髌骨内移对髌股关节压力影响的试验研究

Experimental study on effect of patellar shift on patellofemoral joint pressure

目的探讨髌骨内移对髌股关节压力变化的影响,为临床采用手法内推髌骨治疗髌股关节炎提供生物力学依据。方法选取6具膝关节尸体标本,对股四头肌肌腱轴向施加200 N载荷,将压力传感器置入髌股关节内、外侧面,分别于膝关节伸直位及屈曲30°、45°、60°时进行加压,记录压力值大小。髌骨向外移位10 mm及向内移位10 mm后重复以上操作,记录髌股关节压力大小。结果髌骨生理状态下,髌股关节压力随着膝关节屈曲角度增大而呈逐渐增高,屈曲30°时髌股关节压力大于伸直位,屈曲45°时髌股关节压力大于屈曲30°位,屈曲60°时髌股关节压力大于屈曲45°位,差异有统计学意义(P <0.05)。膝关节屈曲30°、45°、60°时,髌骨内移后髌股关节压力均低于髌骨生理状态下压力,而髌骨外移后髌股关节压力均高于髌骨生理状态下压力,差异有统计学意义(P <0.05)。结论髌骨内移后可矫正髌骨异常活动轨迹,有效降低髌股关节外侧面间的压力,改善髌股关节炎患者疼痛症状,提高患者生活质量。

Objective To explore the effect of patellar shift on the pressure changes of patellofemoral joints, and provide a biomechanical basis for the treatment of patellofemoral arthritis by clinical manipulation. Methods Six knee cadaver specimens were selected, and 200 N load was applied to the quadriceps tendon in the axial direction. The pressure sensor was placed in the patellofemoral joint and the lateral side, respectively, and the knee joint was extended and flexed by 30 °, 45°,60°. Pressure was applied and the pressure value was recorded. The above procedure was repeated after the humerus was displaced 10 mm outward and 10 mm inward, and the pressure of the patellofemoral joint was recorded. Results In the physiological state of the tibia, the patellofemoral joint pressure gradually increased with the knee flexion angle. When the flexion was 30°, the patellofemoral joint pressure was greater than the extension position. When the flexion was 45 °, the patellofemoral joint pressure was greater than the flexion 30° position. At 60°, the patellofemoral joint pressure was greater than 45° flexion, and the difference was statistically significant(P <0.05). When the knee flexed 30°, 45°, 60°, the patellofemoral joint pressure was lower than the tibia physiological pressure under the patella, and the patellofemoral joint pressure was higher than the tibia physiological state under the tibia, the difference was statistically significant( P <0.05).Conclusion After the humerus is moved, the abnormal trajectory of the tibia can be corrected, the pressure between the lateral sides of the patellofemoral joint can be effectively reduced, the pain symptoms of the patellofemoral arthritis patients can be improved, and the quality of life of the patient can be improved.