前交叉韧带不同断裂程度对髌骨内外侧关节面的生物力学影响

Effect of ACL Rupture on Biomechanics of Patellar in Medial and Lateral Articular Surface

目的:探讨前交叉韧带(ACL)完全断裂和部分断裂对髌骨内外侧关节面生物力学的影响。方法:10例新鲜正常成人膝关节标本作为ACL完整组,在200N轴向载荷下,测试膝关节0°、30°、60°、90°髌骨内外侧关节面应变,测试完毕后随机将标本造模成前内侧束(AMB)切断组和后外侧束(PLB)切断组,各5例,在上述条件下测试,再将ACL中下1/3全切作为全切组进行测试。结果:膝伸直0°位各组应变无显著性差异(P>0.05),膝屈曲30°、60°、90°各组间均有显著性差异(P<0.05),其应变变化趋势为ACL完整组>PLB切断组>AMB切断组>全切组。且髌骨内侧面应变小于髌骨外侧面应变(P<0.05)。结论:ACL完全断裂,在不同载荷和角度下,对髌骨内外侧关节面的应变均有影响。ACL部分断裂在膝关节屈曲30°、60°、90°位可引起髌骨内外侧生物力学改变。ACL完全断裂,髌骨外侧应变高于髌骨内侧应变,其意义尚需进一步探讨。

Objective： To investigate the effect of the ACL rupture on the biomechanics of patellar in the medial and lateral articular surface. Methods： There were 10 normal fresh knees joints of adults have been detected in this experiment. At first, all the keen joints, whose medial and lateral articular surface ofpatellar were measured at different angles（0° ,30° ,60°,90°） under 200N load, were regarded as the group with intact ACL.Then, 5 adult keens were randomly treated as the group with the anterimedial part of AeL ruptured. The other 5 knees were treated as the group whose posterolateral part of ACL ruptured. Measuring the straining of the medial and lateral of patellar aricular surface in the group with the ACL completely ruptured. Results： At 0° ,the strain at medial and lateral articular surface was no significant different （P〉0.05）; At 30° ,60° ,90° angles, the strains of all groups were significant different （P〈0.05）. the A- CL intact group was the biggest, then, the PLB group is bigger than the AMB group, the ACL completely ruptured is the smallest. The lateral of patellar articular surface is bigger than the medial of patellar articular surface （P〈0.05）. Conclusion： ACL total rupture may cause abnormal load on the patellar in the medial and lateral articular surface. AMB rupture may cause abnormal load on the patellar in the medial and lateral articular surface at the positions in 30° ,60° ,90° positions. ACL total rupture can cause the strain of lateral of patellar was larger than medial ofpatellar, which need to be further explored.