国人腘绳肌腱移植不同固定方式重建ACL的生物力学研究

Biomechanical study of different internal fixations with Chinese hamstring tendon in anterior cruciate ligament reconstruction

[目的]探讨腘绳肌腱移植重建ACL股骨与胫骨侧采用不同固定方式的生物力学特性。[方法]采用新鲜冷冻尸体膝关节标本,腘绳肌腱移植,股骨侧分别用Endobutton(n=8)、Rigidfix(n=8)、肌腱结(n=8)和界面螺钉固定(n=8)。胫骨端采用可吸收界面螺钉(n=7)和Intrafix(n=7)固定,模拟ACL重建。进行循环载后位移、抗拉刚度、失效载荷、最大载荷等生物力学。[结果]失效载荷和最大载荷:Endobutton>Rigidfix>肌腱结>界面螺钉固定法,差异有统计学意义(P<0.01),Rigidfix和界面螺钉之间的差异有统计学意义(P<0.05)。抗拉刚度:Rigidfix=肌腱结>界面螺钉固定>Endobutton。循环载荷位移:肌腱结固定组>Rigidfix固定组>Endobutton固定组>界面螺钉固定组。胫骨端最大载荷:Intrafix固定组>可吸收界面螺钉组,两者之间差异有统计学意义(P<0.05);100 N、400 N抗拉刚度两组间差异无统计学意义(P>0.05)。[结论]采用Endobutton、Rigidfix、intrafix、肌腱结和界面螺钉ACL重建固定均可满足力学需求;Rigidfix和Intrafix固定系统较界面螺钉固定更具有生物力学优势。

[Objective]To analyze the biomechanics of different internal fixations with Chinese hamstring tendon in anterior cruciate ligament（ACL） reconstruction.[Method]Reconstruction models of ACL were established in human cadaver knee joint and randomly divided into different groups according to different materials： Endobutton（n=8）,Rigidfix（n=8）,Hamstring tendon knot（n=8）,Interface absorbable screw（n=8） in femoral side.Interface absorbable screw（n=7） and Intrafix（n=7） in tibial side.The stiffness,max loading,failure loading,displacement loading were tested after cycling loading.[Result]Failure and max loading： Endobutton Rigidfix Hamstring tendon knot interface screw,with significant differences（P〈0.01）.There was significant difference between Rigidfix and interface screw（P〈0.05）.Stiffness： Rigidfix Hamstring tendon knot Interface screw Endobutton.Displacement： Hamstring tendon knot Rigidfix Endobutton interface screw.Max loading in tibial side： Intrafix interface screw,with significant difference（P〈0.05）,while no significant difference was found under 100 N,400 N loading（P〈0.05）.[Conclusion]All internal fixations in this study could meet biomechanical requirement,but Rigidfix and Intrafix showed more advantages.