同种异体肌腱与螺钉固定修复Lisfranc关节韧带损伤的生物力学比较研究
Comparison Between Allogeneic Tendon Fixation and Screw Fixation in Ligamentous Lisfranc Injury: a Biomechanical Analysis
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摘要: 目的 分别比较螺钉和同种异体肌腱固定修复Lisfranc关节韧带损伤的生物力学强度。 方法 6对新鲜冷冻尸体足部标本,分别制备Lisfranc关节韧带完整模型、损伤模型及损伤后的螺钉或同种异体肌腱固定模型,并分别给予轴向和外展负荷加载,数码显微摄像头记录内侧楔骨和第2跖骨底间的位移变化。 结果 ①在轴向和外展加载时,完整模型中的内侧楔骨-第2跖骨间的位移变化分别为(0.65±0.23)mm和(1.10±0.45)mm,损伤模型为(1.60±0.64)mm和(4.14±1.02)mm,损伤模型位移变化均大于完整模型(P均=0.000),损伤模型中外展加载的平均位移较轴向加载大。②在轴向和外展加载时,螺钉固定组中,损伤模型内侧楔骨-第2跖骨底间的平均位移分别为(1.53±0.62)mm和(4.06±1.05)mm,固定后模型为(0.76±0.35)mm和(1.20±0.53)mm,固定后模型位移均小于损伤模型(P均=0.000),固定后模型与完整模型的位移差异无统计学意义;同种异体肌腱固定组中,损伤模型内侧楔骨-第2跖骨底间的平均位移分别为(1.66±0.65)mm和(4.21±1.00)mm,固定后模型为(0.90±0.41)mm和(1.33±0.61)mm,固定后模型位移均小于损伤模型(P均=0.000),固定后模型与完整模型的位移差异无统计学意义。 结论 外展应力加载时,损伤模型位移变化更加明显,在诊断Lisfranc关节韧带损伤时有较大的临床应用价值。Lisfranc关节韧带损伤模型中,同种异体肌腱固定和螺钉固定可提供相似的生物力学固定强度。Abstract: Objective To compare the stability provided by a allogeneic tendon with a screw for the treatment of ligamentous Lisfranc injury. Methods Six fresh-frozen, paired cadaveric feet were loaded in the condition of Lisfranc ligament intact, injury and fixation models. With axial or abduction stress, the distance between medial cuneiform and second metatarsal was recorded. Results With both two types of stress, there were statistically significant differences in motion detected between the intact and post-injury conditions (all P=0.000), and the magnitudes were greater with abduction (4.14±1.02) mm than axial load (1.60±0.64) mm. In screw fixation group, the mean position changes under axial load and abduction load were (1.53±0.62) mm and (4.06±1.05) mm in post-injury model respectively, while the changes were (0.76±0.35) mm and (1.20±0.53) mm in the fixation model (all P=0.000) which were not statistical different to that in the intact model. In allogeneic tendon fixation group, the mean position changes were (1.66±0.65) mm and (4.21±1.00) mm in the post-injury model, while were (0.90±0.41) mm and (1.33±0.61) mm in the fixation model (all P=0.000) which also were not statistical different to that in the intact model. Conclusion Under abduction stress, a significantly greater difference was found between pre- and post-injury, which may be valuable for diagnosing and testing ligamentous Lisfranc injury. Allogeneic tendon fixation can provide similar stability as screw fixation in ligamentous Lisfranc injury.