单双束重建前交叉韧带的生物力学研究

Biomechanical study of knee following anterior cruciate ligament reconstruction

目的比较前内束(AMB)重建、后外束(PLB)重建和双束重建前交叉韧带在关节稳定方面的差异。方法选用6具新鲜冷冻人膝关节标本在关节镜下双束重建前交叉韧带,在膝关节生物力学测定仪上分别测定前交叉韧带完整组、AMB重建组、双束重建组、PLB重建组和前交叉韧带断裂组膝关节生物力学特性的变化。结果(1)胫骨前移:双束重建组在接近伸直位时,与正常前交叉韧带组及PLB组差异不明显(P>0.05),与其他组比较移位明显减小(P<0.05);在屈膝60°、90°位时,双束组与AMB组比较无显著性差异(P>0.05),与PLB组比较移位明显减小(P<0.05);AMB组和PLB组比较,屈膝20°位时无统计学差异(P>0.05),其他屈膝角度时AMB组明显移位小(P<0.05)。(2)胫骨内、外旋:在20°、30°、60°、90°位时,双束组与AMB组及PLB组差异均显著(P<0.05),双束重建明显好于ACL单束重建;AMB组与PLB组无显著性差异(P>0.05)。(3)膝关节内、外翻:双束组、AMB组和PLB组各组之间膝关节内、外翻角度差异不明显。结论双束重建前交叉韧带在恢复膝关节前向稳定性及控制胫骨内、外旋方面均好于单束重建,接近正常。单独前内束重建能较好地恢复膝关节前向稳定性,单独后外束重建ACL不能很好地恢复膝关节前向稳定性,两者均有限制胫骨过度内、外旋转作用。

Objective To compare the stability of the knees following anterior cruciate ligament （ACL） reconstruction among anteromedial bundle （AMB）, posterolateral bundle （PLB） and double bundle reconstruction groups. Methods Six fresh-frozen were tested using a homemade mechanical instrument through sequential cutting and reconstructing of ACL with Arthroscopy. The biomechanical characters were measured in the intact ACL group, AMB reconstruction group, double-bundle reconstruction group, PLB reconstruction group and total rupture group separately. Result （1） Tibia translation control： There was no significant difference found between double-bundle group and intact group, as well as between double-bundle group and PLB group at knee 20° flexion （P〉0.05）. Tibia translation in double bundle group decreased markedly as compared with other groups. There was not difference in tibia translation between double bundle group and AMB group at knee flexion 60° and 90°. However, there was significant difference between double bundle group and PLB group at the same knee flexion angle. There was no significant difference between AMB group and PLB group （P〉0.05）. At other knee flexion angles, AMB group was much better the PLB group （P〈0.05）. （2）Tibia rotation control： Double-bundle group has a obviously advantage to AMB group and PLB group at 20°,30°,60°and 90° of knee flexion in rotation control（P〈0.05）; there was no significant difference between AMB group and PLB group （P〉0.05）.（3） Varus and valgus control： There was no significant difference among double bundle group, AMB group and PLB in varus and valgus of knee. Conclusion Double bundle reconstructed ACL was better than the single bundle reconstructed ACL on anterior-posterior and rotational stability biomechanical, Single AM bundle reconstruction could regain mostly the anterior-posterior stability while single PL bundle reconstruction did not. Both bundles could improve rotational stability of knee in a certain extent.