后交叉韧带断裂对髌骨生物力学影响的实验研究
摘要
后交叉韧带(posterior cruciate ligament,PCL)损伤在临床中为常见运动损伤,严重影响膝关节的稳定性。PCL损伤是否对髌骨产生影响,目前尚未有文献报道。本研究采用生物力学测定的方法,将其分为PCL完整组、后内侧束(Posteromedial bundle, PMB)切断组、前外侧束(Anterolateral bundle, ALB)切断组、PCL完全切除组在各角度及各载荷下观察对髌骨上极、下极、内侧、外侧的影响,为PCL损伤是否对髌骨产生影响提供理论依据。
目的探讨PCL完全断裂和部分断裂对髌骨的生物力学影响。
方法新鲜成人尸体膝关节标本6具,依PCL完整(6具)、PMB切断(3具)、ALB切断(3具)和PCL完全切断(6具)分别在膝关节0°、30°、60°、90°位轴向加载200～800N,测量髌骨上、下极,髌骨内、外侧关节面的应变并对数据进行统计分析。
结果1.PCL完整组：①膝关节0°位,髌骨上下极、髌骨内外侧应变值均为最小,均无统计学差异,P>0.05。②膝关节屈曲30°位时,髌骨下极为压应变,髌骨上极为拉应变,应变绝对值随载荷增加而增加；60°位时,髌骨上、下极均为拉应变,90°位时,髌骨上极为压应变,髌骨下极为拉应变,应变绝对值随载荷增加而增加；各角度间应变均有统计学差异,P<0.05。③30°、60°、90°位时,髌骨内、外侧均为压应变,应变绝对值随载荷增加而增加,各角度间应变值均有统计学差异,P<0.05。2.ALB切断组：①膝关节0°位,髌骨上下极、髌骨内外侧应变值均为最小,均无统计学差异,P>0.05。②膝关节屈曲30°位时,髌骨下极为压应变,髌骨上极为拉应变,应变绝对值随载荷增加而增加；60°及90°位时,髌骨上、下极均为拉应变,应变绝对值随载荷增加而增加：各角度间应变均有统计学差异,P<0.05。③30°、60°、90°位时,髌骨内、外侧均为压应变,应变绝对值随载荷增加而减小,各角度间应变值均有统计学差异,P<0.05。3.PMB切断组：①膝关节0°位,髌骨上下极、髌骨内外侧应变值均为最小,均无统计学差异,P>0.05。②膝关节屈曲30°位时,髌骨上极为拉应变,下极为压应变,髌骨上、下极应变绝对值随载荷增加而增加；60°及90°位时,髌骨上、下极均为拉应变,应变绝对值均随载荷增加而增加；各角度间应变均有统计学差异,P<0.05。③30°、60°、90°位时,髌骨内、外侧均为压应变,30°时应变绝对值随载荷增加先增加后减小,60°、90°时应变绝对值随载荷增加而减小,各角度间应变值均有统计学差异,P<0.05。4.ACL切断组：①膝关节0°位,髌骨上下极、髌骨内外侧应变值均为最小,均无统计学差异,P>0.05。②膝关节屈曲30°位时髌骨下极为压应变、上极为拉应变,60°、90°位时,髌骨上、下极均为拉应变,应变绝对值随载荷增加而增加；各角度间应变均有统计学差异,P<0.05。③30°位时髌骨内侧为拉应变、外侧为压应变,60°、90°位时,髌骨内、外侧均为压应变,应变绝对值随载荷增加而减小,各角度间应变值均有统计学差异,P<0.05。
结论1、PCL完全切断,在不同载荷和角度下,对髌骨各部的应变均有影响。
2、前外侧束切断在膝关节屈曲30°、60°、90°位各载荷下可引起髌骨各部生物力学改变。
3、后内侧束在膝关节屈曲0°、30°位200N、400N载荷下对髌骨各部位应变无影响。
4、PCL完全断裂,髌骨内侧应变高于髌骨外侧应变,其意义尚需进一步探讨。
The injuries of posterior Curciate Ligament are very common in sport injuries. The injuries mainly effect the stabilization of knee joint. The PCL injury did effect the patella or not is unknown, there is few literature report it. This research intend to use biomechanic method observe the biomechanic change of patella after PCL complete rupture or incomplete rupture, provide the theory evidence of pathological changes in patella after PCL rupture.
