肌腱结嵌压固定法重建前交叉韧带生物力学实验研究

Biomechanical study of reconstruction of ACL by hamstring tendons knot implant fixation

目的探讨绳肌腱结嵌压固定法重建前交叉韧带(ACL)影响初始固定效果的相关因素及对策。方法采用猪膝关节模拟重建ACL不同术式,即绳肌腱结股骨隧道嵌压固定和胫骨端肌腱编织缝合骨桥打结固定法,与骨-髌腱-骨两端界面螺钉固定法,比较其生物力学初始固定最大拔出载荷、抗拉刚度和位移等生物力学指标。结果最大抗拉载荷肌腱结组与正常ACL组接近,无显著性差异;肌腱结组大于骨-髌腱-骨界面螺钉固定组。抗拉载荷在100N和400N时的位移两组无显著性差异。胫骨端肌腱编织缝合骨桥上打结固定组最大抗拉载荷大于BPTB界面螺钉固定组和肌腱编织缝合后界面螺钉固定组。抗拉刚度正常ACL组>骨-髌腱-骨组>绳肌腱结组。最大位移正常ACL<髌腱骨组<肌腱结组。结论绳肌腱结嵌压固定法抗拉强度和刚度完全可以满足重建后ACL的生理需求;术中克服位移因素,是有效防止ACL重建术后松弛的关键。

Objective:To evaluate the strength of reconstruction of anterior cruciate ligament (ACL) by hamstring tendons knot implant fixation or bone patellar tendon bone(B PT B).Method:Failure test and displacement evaluation were used to study the biomechanics of reconstruction of ACL by hamstring tendons knot implant fixation in 13 porcine knees.The control group of 11 porcine knees were reconstructed with B PT B and interference screw. Result:Hamstring tendons knot implant fixation had greater maximal pull-out force than B PT B.There were similar displacement in 100N and 400N loads between hamstring tendons knot implant fixation and B PT B ( P >0.05).Peak force test maximal displacement evaluation and failure energy absorption measurement showed that hamstring tendons knot implant fixation was significantly greater than B-PT-B( P <0.01). Conclusion:Reconstruction of ACL by hamstring tendons knot implant fixation can satisfy daily physiological demand.Decreasing or eliminating displacement may be helpful to prevent relaxation after reconstruction of ACL.