膝关节腓骨截骨术的生物力学研究

Biomechanical Study of Fibular Osteotomy of Knee Joint

目的探讨膝关节腓骨截骨的生物力学及治疗膝骨关节炎的机理。方法3具健康成人下肢标本,男性标本2个,女性标本1个,年龄分别为30岁、33岁、40岁。右膝关节2个,左膝关节1个。采用Takscan公司生产的薄膜型压力传感器,于800N纵向载荷下测量截取腓骨前、后胫股关节间室四个象限的压强。结果本组实验结果均显示,膝关节内压力分布不均,但具有相似规律,表现为膝关节后外象限压强最大,前内象限次之,外侧平台总压强大于内侧,前外象限、后内象限压强最小。腓骨截骨后前内象限、前外象限压强减小,后外象限压强更大,后内象限的压强亦有增加,但腓骨截骨术后膝关节关节内总压强略大于术前。结论腓骨截骨减轻了膝关节内侧压力,可以用于膝内翻关节炎的治疗,腓骨截骨术后能缓解或解除膝关节炎的内侧疼痛,但术后应进行适应性康复训练,使膝关节适应新的负荷分配,防止腓骨截骨后胫骨负荷增加导致的病情反复或加重。

Objective To investigate the biomechanics of fibula osteotomy and the mechanism of treating knee osteoarthritis.Methods Three healthy adult lower limb specimens were obtained,2 male specimens and 1 female specimen,aged 30,33 and 40 years,respectively.Including 2 right knee joints and 1 left knee joint.The pressure load of the four quadrants of the anterior and posterior tibiofemoral compartment of the fibula was measured with a film pressure sensor manufactured by takscan company under a longitudinal load of 800 N.Results The results showed that the pressure distribution in the knee joint was uneven,but had similar rules.The pressure in the posterolateral quadrant was the largest,followed by the anterior inner quadrant.The total pressure of the lateral platform was greater than that of the medial,and the pressure in the anterolateral and posteromedial quadrants was the smallest.After fibular osteotomy,the pressure in the anterior inner quadrant and the anterior outer quadrant decreased,but the pressure in the posterior outer quadrant was greater,and the pressure in the posterior inner quadrant also increased.Conclusion Fibular osteotomy can reduce the medial pressure of knee joint and can be used for the treatment of knee varus arthritis.The medial pain of knee arthritis can be relieved or disappear after fibula osteotomy.However,adaptive rehabilitation training should be carried out after operation to make the knee joint adapt to the new load distribution and prevent the disease from repeating or aggravating caused by the increase of tibial load after fibula osteotomy.