ACL对膝关节胫骨内、外旋转稳定性控制作用的初步研究

Preliminary Research in Normal Anterior Cruciate Ligament of the Knee Stability of the Internal and External Rotation Control

目的:研究正常人前交叉韧带(Anterior Cruciate Ligament,ACL)对膝关节内、外旋转稳定性的控制作用;探讨膝关节ACL多纤维束动态力学特性。方法:采集5例新鲜正常成年男性左侧膝关节标本,评估标本完整性后,向ACL胫骨止点中心做斜行骨隧道,游离ACL胫骨侧止点,以象限法平均分为4区:1.后内区、2.后外区、3.前外区、4.前内区;将4区的附着纤维束分别连接至自制"膝关节交叉韧带测力计"传感器上,并固定于自主发明的通用生物关节自由度动态应力加载系统。对股内侧、股中间肌股直肌联合肌腱、股外侧肌群分别施以1.25N:1.5N:1N的负荷。分别在膝关节屈曲0°、30°、60°、90°位将ACL各纤维束张紧并系统平衡后,利用扭距传感器测量胫骨做内、外旋转时ACL的受力情况。结果:膝关节屈伸过程中,1区纤维束对膝关节内、外旋转稳定性的控制作用较小。2区纤维胫骨外旋时受力最大,并在屈膝30°时达最大(16.97±1.45N)。3区纤维束时对胫骨内、外旋控制作用相当,并在屈膝60°时最大,分别为10.67+1.34N和16.45+1.34N。4区纤维束对胫骨内旋稳定的控制明显大于胫骨外旋,在屈膝90°时作用最大,为11.67+2.25N。结论:膝关节在屈膝不同角度内、外旋转时,每一纤维束的受力是不同的且不断变化的。膝关节屈伸过程中ACL控制胫骨内、外旋转稳定性的最重要作用纤维束集中在胫骨止点的前内侧和后外侧。ACL后外侧纤维束(2区)对膝关节外旋稳定性控制作用最为重要,且以屈膝30°时控制作用最强。前内侧纤维束(4区)对膝关节内旋稳定性的控制最为重要,并且以屈膝90°控制作用最强。前外侧纤维束(3区)对膝关节的内旋和外旋相当,并且在屈膝60°对膝关节内、外旋转稳定性控制最强。

Objective： To preliminary research in normal anterior cruciate ligament of the knee stability of the internal and external rotation control; Discussion knee ACL fiber multi-bundle dynamic mechanical properties. Methods： A cadaveric study using five cases of flesh normal adult male left knees, After the integrity of each specimen was evaluated, the tibial insertion site of ACL was detached from plateau, The footprint was averagely separated into 4 zones according to axial plane and coronal plane： A, posteromedial zone; B, posterolateral zone; C. anterolateral zone; D. anteromedial zone. Fibers were also separated into 4 bundles according to each attached zone and linked to the gauges. Fixed on the independent invention of Bio-dynamic stress joints freedom Loading System,Anatomically based multiple loadings of the quadriceps mechanism were applide （Vastus medialis： Vastus intermedius/rectus femoris： Vastus lateralis is 12.5N：1.5N：1N） Forces of each bundle were measured in knee-flexion 0° , 30° , 60° and 90° was set to all bundles respectively before that. Results： From Knee flexion to extension process, Zone A fiber bundle play a small role in inside-to-outside rotating stability control. Between the knee flexion, Zone C fiber bundle inside-to-outside rotational stability control is the minimum, Zone B fiber in tibial external rotation is the largest force, and the knees at 30° greatest force for 16.97 ± 1.45N, Zone C fiber bundle at the tibia, swing control of a considerable role in the knees at 60° , respectively to 10.67±1.34N and 16.45±1.34N. Zone D fiber bundle at tibial internal rotation stability control than the tibial external rotation, 90° knees by the largest force for 11.67 ±2.25N. Conclusions： Between the knee flexion both inside-to-outside rotation, each fiber bundle is the force of constantly changing. Knee flexion process control ACL tibial internal and external stability of rotating the most important role of fiber bundles in the tibia only points of the medial and lateral. ACL posterolateral fiber bundle （Zone B ） external rotation right knee stability control most important role, and to bow down 30°strongest control. Before the medial fiber bundles （Zone D） internal rotation right knee stability, control, the most important and 90° knees to controlthe ongest. Anterolateral fiber bundles （Zone C ） fiber bundles right knee supination and pronation considerable, and the knees of 60° right knee inside-to-outside the strongest rotation stability control.