不同手术方式治疗踝关节韧带复合体损伤的生物力学评价

目的　研究不同手术方式治疗踝关节3个韧带复合体同时损伤的生物力学特征。 方法　选用6例成年新鲜正常踝关节，建立3组模型：A组：模拟内、外侧韧带损伤后予以形态和张力完全修复，下胫腓联合不固定。B组：模拟内、外侧韧带损伤后予以形态和张力完全修复，固定下胫腓联合。C组：模拟踝关节外侧韧带损伤后予以形态和张力完全修复，固定下胫腓联合，内侧韧带损伤不修复。 6例踝关节按A 、B、C顺序分别入组，分别在背伸10°等5种状态下加载压力，记录和比较各组标本的峰值压力。 结果　各状态下应力比较：B组＜C组＜A组；B组与A组比较均有统计学差异（P＜0.05）；B组与C组比较在背伸、外翻位有统计学差异（P＜0.05），在其他位置无统计学差异。 结论　当踝关节3个韧带复合体同时损伤时，内、外侧韧带同时完好（或修复），并且固定下胫腓联合的手术方式能使踝关节应力减至最低。

Effects of different surgical mananement of the three-column injury of ankle on the peak contact pressure in the tibiotalar joint

Objective　To study the effects of different surgical procedures of clinical treatment of the three-column injury of ankle on the peak contact pressure in the tibiotalarjoint. Methods Six fresh cadaveric adult ankles were used for creation of 3 models of different surgical proceduresof treatment for the three-column injury of ankle. In model A, the medial and lateral ligaments of ankle joint were intact(repaired), the broken inferior tibiofibular ligament were not fixed. In model B, the medial and lateral ligaments of ankle joint were intact(repaired),the broken inferior tibiofibular ligament was fixed by a screw. In model C, lateral ligaments of ankle joint were intact(repaired), the broken inferior tibiofibular ligament was fixed by a screw, but the broken medial ligaments were not repaired. The three groups were tested in order A、B、C. The 3 models were tested with an electronic pressure sensor in a BOSE material testing machine, respectively, in 5 positions. The peak values of the compressive stresses of the 3 models in 5 positions were recorded. All data were collected and analyzed using SPSS22.0. Results Model B exhibited the smallest average stress in all 5 positions, followed by model C and model A, with significant differences between B and A groups (P＜0.05）.There were significant differences between B and C groups (P＜0.05）at 10° dorsal extension and 10°valgus position. Conclusion The surgical management of the three-column injury of ankle where the medial and lateral ligaments are intact or repaired, and the tibiofibular syndesmosisis effectively fixed can reduce the peak contact pressure in the tibiotalar joint.