Objective:To investigate the biomechanical influences of partial and total PCL rupture on the patella.
Methods:6 fresh cadaveric knees from adult human beings were divided into PCL intact group(6 samples)、PMB broken group(3 samples)、ALB broken group(3 samples) and PCL total broken group(6 samples). The knees were applied with 200N-800N axial loading force when they flexed 0°、30°、60°、90°.The strain on the patella was measured and analysed.
Results:1. In PCL intact group:①In 0°position, the strain of all 4 test place of patellar were the smallest, and the differences among the parts were not significant (P>0.05).②In 30°positions, the inferior of patellar was compressive strain, the superior of patellar was tensile strain, the absolute value of strain was increased with the load increased. In 60° positions, the strain of inferior and superior of patellar were tensile strain, the absolute value of strain was increased with the load increased. In90°positions, the superior of patellar was compressive strain, the inferior of patellar was tensile strain, the absolute value of strain was increased with the load increased.The differences among the parts were all significant (P<0.05).③In 30°、60°、90°positions, the medial and lateral of patellar were compressive strain, the absolute value of strain was increased with the load increased. The differences among the parts were all significant (P<0.05).2. In ALB broken group:①In 0°position, the strain of all 4 test place of patellar were the smallest, and the differences among the parts were not significant (P>0.05).②In 30°positions, the superior of patellar was tensile strain, the inferior of patellar was compressive strain, the absolute value of strain on the superior and inferior of patellar was increased with the load increased. In 60°and 90°positions, the superior and inferior of patellar was tensile strain, and the absolute value of strain was increased with the load increased. The differences among the parts were all significant (P<0.05).③In 30°、60°、90°positions, the medial and lateral of patellar were compressive strain, the absolute value of strain was decreased with the load increased. The differences among the parts were all significant (P<0.05).3. In PMB broken group:①In 0°position, the strain of all 4 test place of patellar were the smallest, and thedifferences among the parts were not significant (P>0.05).②In 30° positions, the strain of superior of patellar were tensile strain, the inferior of patellar was compressive strain, the absolute value of strain on the superior and inferior of patellar was increased with the load increased. In 60°and 90°positions, the superior and inferior of patellar was tensile strain, the absolute value of strain was increased with the load increased. The differences among the parts were all significant (P<0.05).③In 30°、60°、90°positions, the medial and lateral of patellar were compressive strain, In 30°positions, the absolute value of strain was increased in first, then decreased with the load increased. In 60°、90°positions,the absolute value of strain was decreased with the load increased. The differences among the parts were all significant (P<0.05).4. In PCL total broken group:①In 0°position, the strain of all 4 test place of patellar were the smallest, and the differences among the parts were not significant (P>0.05).②In 30°positions, the strain of superior of patellar were tensile strain, the inferior of patellar was compressive strain. In 60°、90°positions, the superior and inferior of patellar were tensile strain, the absolute value of strain was increased with the load increased. The differences among the parts were all significant (P<0.05).③In 30°positions, the strain of medial of patellar were tensile strain, the lateral of patellar was compressive strain. In 60°、90°positions, the medial and lateral of patellar were compressive strain, the absolute value of strain was decreased with the load increased. The differences among the parts were all significant (P<0.05).
Conclusion:1. PCL total rupture may cause abnormal load on the patellar in all the positions.2. ALB rupture may cause abnormal load on the patellar in 30°、60°、90°positions.3. PMB rupture not cause abnormal biomechanical change on patella in 0°position and 200N、400N loaded in 30°position.4. PCL total rupture can cause the strain of medial of patellar was larger than lateral of patellar, which need to be further explored.
