| 髋关节置换修复关节囊的解剖和拉伸力学分析 |
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Received:May 17, 2020
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| 作者 | Author | 单位 | Unit | E-Mail |
| 胡翰生 |
HU Han-sheng |
南京医科大学第一附属医院 骨科, 江苏 南京 210029 |
Department of Orthopaedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China |
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| 王静成 |
WANG Jing-cheng |
江苏苏北人民医院 骨科, 江苏 扬州 225000 |
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| 卢志华 |
LU Zhi-hua |
江苏苏北人民医院 骨科, 江苏 扬州 225000 |
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| 范卫民 |
and FAN Wei-min |
南京医科大学第一附属医院 骨科, 江苏 南京 210029 |
Department of Orthopaedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China |
fanweimin_vip@sina.com |
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| 期刊信息：《中国骨伤》2020年33卷，第8期，第761-765页 |
| DOI：10.12200/j.issn.1003-0034.2020.08.015 |
| 基金项目:江苏省骨科创新团队项目（编号：CXTDB2017004）；扬州市自然科学基金青年人才项目（编号：YZ2016109） |
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目的：研究髋关节后关节囊的拉伸力学和解剖特点，为全髋置换术中修复关节囊提供生物力学和解剖学依据。
方法：以骨-关节囊-骨方式采集6个冷冻髋关节后关节囊韧带复合体标本，装载于Instron万能材料试验机，测定标本的载荷-应变曲线、极限拉伸应变、极限拉伸载荷、弹性模量等拉伸力学特性。解剖12具尸体髋关节标本至关节囊，记录屈髋90°位，正常关节囊和经转子钻孔（传统法）修复关节囊的拉伸应变；将后关节囊可缝合区划分为9个区域，测量、比较不同分区的关节囊厚度；在尸体标本的两侧髋关节，分别采用传统法和经股骨颈解剖止点钻孔（解剖法）修复后方关节囊，并模拟早期康复活动，观察康复对修复后关节囊的影响。
结果：关节囊韧带复合体标本载荷-应变曲线符合流变学和粘弹性特征，其极限拉伸应变为（39.21±5.23）%、极限拉伸载荷为（142.06±34.15）N，拉伸强度为（1.65±0.38）MPa，弹性模量为（14.23±5.62）MPa。屈髋90°位，传统修复关节囊拉伸应变大于正常关节囊（P<0.05），正常关节囊拉伸应变为：上部（17.0±2.6）%，中部（24.1±1.4）%，下部（26.0±4.3）%；传统修复法拉伸应变为：上部（37.0±4.9）%，中部（53.3±1.1）%，下部（68.3±6.2）%。后关节囊不同分区的厚度差异有统计学意义（P<0.05），股骨止点近端0.5 cm处各部厚度适合缝合，此处关节囊平均厚度为：上部（3.48±0.11）mm，中部（2.36±0.09）mm，下部（1.59±0.24）mm，后下关节囊距股骨止点（1.42±0.02）cm处最薄，应避免此处进针。模拟康复活动后，传统法修复的关节囊后下部分发生撕脱（10/12），解剖法修复的关节囊完整。
结论：传统法修复关节囊后下部分拉伸应变过大，容易撕脱，解剖修复关节囊符合拉伸力学要求，有助于提高关节囊修复成功率。 |
| [关键词]:关节成形术,置换,髋 关节囊 生物力学 解剖学 |
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| Anatomical and tensile mechanical analysis of hip joint capsule repair in total hip replacement |
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Abstract:Objective: To explore the tensile mechanics and anatomical characteristics of the posterior hip capsule,and provide biomechanical and anatomical evidence for capsule repair in total hip replacement.
Methods: Six bone-capsule-bone specimens were obtained from posterior hip joint of fresh frozen cadavers. The maximum strain,load,elastic modulus and load-strain curves of the capsule ligament complex specimens were recorded by Instron Universal Material Testing Machine. Twelve cadaveric hip specimens were dissected to the capsule. The tensile strain of normal capsule and conventionally reconstructed capsule at 90 degrees of hip flexion were documented. The suture area of the posterior capsule was divided into nine sections,and the thickness of different sections was measured and compared. Posterior capsule of the cadavers was repaired in conventionally way and anatomical way separately and simulated rehabilitation was conducted. The effect of rehabilitation on the repaired capsule was observed.
Results: The load-strain curve of capsule ligament complex conforms to rheological and viscoelastic characteristics. The maximum tensile strain of the complex was (39.21±5.23)%,the maximum load was (142.06±34.15) N,the tensile strength was (1.65±0.38) MPa,and the elastic modulus is (14.23±5.62) MPa. At 90 ° hip flexion,the tensile strain of repaired capsule was higher than that of normal capsule,and the difference was statistically significant(P<0.05). Tensile strain of conventionally reconstructed capsule is:upper part (37.0±4.9)%,middle part (53.3±1.1)%,lower part (68.3±6.2)%,tensile strain of normal capsule is:upper part (17.0±2.6)%,middle part (24.1±1.4)%,lower part (26.0±4.3)%. The thickness of the posterior joint capsule in different sections is statistically significant(P<0.05),and capsule at 0.5cm proximal to the femoral insertion is suitable for suture. There the average thickness of capsule is:upper part (3.48 ±0.11) mm,middle part (2.36 ±0.09) mm,lower part (1.59±0.24) mm. The posterior inferior joint capsule is thinnest at (1.42 ±0.02) cm proximal to the femoral insertion,and sutures should be avoided here. After simulating rehabilitation,avulsion occurred in the lower part of the posterior capsule repaired conventionally(10/12),and the anatomically repaired capsule remained intact.
Conclusion: The lower part of conventionally repaired capsule is overstretched and tends to fail. Anatomically repaired capsule conforms to tensile mechanics and is helpful to reduce the failure rate of repair. |
| KEYWORDS:Arthroplasty,replacement,hip Capsule Biomechanics Anatomy |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 胡翰生,王静成,卢志华,范卫民.髋关节置换修复关节囊的解剖和拉伸力学分析[J].中国骨伤,2020,33(8):761~765 |
| 英文格式: | HU Han-sheng,WANG Jing-cheng,LU Zhi-hua,and FAN Wei-min.Anatomical and tensile mechanical analysis of hip joint capsule repair in total hip replacement[J].zhongguo gu shang / China J Orthop Trauma ,2020,33(8):761~765 |
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