束股骨双隧道重建膝后十字韧带[J].中华骨科杂志,2004,24(8)：491-494.
23.赵统海,刘天平等.关节镜下股四头肌腱-髌骨块重建后交叉韧带[J].中国现代手术学杂志2008,12(6)：409.
24.梁兴森.膝关节周围软组织与髌股关节稳定性关系的解剖及生物力学研究[D].广州：南方医科大学,2009.
25. Zeiss J, Saddemi SR, Ebraheim NA. MR imaging of the quadriceps tendon: normal layered configuration and its importance in cases of tendon rupture. AJR Am J Roentgenol.1992; 159:1031-1034
26. Standring S. Gray's Anatomy[M]. Ed 39. Edinburgh, United Kingdom:Elsevier Churchill Livingstone;2005.
27. Staubli HU, Schatzmann L. Brunner P, Rincon L, Nolte LP. Mechanical tensile properties of the quadriceps tendon and patella ligament in young adults [J]. Am J Sports Med 1999,27(1): 27-34.
28. Morgan CD, Leitman EH. Quadriceps tendon autograft harvesting [A]. In:Jackson DW, ed. Reconstructive knee surgery [M]. Philadelphia: Lipp incott Williams & Wilkins,2003.151-158.
29.Houe T, Jorgensen U. Arthroscop ic posterior cruciate ligament reconstruction:one vs. two tunnel technique[J]. Scand J Med Sci Sports,2004,14(2):107-111.
3O.Chuang TY, Chen CH, Chou SW, et al. Tibial inlay technique with quadriceps tendon-bone autograft for posterior cruciate ligament reconstruction [J]. A rthroscopy,2004,20 (3):331-335.
31.陈百成,高石军,王晓峰,等.关节镜下股骨单隧道与双隧道重建后十字韧带的疗效分析[J].中华骨科杂志,2004,24(3)：129.
32. C.—H. Chen, W.—j. Chen, C.—h. Shih. Arthroscopic posterior cruciate ligament reconsmmtion with quadriceps tendon—patellar bone autograft[J].Arch orthop tuaunla surg,1999, 119:86-88.
33.陈百成.前、后交叉韧带重建移植物选择的相关性研究[R].厦门：中华医学会第十一届骨科学术会议暨第四届国际COA学术大会骨科教程,2009.
34.吴延平,王英振,焦兆德等.反复冻融处理同种异体移植兔跟腱组织学及生物力学变化[J].中国组织工程研究与临床康复.2009,13(5)：816-820.
35.魏娴.肌腱生物力学研究进展.[J]组织工程与重建外科杂志.2005,1(6)：350-352.
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2. Strobel MJ. Arthroskopische chirurgie [M].1st ed. Berlin Heidelberg: Springer-Verlag,1998, 571-659
3. Girgis FG, Marshall JL, Monajem A. The cruciate ligaments of the knee joint:anatomical, functional and experimental analysis. Clin Orthop 1975;106:216-31
4. Van Dommelen BA, Fowler PJ. Anatomy of the posterior cruciate ligament: a review. Am J Sports Med 1989;17:24-9
5. Harner CD, Livesay GA, Kashiwaguchi S, et al. Comparative study of the size and shape of human anterior and posterior cruciate ligaments. J Orthop Res 1995;13:429-34
6. Harner CD, Xerogeanes JW, Livesay GA, et al. The human posterior cruciate ligament complex: an interdisciplinary study:ligament morphology and biomechanical evaluation. Am J Sports Med 1995; 23:736-45
7. Harner CD. Baek GH, Vogrin TM,et al. Quantitative analysis of human cruciate ligament insertions. Arthroscopy 1999; 15:741-9
8. Hefzy MS. Grood ES. Lindenfield TL. The posterior cruciate ligament:a new look at length patterns [J]. Trans Orthop Res Soc 1986; 11:128
9. Ahmad CS, Cohen ZA, Levine WN, et al:Codominance of the individual posterior cruciate ligament bundles. An analysis of bundle lengths and orientation. Am J Sports Med 31:221-225, 2003
10. AmisAA, Gup te CM, Bull AM, et al. Anatomy of the posterior cruciate ligament and the meniscofemoral ligaments [J]. Knee Surg Sports Traumatol Arthrosc.2006,14(3):257-263. Epub 2005 Oct 14.
11. Race A, Amis A A. Loading of the two bundles of the posterior cruciate ligament:an analysis of bundle function in A-P drawer [J]. J Biomech,1996,29 (7):873-879.
