Evans和Chrisman-Snook术式治疗踝关节外侧副韧带Ⅱ度损伤的生物力学比较

Biomechanical comparison of Evans procedure and Chrisman-Snook technique for the treatment of Ⅱ degree lateral collateral ligament of ankle joint

目的:测试Evans和Chrisman-Snook术式治疗踝关节外侧副韧带Ⅱ度损伤的术后稳定性,为临床治疗方法的选择及预后的判断提供依据。方法:2008年7月至2009年6月,采集18具冰冻下肢标本,男10例,女8例,平均年龄(39.3±11.2)岁,随机分为3组:正常对照组(A组),Evans术式组(B组)和Chrisman-Snook术式组(C组),每组6只标本。解冻后在B、C组中切断距腓前韧带和跟腓韧带,造成外侧副韧带Ⅱ度损伤,并采用Evans术式和Chrisman-Snook术式重建外侧副韧带,进行生物力学测试,观察胫距关节和距下关节侧方应力加载下的位移情况。结果:①胫距关节侧方应力试验显示B组对外侧副韧带损伤修复后位移大于A、C组(P<0.0001),A组与C组差异无统计学意义(P>0.05)。②距下关节侧方应力试验显示B组术后位移大于A、C组(P<0.0001),A组与C组差异无统计学意义(P>0.05)。结论:踝关节外侧副韧带损伤造成踝关节不稳,在其修复术式中Chrisman-Snook术式比Evans术式在重建踝关节术后初期稳定性上优于Evans术式,Chrisman-Snook术式更符合生物力学原理。

Objective： To measure the stability of Evans procedure and Chrisman-Snook technique in the treatment of II degree lateral collateral ligament of ankle joint, and provide basis for treatment and prognosis. Methods：From July 2008 to June 2009,18 frozen corpes were collected, including 10 males and 8 females, with an average age of fresh 39.3±11.2 years. The frozen corpes were randomly divided into three group, including normal controls （group A）, Evans procedure （group B）and Chrisman-Snook technique （ group C）, 6 specimens in each group. Anterior talofibnlar ligament and caleaneofibular ligament were cut off to cause II degree lateral collateral ligament in group B and C. Evans procedure or Chrisman-Snook technique were applied to restore lateral collateral ligament, and measure biomechnics. The displacement of tibiotalar joint and subtalar joint were observed. Results： （1）The lateral stress results of tibiotalar joint showed the displacement by Evans procedure （group B） was greater than other groups （P〈0.000 1 ）. There were no significant differences between group A and C （P〉0.05）. （2）The lateral stress results of subtalar joint showed the displacement by Evans procedure （group B） was greater than other groups （P〈 0.000 1 ）. There were no significant differences between group A and C （P〉0.05）. Conclusion：Ankle instability is caused by ankle joint lateral collateral ligament injury. Chrisman-Snook technique is better than Evans procedure in stability on the early stage of ankle joint restoration, and conform to principle of biomechanics.