骨隧道封闭状态下前交叉韧带重建的生物力学研究

Biomechanical study on anterior cruciate ligament reconstruction with preserving or removing the remnant under sealing the bone tunnels

[目的]探讨骨隧道封闭状态下是否保留残迹对前交叉韧带(ACL)重建的生物力学影响。[方法]采用成年健康新西兰兔12只,随机选取其一侧膝关节作为实验组,保留ACL残迹、骨隧道封闭状态下重建ACL;对侧为对照组:切除ACL残迹、骨隧道封闭状态下重建ACL。于术后12周处死动物,在858 Mini BionixⅡ型生物力学测试机测定股骨-移植物-胫骨的复合极限载荷、断裂部位。[结果]术后12周时保留残迹组股骨-移植物-胫骨的极限载荷为(23.46±7.4)N,切除残迹组为(18.63±4.26)N,实验组为对照组的126%,两组间有显著差异(t=3.058,P<0.05)。移植物断裂部位:保残迹组中11例在韧带关节内部分,1例在腱骨交界处;不保留残迹组中9例在韧带关节内部分,2例在腱骨交界处,1例从隧道内拔出。[结论]保留残迹的ACL重建有利于移植关节内愈合,改善移植物生物力学性能。

[ Objective ] To explore the biomechanical effects of preserving the remnants in anterior eruciate ligament（ACL） reconstruction under sealing the bone tunnel. [ Method ] Twelve skeletally matured New Zealand white rabbits underwent ACL reconstruction with preserving the remnants and sealing the bone tunnels on one knee randomly,the opposite knee was served as the paired control - ACL reconstruction with removing the remnants and sealing the bone tunnels. Rabbits were sacrificed at 12 weeks. The maximum loading of the femur - graft - tibia complexes were determined in 858 Mini Bionix Ⅱ testor, and the rupture site was observed. [ Result ] The mean maximum load at 12 weeks was （23.46 ±7.4） N in the preserving remnants group, （ 18.63 ±4.26 ）N in the removing remnants group ,the maximum load in the expermental group was 126% of the control. There was significant difference between two groups （ t = 3. 058,P 〈 0.05 ）. All the rupture site in the preserving remnants group was at the intraarticular part of the graft except one at the tendon - bone interface,in contrast,in removing remnants group rupture site was at intraartieular part in 9 grafts, at tendon - bone interface in 2 grafts and pulling out from the bone tunnel in one graft. [ Conclusion] Preserving the remnants in ACL reconstruction is beneficial to healing of the graft and improvement of biomechanical properpies of the ACL graft.