中国修复重建外科杂志

中国修复重建外科杂志

骨锚技术修复深层尺桡韧带对远侧尺桡关节旋转稳定性影响的生物力学研究

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目的 通过生物力学测试探讨骨锚技术修复深层尺桡韧带于尺骨凹对于恢复远侧尺桡关节旋转稳定性的重要性,为选择手术方法提供生物力学理论依据。 方法 取 9 具新鲜成年尸体上肢标本,按照完整标本(正常组)、深层尺桡韧带损伤(损伤组)、螺钉固定并肌腱缝线缝合修复深层尺桡韧带(修复组)顺序制备模型后,采用 AG-IS 系列 MS 型生物力学测试系统,分别于腕关节背伸 45°、中立位及屈曲 45° 进行内、外旋生物力学测试,测量其扭矩。统计分析比较各组内、外旋扭矩差异。 结果 腕关节背伸 45°、中立位及屈曲 45° 时,正常组内旋扭矩分别为(0.83±0.33)、(0.86±0.34)、(0.36±0.30)N·m,外旋扭矩分别为(0.86±0.38)、(0.44±0.22)、(0.25±0.21)N·m;损伤组内旋扭矩分别为(0.18±0.17)、(0.22±0.17)、(0.16±0.15)N·m,外旋扭矩分别为(0.27±0.26)、(0.13±0.17)、(0.04±0.04)N·m;修复组内旋扭矩分别为(0.79±0.34)、(0.73±0.33)、(0.41±0.23)N·m,外旋扭矩分别为(0.80±0.39)、(0.41±0.22)、(0.41±0.40)N·m。腕关节背伸 45°、中立位及屈曲 45° 时,损伤组内、外旋扭矩显著低于正常组和修复组,差异均有统计学意义(P<0.05); 3种位置下修复组内、外旋扭矩与正常组比较差异均无统计学意义(P>0.05)。 结论 深层尺桡韧带是维持远侧尺桡关节旋转稳定性的重要结构,骨锚技术修复深层尺桡韧带于尺骨凹止点,对于恢复远侧尺桡关节旋转稳定性有着重要意义。

Objective To discuss the role of the bone suture anchors for repair of avulsed deep radioulnar ligaments in maintaining the rotatory stability of the distal radioulnar joint. Methods Nine upper limbs specimens were selected from fresh adult cadavers to make wrist joint-bone capsular ligaments complex specimen. All the specimen were tested under conditions of intact (normal group), deep radioulnar ligaments injury (injury group), and deep radioulnar ligaments injury repaired with anchoring (repair group). The internal and external rotation torque values were recorded in 45° wrist extension, neutral position, and 45° wrist flexion by AG-IS series MS biomechanical testing system. The statistic software was used to compare difference in rotation torque between groups. Results In 45° wrist extension, neutral position, and 45° wrist flexion, the internal rotation torque values in normal group were (0.83±0.33), (0.86±0.34), and (0.36±0.30) N·m respectively; the external rotation torque values were (0.86±0.38), (0.44±0.22), and (0.25±0.21) N·m respectively. The internal rotation torque values in injury group were (0.18±0.17), (0.22±0.17),and (0.16±0.15) N·m respectively; the external rotation torque values were (0.27±0.26), (0.13±0.17),and (0.04±0.04) N·m respectively. The internal rotation torque values in repair group were (0.79±0.34), (0.73±0.33),and (0.41±0.23) N·m respectively; the external rotation torque were (0.80±0.39), (0.41±0.22), (0.41±0.40) N·m respectively. In 45° wrist extension, neutral position, and 45° wrist flexion, the internal and external rotation torque values in injury group were significantly lower than those in normal group and repair group (P<0.05), but no significant difference was found between repair group and normal group (P>0.05). Conclusion The deep radioulnar ligaments are important structure for maintaining rotatory stability of distal radioulnar joint. Bone anchoring of the avulsed deep radioulnar ligaments to the ulna fovea is critically important in reconstructing function anatomy of the distal radioulnar joint.

关键词: 腕关节; 远侧尺桡关节; 深层尺桡韧带; 三角纤维软骨复合体; 生物力学

Key words: Wrist; distal radioulnar joint; deep radioulnar ligament; triangular fibrocartilage complex; biomechanics

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