12. TakahashiM. Matsubara T. DoiM, et al. Anatomical study of the femoral and tibial insertions of the anterolateral and posteromedial bundles of human posterior cruciate ligament [J]. Knee Surg Sports Traumatol Arthrosc,2006,14 (11):1055-1059. Epub 2006 Aug 4.
13. Carofalo R, Jolles BM, Moretti B, et al. Double-bundle transtibial posterior cruciate ligament reconstruction with a tendon-patellar bone-semitendinosus tendon autograft:clinical results with a minimum of 2 years'follow-up[J].Arthroscopy,2006,22(12):1331-1338.
14. Stahelin AC.Sudkamp NP,Weiler A.Anatomic double-bundle posterior cruciate ligament reconstruction using hamstring tendons[J].Arthroscopy.2001,17(1):88.
15. Fanelli GC.Giannotti BF,Edson CJ.Arthroscopically asscombined anterior and posterior cruciate ligament reconstruction[J].Arthroscopy,1996.12(1):5-14.
16. Markolf KL, Feeley BT, Jackson SR, et al. Biomechanical Studies of Double—Bundle Posterior Cruciate Ligament Reconstructions. J Bone Joint Surg(Am),2006,88:1788-1794.
17.Keller PM, Shelbourne K D, McCarroll JR. et al. Nonoperatively treated isolated posterior cruciate ligament injuries [J]. Am J Sports Med,1993,21 (1):132-136.
18.Chuang TY, Chen CH, Chou SW, et al. Tibial inlay technique with quadriceps tendon-bone autograft for posterior cruciate ligament reconstruction [J]. Arthroscopy,2004,20 (3):331-335.
19.Wang CJ, Chen HS, Huang TW. Outcome of arthroscopic single bundle reconstruction for complete posterior cruciate ligament tear[J]. Injury,2003,34 (10):747-751.
20.Mckernan DJ, Paulos LE. Craft selection[A].In:Fu FH, Harner CD, Vince KG. Knee surgery [M]. Baltimore:Williams & Winkins,1994.667-678.
21.Morgan CD, Leitman EH. Quadriceps tendon autograft harvesting [A]. In:Jackson DW, ed. Reconstructive knee surgery [M]. Philadelphia: Lippincott Williams & Wilkins,2003.151-158.
22.孙康,汤继文,王立德,等.关节镜下股四头肌腱-骨双束股骨双隧道重建膝后十字韧带[J].中华骨科杂志,2004,24(8)：491-494.
23.赵统海,刘天平等.关节镜下股四头肌腱-髌骨块重建后交叉韧带[J].中国现代手术学杂志2008,12(6)：409.
24.梁兴森.膝关节周围软组织与髌股关节稳定性关系的解剖及生物力学研究[D].广州：南方医科大学,2009.
25. Zeiss J, Saddemi SR, Ebraheim NA. MR imaging of the quadriceps tendon: normal layered configuration and its importance in cases of tendon rupture. AJR Am J Roentgenol.1992; 159:1031-1034
26. Standring S. Gray's Anatomy[M]. Ed 39. Edinburgh, United Kingdom:Elsevier Churchill Livingstone;2005.
27. Staubli HU, Schatzmann L. Brunner P, Rincon L, Nolte LP. Mechanical tensile properties of the quadriceps tendon and patella ligament in young adults [J]. Am J Sports Med 1999,27(1): 27-34.
28. Morgan CD, Leitman EH. Quadriceps tendon autograft harvesting [A]. In:Jackson DW, ed. Reconstructive knee surgery [M]. Philadelphia: Lipp incott Williams & Wilkins,2003.151-158.
29.Houe T, Jorgensen U. Arthroscop ic posterior cruciate ligament reconstruction:one vs. two tunnel technique[J]. Scand J Med Sci Sports,2004,14(2):107-111.
3O.Chuang TY, Chen CH, Chou SW, et al. Tibial inlay technique with quadriceps tendon-bone autograft for posterior cruciate ligament reconstruction [J]. A rthroscopy,2004,20 (3):331-335.
31.陈百成,高石军,王晓峰,等.关节镜下股骨单隧道与双隧道重建后十字韧带的疗效分析[J].中华骨科杂志,2004,24(3)：129.
32. C.—H. Chen, W.—j. Chen, C.—h. Shih. Arthroscopic posterior cruciate ligament reconsmmtion with quadriceps tendon—patellar bone autograft[J].Arch orthop tuaunla surg,1999, 119:86-88.
33.陈百成.前、后交叉韧带重建移植物选择的相关性研究[R].厦门：中华医学会第十一届骨科学术会议暨第四届国际COA学术大会骨科教程,2009.
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