不同半月板修复方式与半月板部分切除术后胫股关节的接触力学研究

摘要

目的：研究内侧半月板桶柄样撕裂后不同的半月板手术方式对胫股关节接触力学的影响。方法：每具膝关节均记录以下3种状态：对照组（完整半月板）、桶柄样撕裂和半月板修复术后。首先记录对照组（完整半月板）的接触图；制备桶柄样撕裂的半月板模型；用不同的手术方式处理桶柄样半月板损伤：垂直缝合、水平缝合、交叉缝合及半月板切除。24具标本随机用上述办法处理，所以最终每种手术方式均含有6具标本。记录瞬时接触面积（instantaneous contact area，CA）、平均接触压力（mean contact pressure，MCP）及峰值接触压力（peak contact pressure，PCP）。单因素方差分析进行统计学分析。结果：桶柄样撕裂的半月板与对照组相比，CA 显著减少， MCP（P ＜0．001）和 PCP（P ＜0．001）明显升高。半月板缝合术后膝关节的接触力学与对照组相比差异无统计学意义。水平、垂直及交叉缝合后 CA 的恢复差异无统计学意义。与半月板切除术相比，3种缝合方式导致的 MCP 及 PCP 改变更接近于对照组， MCP 和 PCP 恢复百分比差异无统计学意义（P分别为0．851和0．987）。结论：水平、垂直及交叉缝合半月板后胫股关节的接触力学优于半月板部分切除术。因此，对于桶柄样半月板撕裂的患者，应尽量选择半月板缝合术，以延缓或者避免膝关节的退行性变。%Objective To evaluate the biomechanical effect of horizontal, vertical, and cruciate suture repairs and partial meniscectomy on contact mechanics. Methods Control group (complete meniscus), buckethandletear group and suture repaired group were recorded. The contact map of the control group was firstly recorded; simulated bucket handle medial meniscal tears were then created. Tears were treated with 1 of 3 suture repair techniques or partial meniscectomy. The 24 samples were treated randomly and thus there were 6 samples evaluated for every operation method. Instantaneous contact area (CA), mean contact pressure (MCP), and peak contact pressure (PCP) measurements were recorded with a pressure sensing system. CA, MCP, and PCP for intact stifles (control), stifles with simulated tears, and stifles after treatment were recorded and compared using 1-way repeated measures ANOVA. Results Stifleswithbuckethandletearshadsignificantlydecreased CA, increased MCP and increased PCP when compared with control group. All meniscal repair techniques reestablished normal contact mechanics. When comparing meniscal repair and partial meniscectomy, stifles with partial meniscectomy had lower CA, higher MCP and PCP than stifles undergoing repair (P = 0.851 and 0.987, respectively). Conclusions Contact mechanics obtained from each repair technique were mechanically superior to partial meniscectomy. Performing meniscal repair instead of partial meniscectomy with select meniscal tears may mitigate the development of degenerative joint disease.