双骨道与三骨道前交叉韧带双束重建的生物力学比较

Biomechanical comparison of double-tunnel and three-tunnel double-bundle anterior cruciate ligament reconstructions

背景:关节镜下前交叉韧带重建可以有效地解决前交叉韧带损伤引起的膝关节不稳症状,而双骨道(胫骨单骨道-股骨单骨道)与三骨道(胫骨单骨道-股骨双骨道)前交叉韧带重建是目前较为常用的重建方式。目的:探讨双骨道与三骨道前交叉韧带双束重建对膝关节稳定性的影响。方法:选用8具新鲜正常成人尸体膝关节标本,分别进行双骨道与三骨道前交叉韧带双束重建,然后在MTS-809生物力学测试系统上测试膝关节在胫前加载(134N)以及胫骨旋转加载(5Nm内旋)下屈曲0°,15°,30°,60°,90°时的膝关节稳定性。结果与结论:①胫前加载:在所测的5个角度下,两重建组的胫前位移较前交叉韧带完整组均增大,但差异无显著性意义(P>0.05);双骨道重建组较三骨道重建组胫前位移增大,但差异无显著性意义(P>0.05)。②旋转加载:在所测的5个角度下,前交叉韧带完整组的胫前位移最小,双骨道重建组与三骨道重建组比较,在膝关节屈曲0°,15°和90°时,差异无显著性意义(P>0.05),在膝关节屈曲30°和60°时,三骨道重建组胫前位移小于双骨道重建组,差异有显著性意义(P<0.05);三骨道重建组与前交叉韧带完整组比较,差异无显著性意义(P>0.05)。提示双骨道与三骨道前交叉韧带双束重建均可促进膝关节前后及旋转稳定性的恢复,三骨道前交叉韧带双束重建与双骨道前交叉韧带双束重建相比,显示了更好恢复膝关节旋转稳定性的作用。

BACKGROUND： Arthroscopic anterior cruciate ligament reconstruction can effectively solve the symptoms of knee instability caused by anterior cruciate ligament injury, while double-tunnel double-bundle （single tibia tunnel-single femoral tunnel） and three-tunnel double-bundle （single tibia tunnel-double femoral tunnel） anterior cruciate ligament reconstruction are common repairing methods in clinic. OBJECTIVE： To investigate the effect of double-tunnel double-bundle and three-tunnel double-bundle anterior cruciate ligament reconstructions on the instability of knee joint. METHODS： Eight fresh-frozen human cadaveric knee specimens were selected and treated with double-tunnel double-bundle and three-tunnel double-bundle anterior cruciate ligament reconstructions respectively, and the instability of knee joint under an anterior tibial load （134 N） and internal tibial torques load （5 N m） at 0°, 15°, 30°, 60 ° and 90 °of flexion were tested using MTS-809 biomechanics test system. RESULTS AND CONCLUSION： ①Anterior tibial load： the displacement of two reconstruction groups under five angles stated above were larger than that of anterior cruciate ligament intact group, and the difference was not significant （P 0.05）; while the anterior tibial replacement in double-tunnel double-bundle anterior cruciate ligament reconstruction group was larger than that in the three-tunnel double-bundle anterior cruciate ligament reconstruction group, and the difference was not significant （P 0.05）. ②Tibial torques load： under five angles stated above, the anterior tibial replacement of anterior cruciate ligament intact group was smallest, and there was no significant difference of anterior tibial replacement under 0°, 15° and 90° flexion between double-tunnel double-bundle anterior cruciate ligament reconstruction group and three-tunnel double-bundle anterior cruciate ligament reconstruction group （P 0.05）, while the anterior tibial replacement under 30° and 60° flexion in the three-tunnel double-bundle anterior cruciate ligament reconstruction group was smaller than that in the double-tunnel double-bundle anterior cruciate ligament reconstruction group, and the difference was significant （P 0.05）; there was no significant difference of anterior tibial replacement between three-tunnel double-bundle anterior cruciate ligament reconstruction group and anterior cruciate ligament intact group （P 0.05）. The anterior-posterior and rotational stability of knee joint could be improved by double-tunnel double-bundle and three-tunnel double-bundle anterior cruciate ligament reconstructions. But compared with double-tunnel double-bundle anterior cruciate ligament reconstruction, three-tunnel double-bundle anterior cruciate ligament reconstruction can effectively provide more rotational stability of knee joint.