半月板不同切除术对髌股关节影响的生物力学研究

Biomechanical study in patellofemoral joint after different meniscectomy

目的探讨半月板不同部位,不同程度切除后对膝关节髌股关节的影响,为半月板不同切除术的比较提供生物力学依据。方法采用6具人膝关节新鲜标本,保留内、外侧副韧带、关节囊及膝关节伸膝装置,Staubli机器人模拟生理状态下膝关节站立至下蹲屈膝过程,采用超低压型压敏片测量完整膝关节和半月板不同部位及程度切除术后不同屈膝角度下髌股关节接触面积、接触压,并用SPSS12.0进行双因素方差分析。结果1.无论何种状态的半月板切除,其髌股关节接触的总体趋势没有改变,即膝关节屈曲0°～90°髌股关节的接触面积会逐渐增加;2.半月板部分切除与正常膝关节在髌股接触面积、髌股平均接触压力间的差异无统计学意义;3.外侧半月板全切除与正常膝关节在髌股接触面积之间的差异有统计学意义,其髌股接触面积在各个屈曲角度均小于正常膝关节,其髌股接触平均压力在各个屈曲角度均大于正常膝关节的髌股接触平均压力;4.内侧半月板全切除与正常膝关节在髌股接触面积间的差异无统计学意义,内侧半月板全切其在膝关节屈曲0°～30°之间其髌股关节平均压力均大于正常膝关节髌股关节间平均压力;60°～90°之间与正常膝关节髌股关节间平均压力间的差异无统计学意义。结论外侧半月板全切除术后髌股关节高接触压力、内侧半月板全切除术后髌股关节低接触压力及半月板部分切除术后髌股关节压力分布不均是术后髌股关节炎发生不可忽视的原因。

Objective Investigate the pathogenesis of contact pressures and areas of patellofemoral joint both before and after different of meniscectomy, so as to provide biomechanical basis for different of meuiscectomy and provide scientific basis for the clinical application of different meniscus injury. Methods Six fresh cadaver knees were obtained for study. The skin and subcutaneous tissue of knee were removed but medial and lateral collateral ligaments, the joint capsule, individual componts of the extensor mechanism, patellofemoral joint, tibiofemoral joint and peripatellar retinaculum were preserved so as to simulate the biomechanical properties of the human knee as closely as possible. The statistical tool that used to analyze the database was spss12.0 and double factirial analysis of variancedata was made. Results No matter what kind of meniscectomy state, the contact area of patellofemoral also always enlarged with the increase of knee flexion angle. From the values obtained from contact area and the average contact pressure of patellofemoral, we found no significant difference between intact knee and partial meniscectomy, but a significant difference was found between meniscectomy and intact knee. The contact area of lateral meniscectomy was statistically less than contact area of intact knee. The average contact pressure of patellofemoral of lateral meniscectomy were larger than intact knee at each of angles of flexion. The contact area of medial meniscectomy were found no significant difference between intact knee and medial meniscectomy, the average contact pressure of patellofemoral of medial meniscectomy were larger than intact knee from 0° - 30° of knee flexion, then no significant difference were found between intact knee and medial menisceetomy on knee bending from 60° to 90°. Conclusions Different meniseectomy might bring out the patellofemoral degenerative arthrosis by disorder of contact presure distribution.