【摘要】 背景:膝关节内侧结构损伤是膝关节损伤中较为常见的损伤,常见损伤原因包括外翻暴力、旋转暴力。目前,临床上对于内侧副韧带(MCL)损伤的治疗仍存在争议。目的:发生前交叉韧带(ACL)损伤后,通过测量内侧关节间隙及膝关节外翻角大小,来评估MCL复合体对于膝关节稳定性的影响。方法:采用8例新鲜冰冻膝关节尸体进行试验。在膝关节屈曲0°、15°和30°时,使用力矩传感器机器人测试系统对标本进行生物力学测试。每具膝关节标本均经历以下3种状态:(1)ACL及MCL复合体完整;(2)ACL缺失,MCL复合体完整;(3)ACL及MCL复合体均缺失。将MCL复合体切断以模拟MCLⅢ级损伤。在给予外翻负荷的情况下,采用两种方法(透视、机器人检测系统)测量内侧关节间隙和外翻角。膝关节内侧间隙采用不透射线的直尺进行测量,外翻角采用Image J软件进行分析。结果:在膝关节屈曲0°、15°和30°时,ACL及MCL复合体均缺失的膝关节标本的内侧关节间隙和外翻角明显大于完整膝关节。在ACL及MCL复合体均缺失的状态下,随着屈膝角度的增大,内侧关节间隙及外翻角亦增大;在屈膝30°时,内侧间隙与外翻角最大。结论:临床随访过程中,对于ACL损伤或ACL损伤合并MCL损伤的患者应加拍屈膝30°位外翻应力位X线片以评估MCL损伤程度,为治疗方案的选择提供客观、有力的依据。更多还原

【Abstract】 Background:The injury of medial structure is a common injury in knee joint.The common causes of injury include valgus violence and rotation violence.At present,the clinical treatment of medial collateral ligament(MCL) injury is still controversial.Objective:To evaluate the contribution of the MCL complex to the stability of the knee with anterior cruciate ligament(ACL) injury using joint gap opening and valgus angle.Methods:Eight fresh frozen cadaver knees were used for testing.Specimens were tested using a robotic testing system at 0°,15° and 30° of knee flexion.The knee states tested were:(1)intact ACL and MCL complex,-deficient ACL and intact MCL complex,-deficient ACL and deficient MCL complex.The MCL complex was cut to simulate grade Ⅲ MCL injury.Robotic testing system and fluoroscope were used in measuring the joint gap opening under valgus loading.Fluoroscopic digital images of the knee joint were captured with a radiopaque certified ruler and the gap angle was measured using the software Image J.Results:At knee flexion of 0°,15° and 30°,medial joint gap and valgus angle of knee specimens with deficient ACL and deficient MCL complex were significantly larger than those of intact knee specimen.In the absence of ACL and MCL complex,the medial articular space and valgus angle increased with the increase of knee bending angle,and reached the maximum at 30° of knee flexion.Conclusions:Clinically,the fluoroscopy image of the knees at 30° of knee flexion under valgus loading can aid in evaluating ACL injury and combined ACL and grade Ⅲ MCL injury.更多还原