上胫腓关节的生物力学研究

Biomechanics study on proximal tibiofibular joint

目的探讨上胫腓关节的生物力学特征。方法收集10具成人尸体膝部标本,采用生物力学方法及压敏片技术测试不同体位下上胫腓关节的压力及上胫腓关节的受力面积。结果上胫腓关节的平均压力均显著小于内、外侧股胫关节的平均压力(P<0.05);在压力为700N、1400N、2800N时,居于中立位的上胫腓关节的受力面积显著小于其他体位(P<0.05);居于中立位的上胫腓关节的平均压力显著大于居于跖屈位、内翻位,但显著小于背伸位、外翻位(P<0.05)。P1组倾斜度>20°,P2组的倾斜度<20°;在700N压力下,P1组的受力面积均显著小于P2组(P<0.05),但P1组的平均压力显著大于P2组(P<0.05),且不受体位的改变影响。结论跖屈位、内翻位时上胫腓关节承受压力大,上胫腓关节压力随踝关节体位的改变而改变,在处理上胫腓关节脱位时,需尽量避免行上胫腓关节融合术;倾斜型的上胫腓关节较水平型承受压力大,较易发生损伤。

Objective To evaluate the biomechanics of upper tibiofibular joint. Methods Chose 10 knee specimens of adult cadavers as research object. The average pressure and stressed area of upper tibiofibular joint were detected by biomechanical method and pressure sensitive piece technology. Results The average pressure bear by superior tibiofibular joint was significantly less than medial/lateral tibiofemoral joint（P〈0.05）. Under different pressure（700N, 1400 N, 2800N）,the stress area within superior tibiofibular joint in the neutral position was significantly less than it within superior tibiofibular joint in plantar flexion, back stretch, varus and valgus position（P〈0.05）; the average pressure bear by superior tibiofibular joint in the neutral position was significantly less than it bear by superior tibiofibular joint in plantar flexion, back stretch, varus and valgus position（P〈0.05）. P1 group was greater than 20°, P2 group was less than 20°.Under pressure of 700 N, stress area for P1 group was significantly less than P2 group（P〈0.05）, but the average pressure bear by P1 group was greater than the P2 group（P〈0.05）, and the effect was independent of body position. Conclusion Because the superior tibiofibular joint bear more pressure under plantar flexion and varus position, and the pressure varies with the change of the ankle position. It is avoided that arthrodesis is used to deal with dislocation superior tibiofibular joint. Tilting superior tibiofibular joint is more prone to be injured in compared to horizontal type because of bearing more pressure.