下胫腓联合损伤不同固定方法生物力学研究

目的比较下胫腓联合损伤不同固定方式的生物力学稳定性。方法新鲜冷冻人小腿标本8具，因部分标本可重复使用．分为5组，下胫腓韧带完整组（8X）、下胫腓韧带切除组（8X）、下胫腓单骨道Suture-Button固定组（4X）、下胫腓双骨道Suture—Button固定组（4X）、下胫腓3．5mm常规皮质骨螺钉组（4X），循环加载750N负荷后，使用光学非接触应变测量系统和应力测试比较踝关节背屈10°、中立位、跖屈10°、跖屈20°下的胫腓骨相对位移，胫距关节最大接触面积和峰值压力以确定各自稳定性。结果单枚常规螺钉固定下胫腓联合损伤时胫腓骨相对位移较正常下胫腓的相对位移小，胫距关节最大接触面积大，关节内峰值压力小；单骨道SUture—button固定下胫腓相对移位大，胫距关节最大接触面积小，关节内峰值压力大；双骨道Suture-Button固定后胫腓骨相对移位、胫距关节最大接触面积、峰值压力与正常下胫腓接近。结论下胫腓联合损伤时应用双骨道Suture-Button固定更符合下胫腓联合的生物力学特征，临床应用可望获得较为满意的疗效。

Objective To compare the biomechanical stability performances of different fixation modes for tibiofibular syndesmosis injuries. Methods 8 normal fresh-frozen cadaver legs were divided into 5 groups owing to partial repetitive use-intact ligament, ligament intact group （ 8 ） , ligament resection group （ 8 ） , conventional screw group （ 4 ） , single bone tunnel suture button group （ 4 ） and duble bone tunnel suture button group （ 4 ） . After cyclic loading 750N, used Optical Non-contact Strain Measurement System and stress test to compare the relative displacement of tibiofibula, tibiotalar joint maximal contact area and peak pressure in the position of ankle dorsiflexion 10 degree, neutral position, plantar flexion 10 degree, plantar flexion 20 degree respectively to determine their stability. Results With the single conventional screw fixation, the tibiofibula relative displacement and tibiotalar join peak pressure were smaller, the maximal tibiotalar joint contact area was larger compared to the normal tibiofibular syndesmosis , and fxation with the single bone tunnel suture button, the relative displacement and peak pressure were larger, the maximal contact area was smaller, but with dune bone tunnel suture button fixation, the relative displacement, maximal tibiotalar joint contact area and peak pressure were close to the normal tibiofibular syndesmosis. Conclusions Fixation the damage tibiofibular syndesmosis with double bone tunnel suture botton, the biomechanics characteristics are close to the normal, the more satisfactory curative effect is expected to obtain.