髌内外侧稳定结构与髌股关节稳定性实验研究

目的 :了解髌内外侧稳定结构对髌骨的稳定作用,探讨临床中松解髌外侧支持带的治疗作用及效果,为临床治疗髌骨不稳提供生物力学依据。方法:6例新鲜膝关节标本,对股四头肌进行加载(模拟肌力正常的情况),在不同屈曲度,对髌骨施加外侧方移位载荷,使髌骨外侧半脱位,读取记录载荷大小。干预1:松解髌内侧支持带(模拟病理状态),重复上述操作,读取记录载荷大小;干预2:在干预1的基础上进一步松解外侧支持带(模拟手术治疗),重复上述操作,读取记录载荷大小。结果:松解髌内侧支持带后,使髌骨半脱位的载荷比支持带完整时减小,差异有统计学意义(P0.05)。进一步松解外侧支持带,半脱位载荷进一步减小,但与干预1差异无统计学意义(P0.05)。结论:髌内侧支持带在维持髌骨稳定及髌股关节正常运动轨迹中有重要作用,在临床治疗复发性髌骨脱位或半脱位时,应该重视髌内侧支持带的修复重建,单纯松解外侧支持带的方法并非最佳选择。

Experimentation of the relationship between medial or lateral patellar stabilizer and patellofemoral stabilization

Objective: To study the contribution of medial or lateral stabilizer to the stability of the patella,to explore the function and effect of releasing the LPR clinically and to provide a biomechanical basis for the clinical treatment of patellar instability(PI).Methods: The quadriceps femoris of 6 fresh human cadaver knees were loaded to simulate a normal condition of muscle strength. First the loading force was measured and recorded,which subluxated the patella with the different degrees of knee flexion. Intervention 1:released the medial patellar retinaculum(MPR) to simulate pathologic conditions,then repeated the above manipulates and recorded the loading force. Intervention 2:released the LPR furthermore to simulate clinical surgical treatment,then repeated the above manipulates and recorded the loading force.Results: After releasing the MPR,the loading force which subluxated the patella were decreased obviously,and there were significant differences between the two groups(P<0.05). The above loading force was further decreased after the further release of LPR,but the difference was not significant(P>0.05).Conclusion: MPR plays an important role in maintaining the stability of the patella and in the normal trajectory of the patellofemoral joint. The attention should be paid to the repair or reconstruction of the MPR in the treatment for patella recurrent lateral dislocation subluxation. Releasing the LPR is not a best choice.