循环载荷对腓骨长肌腱重建下胫腓联合损伤的生物力学性能分析

Analysis of cyclic loading on the biomechanical properties of tibiofibular syndesmosis injury reconstruction using the tendon of peroneus longus

[目的]探讨循环载荷对腓骨长肌腱重建下胫腓联合损伤的生物力学性能,为临床选择有效的弹性固定提供基础理论依据。[方法]采集8具新鲜成人下肢尸体标本,制成正常组、失稳组与腓骨长肌腱重建组,行生物力学动态应力分析,模拟人体下肢正常行走状态循环载荷作用下胫腓骨的生物力学性能。[结果]下胫腓联合损伤后,胫腓骨的动态位移性能发生异常变化,与正常标本相比差异具有统计学意义(P<0.05);腓骨长肌腱重建下胫腓联合损伤能达到弹性固定的目的,其动态分离位移能达到或接近正常(P>0.05);在不同预张力下用腓骨长肌腱重建对踝关节稳定性有明显影响,以60 N预张力重建为宜。[结论]腓骨长肌腱重建下胫腓联合损伤的循环载荷试验证明腓骨长肌腱重建动态力学性能十分优越,大大改善踝关节的活动度,能适应距骨运动顺应性调节,达到并恢复踝关节的正常生理功能,避免了常规螺钉固定易松动或发生疲劳断裂的弊端。

[Objective]To investigate the cyclic loading on the biomechanical properties of distal tibiofibular syndesmosis injury reconstruction using the tendon of peroneus longus,and provide basic theory for clinical choice of effective elastic fixation.[Method]Eight specimen of fresh adult ankle were used. The modles were divided to three groups（normal group,the instablility and long peroneal tendon reconstruction groups）. The biomechanical experiment was perfomed for dynamic stres analysis and imitating the biomechanical properties of tibiofibula in the state of human lower limb walking. [Result]Under the distal tibiofibular syndesmosis injury,the dynamic displacement of tibiofibular changed,and showed a significant difference compared with normal group（ P 0. 05）. Reconstruction the distal tibiofibular syndesmosis with long peroneal tendon could reach the purpose of the elastic fixtion,and its dynamic separation could be achieved or close to the normal（ P 0. 05）. Different pretension with long peroneal tendon reconstruction had obvious influence on the stability of the ankle,and 60 N pretension was advisable.[Conclusion]Cyclic loading test of reconstruction distal tibiofibular syndesmosis injury using long peroneal tendon has proved that dynamic mechanical properties of long peroneal tendon reconstruction was very superior,greatly improved the ankle motion,could adapt the talus compliance regulation,achieved and restored the normal physiological function of ankle joint,and avoided the screw loosening or fatigue fracture.