骨性和软组织性髌骨脱位模型中滑车发育的实验研究

来源 :中华骨科杂志 | 被引量 : 0次 | 上传用户:onlylisong
下载到本地 , 更方便阅读
声明 : 本文档内容版权归属内容提供方 , 如果您对本文有版权争议 , 可与客服联系进行内容授权或下架
论文部分内容阅读
目的:通过股骨截骨术增大股骨前倾角和髌骨内外侧软组织失平衡手术制作髌骨脱位模型,观察股骨滑车局部形态和骨小梁结构的变化。方法:取40只3个月龄的新西兰幼兔,分别对其右膝进行两种手术方式(每组20只):①截骨组,接受股骨旋转截骨术,股骨远端内旋来增大股骨前倾角;②软组织组,行髌骨内侧支持带松解和外侧支持带紧缩缝合术。所有左膝作为正常对照组。术后观察4个月至骨骼成熟,将股骨远端进行Micro-CT扫描,测量滑车形态:外侧髁、滑车沟和内侧髁的高度,滑车沟角,滑车的外侧和内侧关节面倾斜角等,并对骨小梁进行分析:骨体积分数、骨小梁厚度、骨小梁数量、骨小梁分离度和骨密度等。相关指标的结果进行组间比较。结果:截骨组中1例发生髋关节脱位,而髌骨未发生脱位;3例在屈膝状态下出现完全性的髌骨脱位;16膝在膝关节被动伸直时,髌骨发生脱位。软组织组中15膝在屈膝状态下出现完全性的髌骨脱位,5膝未发生髌骨脱位。截骨组的股骨滑车在滑车入口处伴有局部的突起形成,称为“骨突”,而滑车关节面比较光滑,未出现明显的软骨破裂等,而软组织组的股骨滑车未见“骨突”形成,滑车关节面出现软骨破裂、缺损等关节炎表现。与对照组相比,截骨组和软组织组的滑车均变浅和变宽,滑车沟高度和滑车沟角变大,但两组比较没有统计学差异。与对照组相比,截骨组骨小梁发生汇聚,内侧髁和外侧髁的骨小梁厚度增大,内侧髁骨小梁数量减少,而软组织组表现为骨质疏松,内侧髁和外侧髁的骨体积分数、骨小梁厚度、骨小梁数量和骨密度都减少,骨小梁分离度增大。与软组织组相比,截骨组内侧髁和外侧髁的骨体积分数、骨小梁厚度、骨小梁数量和骨密度都较大,骨小梁分离度较小,差异有统计学意义。结论:通过股骨截骨术增大股骨前倾角和髌骨内外侧软组织失平衡手术可成功构建髌骨脱位的骨性和软组织型模型,并继发形成不同的滑车形态学改变和骨小梁结构变化。“,”Objective:To establish a model of patellar dislocation by femoral osteotomy or surgical release of medial retinaculum in immature rabbits, and observe morphological and trabecular microarchitectural changes in the trochlea.Methods:Forty rabbits at 3 months of age were included. All right knees underwent surgery, 20 knees were treated with femoral osteotomy and internal rotation of distal femur to increase femoral anteversion angle (Osteotomy group, OS group), and another 20 knees were treated with surgical release of medial retinaculum and overlap suture of lateral retinaculum (Soft tissue group, ST group). All left knees were acting as internal controls. Micro-CT scans for distal femur were acquired after 4 months post surgery. the height of Medial, central, and lateral trochlear, sulcus angle, and lateral and medial trochlear slope were measured to describe the trochlear morphology, and bone volume fraction (BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), trabecular spacing (Tb.Sp), and bone mineral density (BMD) were calculated to evaluate the microarchitectural structure. All parameters were compared between groups.Results:In OS group, one rabbit sustained a hip dislocation without patellar dislocation. Three knees developed complete patellar dislocation in daily flexion position, and the remaining 16 patellae were dislocated when the knee was placed in the maximal extension position. In ST group, 15 knees were complete patellar dislocation in daily flexion position, and 5 knees were without dislocation. A local boss was formed proximal to the entrance of the groove and the articular cartilage was smooth, and no obvious osteoarthritis was observed in OS group. In ST group no boss was formed, while obvious cartilage degeneration and defect was seen. Compared to the control group, the central trochlear height and sulcus angle were greater in both groups, but without significant difference between the two groups. The Tb.Th was increased in both medial and lateral condyle, and Tb.N was decreased in medial condyle compared with its control knees in OS group. The BV/TV, Tb.Th, Tb.N and BMD were decreased and Tb.Sp was increased in both medial and lateral condyle compared with its control knees in ST group. Compared to the OS group, the BV/TV, Tb.Th, Tb.N and BMD were smaller and Tb.Sp was greater in both medial and lateral condyle in ST group, with significant differences.Conclusion:The model of patellar dislocation could be successfully achieved by femoral rotational osteotomy to increase femoral anteversion or surgical release of medial retinaculum and overlap suture of lateral retinaculum, and subsequent morphological and trabecular microarchitectural changes in the trochlea are different. Different bony and soft tissue factors should be addressed for different patients with patellar dislocation in clinical practice.
其他文献
分层教学作为一种教育教学方法,它的前提是进步,基础是层次,手段是竞争,重点是辅导,核心是实现目标,这是分层教学的实质.分层教学能够充分发挥教师的指导作用,充分调动学生的
随着数控机床在管料和棒料加工中的应用,尤其是在管料和棒料的连续加工机床中大量应用,管料和棒料的加工效率和加工精度都有了很大的提高。与此同时,对中空液压卡盘的要求也
在对高温合金磨削力的建模方面,首先通过对磨削加工过程和理论经验公式分析,再根据高温合金在磨削时砂轮会出现明显的粘附现象建立了基于摩擦、耕犁、成屑三过程及粘附条件的
服装类商品是网上购买人数最多、网购金额最大的商品类别,其销售规模占到中国整个网上零售市场规模的四分之一。服装网络营销得以快速发展并占据相当可观的服装市场份额,价格策
砂性土层压缩性高、孔隙比大、强度低、稳定时间长,在动力作用下易产生流变、触变现象,造成管片上浮.为了解决管片上浮问题,对盾构隧道管片上浮进行了实时跟踪观测并总结了管
由于传统悬挑脚手架在装配式建筑中存在U型箍锚固长度不足、预留洞口渗漏隐患等问题,急需研发一种适应于装配式建筑的新型脚手架.提出了在预制装配式建筑中运用组合式盘扣脚
[目的]探究昆山市2006~2014年白血病发病与死亡趋势。[方法]昆山市2006~2014年白血病发病和死亡病例来源于昆山市肿瘤登记报告;计算历年白血病粗发病率与粗死亡率,以及中国20
眼下,我国汽车产业的发展势头迅猛,汽车保有量正在快速增长,汽车不仅给人们提供了舒适和方便,还带来了交通堵塞、交通事故以及有害尾气等危害。尤其是有害尾气(一氧化碳、氮
目的:探讨不同粒径大小对γ辐照中脱钙骨基质(demineralized bone matrix,DBM)中胶原结构的影响以及辐照保护剂的有效性。方法:取同一供体的冻干皮质骨,依据Urist改良法制备不同
在摩托车运动中,安全一直是一个备受关注的话题,如何在追求刺激、速度的同时保证车手的人身安全,成为人们研究的关键。本课题主要针对摩托车防护用具的抗冲击性能和透气性能展开