摘要
目的通过生物力学测试,探讨自体肌腱重建Lisfranc韧带的可行性。方法取12只成年男性新鲜下肢尸体标本,将标本按顺序制备Lisfranc韧带完整（正常组）、Lisfranc韧带断裂（断裂组）、Lisfranc韧带重建（重建组）模型。固定于Bose力学试验机,分别在中立位和跖屈30°位下,以10 N/s速度、0~600 N给予轴向加载,每隔100 N加载停止1 min。记录不同载荷下内侧楔骨（C1）和第2跖骨（M2）基底间位移（C1-M2间位移）以及第2跖骨基底部高度（代表足横弓高度）图像。将图像导入Adobe photoshop CS6软件中,计算中立位、跖屈30°位0、600 N载荷下C1-M2间位移变化值以及中立位0、600 N载荷下足横弓高度变化值。结果中立位及跖屈30°位,随着载荷增加,C1-M2间位移及足横弓高度均呈逐渐增加的趋势。两种体位下,正常组、断裂组、重建组间C1-M2间位移变化值比较,差异均有统计学意义（P〈0.05）。其中,断裂组中立位C1-M2间位移变化值显著小于跖屈30°位,差异有统计学意义（t=7.392,P=0.000）。中立位时,断裂组和重建组足横弓高度变化值明显大于正常组,差异有统计学意义（P〈0.05）;断裂组和重建组比较,差异无统计学意义（P〉0.05）。结论采用自体肌腱重建Lisfranc韧带能减小C1-M2间位移变化,能在一定程度上稳定Lisfranc关节;重建背侧韧带和Lisfranc韧带后不能提高足横弓的缓冲能力;在跖屈30°位下C1-M2间位移变化值较中立位更明显,有助于提高临床诊断隐匿性Lisfranc损伤。
Objective To explore the feasibility of Lisfranc ligament reconstruction with autogenous tendon through biomechanical testing. Methods Twelve fresh-frozen cadaveric lower limbs were prepared three sequential testing conditions： intact Lisfranc ligament（intact group）, disrupted Lisfranc ligament（disrupted group）, and Lisfranc ligament reconstruction（reconstruction group）. Under fixing on the Bose mechanical test machine, three models were given 0-600 N axial loading in the neutral position and the plantar flexion of 30° according to the speed of 10 N/s, every 100 N load with a 1-minute interval. The medial cuneiform（C1） and the second metatarsal（M2） base displacement and the foot transverse arch height were recorded under different loads. Results In the neutral position and the plantar flexion of 30°, C1-M2 displacement and foot transverse arch height showed an increasing trend with increased load under 0-600 N axial loading. There were significant differences in C1-M2 displacement variation in 2 positions among groups（P〈0.05）. In disrupted group, the C1-M2 displacement variation in neutral position was significantly lower than that in plantar flexion of 30°（t=7.392,P=0.000）. In the neutral position, the foot transverse arch height variation in the disrupted group and the reconstruction group was significantly higher than that in the intact group（P〈0.05）, but there was no significant difference between the disrupted group and reconstruction group（P〉0.05）. Conclusion Lisfranc ligament reconstruction with autogenous tendon can reduce the C1-M2 displacement variation and stabilize Lisfranc joint to a certain degree. Reconstruction of both dorsal ligament and Lisfranc ligament will not improve the buffering capacity. The C1-M2 displacement variation in the plantar flexion of 30° is more obvious than that in neutral position, so it is helpful to improve clinical diagnosis of occult Lisfranc damage.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2016年第1期60-64,共5页
Chinese Journal of Reparative and Reconstructive Surgery