目的探讨PCL完全断裂和部分断裂对髌骨的生物力学影响。
方法新鲜成人尸体膝关节标本6具,依PCL完整(6具)、PMB切断(3具)、ALB切断(3具)和PCL完全切断(6具)分别在膝关节0°、30°、60°、90°位轴向加载200～800N,测量髌骨上、下极,髌骨内、外侧关节面的应变并对数据进行统计分析。
结果1.PCL完整组：①膝关节0°位,髌骨上下极、髌骨内外侧应变值均为最小,均无统计学差异,P>0.05。②膝关节屈曲30°位时,髌骨下极为压应变,髌骨上极为拉应变,应变绝对值随载荷增加而增加；60°位时,髌骨上、下极均为拉应变,90°位时,髌骨上极为压应变,髌骨下极为拉应变,应变绝对值随载荷增加而增加；各角度间应变均有统计学差异,P<0.05。③30°、60°、90°位时,髌骨内、外侧均为压应变,应变绝对值随载荷增加而增加,各角度间应变值均有统计学差异,P<0.05。2.ALB切断组：①膝关节0°位,髌骨上下极、髌骨内外侧应变值均为最小,均无统计学差异,P>0.05。②膝关节屈曲30°位时,髌骨下极为压应变,髌骨上极为拉应变,应变绝对值随载荷增加而增加；60°及90°位时,髌骨上、下极均为拉应变,应变绝对值随载荷增加而增加：各角度间应变均有统计学差异,P<0.05。③30°、60°、90°位时,髌骨内、外侧均为压应变,应变绝对值随载荷增加而减小,各角度间应变值均有统计学差异,P<0.05。3.PMB切断组：①膝关节0°位,髌骨上下极、髌骨内外侧应变值均为最小,均无统计学差异,P>0.05。②膝关节屈曲30°位时,髌骨上极为拉应变,下极为压应变,髌骨上、下极应变绝对值随载荷增加而增加；60°及90°位时,髌骨上、下极均为拉应变,应变绝对值均随载荷增加而增加；各角度间应变均有统计学差异,P<0.05。③30°、60°、90°位时,髌骨内、外侧均为压应变,30°时应变绝对值随载荷增加先增加后减小,60°、90°时应变绝对值随载荷增加而减小,各角度间应变值均有统计学差异,P<0.05。4.ACL切断组：①膝关节0°位,髌骨上下极、髌骨内外侧应变值均为最小,均无统计学差异,P>0.05。②膝关节屈曲30°位时髌骨下极为压应变、上极为拉应变,60°、90°位时,髌骨上、下极均为拉应变,应变绝对值随载荷增加而增加；各角度间应变均有统计学差异,P<0.05。③30°位时髌骨内侧为拉应变、外侧为压应变,60°、90°位时,髌骨内、外侧均为压应变,应变绝对值随载荷增加而减小,各角度间应变值均有统计学差异,P<0.05。
结论1、PCL完全切断,在不同载荷和角度下,对髌骨各部的应变均有影响。
2、前外侧束切断在膝关节屈曲30°、60°、90°位各载荷下可引起髌骨各部生物力学改变。
3、后内侧束在膝关节屈曲0°、30°位200N、400N载荷下对髌骨各部位应变无影响。
4、PCL完全断裂,髌骨内侧应变高于髌骨外侧应变,其意义尚需进一步探讨。
The injuries of posterior Curciate Ligament are very common in sport injuries. The injuries mainly effect the stabilization of knee joint. The PCL injury did effect the patella or not is unknown, there is few literature report it. This research intend to use biomechanic method observe the biomechanic change of patella after PCL complete rupture or incomplete rupture, provide the theory evidence of pathological changes in patella after PCL rupture.
Objective:To investigate the biomechanical influences of partial and total PCL rupture on the patella.
Methods:6 fresh cadaveric knees from adult human beings were divided into PCL intact group(6 samples)、PMB broken group(3 samples)、ALB broken group(3 samples) and PCL total broken group(6 samples). The knees were applied with 200N-800N axial loading force when they flexed 0°、30°、60°、90°.The strain on the patella was measured and analysed.
Results:1. In PCL intact group:①In 0°position, the strain of all 4 test place of patellar were the smallest, and the differences among the parts were not significant (P>0.05).②In 30°positions, the inferior of patellar was compressive strain, the superior of patellar was tensile strain, the absolute value of strain was increased with the load increased. In 60° positions, the strain of inferior and superior of patellar were tensile strain, the absolute value of strain was increased with the load increased. In90°positions, the superior of patellar was compressive strain, the inferior of patellar was tensile strain, the absolute value of strain was increased with the load increased.The differences among the parts were all significant (P<0.05).③In 30°、60°、90°positions, the medial and lateral of patellar were compressive strain, the absolute value of strain was increased with the load increased. The differences among the parts were all significant (P<0.05).2. In ALB broken group:①In 0°position, the strain of all 4 test place of patellar were the smallest, and the differences among the parts were not significant (P>0.05).②In 30°positions, the superior of patellar was tensile strain, the inferior of patellar was compressive strain, the absolute value of strain on the superior and inferior of patellar was increased with the load increased. In 60°and 90°positions, the superior and inferior of patellar was tensile strain, and the absolute value of strain was increased with the load increased. The differences among the parts were all significant (P<0.05).③In 30°、60°、90°positions, the medial and lateral of patellar were compressive strain, the absolute value of strain was decreased with the load increased. The differences among the parts were all significant (P<0.05).3. In PMB broken group:①In 0°position, the strain of all 4 test place of patellar were the smallest, and thedifferences among the parts were not significant (P>0.05).②In 30° positions, the strain of superior of patellar were tensile strain, the inferior of patellar was compressive strain, the absolute value of strain on the superior and inferior of patellar was increased with the load increased. In 60°and 90°positions, the superior and inferior of patellar was tensile strain, the absolute value of strain was increased with the load increased. The differences among the parts were all significant (P<0.05).③In 30°、60°、90°positions, the medial and lateral of patellar were compressive strain, In 30°positions, the absolute value of strain was increased in first, then decreased with the load increased. In 60°、90°positions,the absolute value of strain was decreased with the load increased. The differences among the parts were all significant (P<0.05).4. In PCL total broken group:①In 0°position, the strain of all 4 test place of patellar were the smallest, and the differences among the parts were not significant (P>0.05).②In 30°positions, the strain of superior of patellar were tensile strain, the inferior of patellar was compressive strain. In 60°、90°positions, the superior and inferior of patellar were tensile strain, the absolute value of strain was increased with the load increased. The differences among the parts were all significant (P<0.05).③In 30°positions, the strain of medial of patellar were tensile strain, the lateral of patellar was compressive strain. In 60°、90°positions, the medial and lateral of patellar were compressive strain, the absolute value of strain was decreased with the load increased. The differences among the parts were all significant (P<0.05).
Conclusion:1. PCL total rupture may cause abnormal load on the patellar in all the positions.2. ALB rupture may cause abnormal load on the patellar in 30°、60°、90°positions.3. PMB rupture not cause abnormal biomechanical change on patella in 0°position and 200N、400N loaded in 30°position.4. PCL total rupture can cause the strain of medial of patellar was larger than lateral of patellar, which need to be further explored.
引文
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[41]孙康,徐强,王光达.膝关节后外侧角损伤的诊断与治疗.骨与关节损伤杂志,2004,19(1)：67
[42]Stannard J P, Brown SL, Farris RC,et al. The posterolateral corner of the knee:repair versus reconstruction. Am J Sports Med,2005,33:881
[43]Bottom T, Wentor FA, LaPrade RF,et al. Arthroscopy,2003; 19(6):2-3.
[44]LaPrade RF, Tso A, Wentorf FA, Am J Sports Med,2004; 32(7):1695-1701.
[45]Arciero RA. Anatomic posterolateral comer knee reconstruction [J].Arthroscopy,2005,21 (9):1147.
[46]Stannard JP,Brown SL, Robinson JT, et al.Reconstruction of the posterolateral comer of the knee [J]. Arthroscopy.2005,21 (9):1051-1059.
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