后交叉韧带功能分束及其断裂对内侧胫骨平台影响的实验研究
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摘要
随着各项体育竞技事业和交通运输业的发展,膝关节的运动伤和车祸伤不断增多。后交叉韧带(posterior cruciate ligament,PCL)作为膝关节最主要的后向稳定结构,其损伤的发生率也呈增高趋势,且其中相当部分损伤为PCL部分损伤。临床研究表明PCL损伤后胫股关节内侧间室软骨退变的发生率较高,然而其退变的具体机制尚不明确。为生物力学因素所致,还是生物学因素所致,或是生物力学因素和生物学因素的共同作用所致?这些因素作用的具体机制如何?PCL部分损伤对胫股关节内侧间室的软骨又有何影响?这些问题的解决将为临床PCL损伤治疗方案的确定和PCL损伤后软骨退变的防治提供理论依据。同时,临床上还发现PCL重建的失败率较高,其中一个很重要的原因就是由于移植物应力集中而导致移植物失效。因此,很多学者致力于PCL各纤维束的解剖和功能研究。关于PCL的解剖分束,目前很多学者认识到PCL是一个纤维连续体,并不是由形态学上独立的纤维束组成。因此,PCL各纤维束的功能研究成为了当前研究的热点,但目前大部分研究仍局限于对PCL各纤维束的大体张力模式观察或PCL纤维束起止点距离的测量,不能反映各纤维应变的精细变化,且对膝关节的生理结构破坏比较大。因此,很有必要设计一种对膝关节结构破坏比较小,而又能反映PCL各纤维束精细功能变化的实验方法,以了解PCL各纤维束的力学行为。
本研究拟应用自行设计的电阻应变片,采用微侵袭的方法将其置入膝关节PCL起止点各纤维束表面,对PCL各纤维束的应变变化进行测量并结合聚类分析统计学方法进行功能分束；采用生物力学测试方法,观察PCL完全断裂或部分断裂对内侧胫骨平台前部、中部和后部的应变变化影响。同时本研究将从组织学和分子生物学的角度对PCL断裂后内侧胫骨平台软骨的组织学改变及MMP-13和TIMP-1的表达变化进行研究,以探讨PCL断裂后是否会导致内侧胫骨平台软骨退变及其可能的发生机制。
目的通过测量后交叉韧带各束在膝关节屈伸过程中的生物力学变化,探讨其相应的功能及分类,为后续实验及临床工作提供理论依据。
方法12具新鲜成人尸体膝关节标本,依据PCL在膝关节中的空间位置将PCL分为：前内侧区纤维束(前内侧束)、前外侧区纤维束(前外侧束)、后内侧区纤维束(后内侧束)、后外侧区纤维束(后外侧束)。在膝关节标本上施加1000N轴向载荷下,分别测试膝关节0°、30°、60°、90°状态下PCL各纤维束应变。比较各束应变的差异,采用样品聚类方法进行分类。
结果1.膝关节0°位,后内侧束、后外侧束应变明显大于前内侧束和前外侧束,差异有显著性,p<0.05；后内侧束与后外侧束应变无显著性差异,p>0.05；前内侧束与前外侧束无显著性差异,p>0.05。膝关节300位、60°位和90°位时,前外侧束、前内侧束应变大于后外侧束、后内侧束,差异有显著性,p<0.05；前外侧束与前内侧束应变无显著性差异,p>0.05；后外侧束与后内侧束无显著性差异,p>0.05。2.前内侧束和前外侧束应变变化一致,依序0°、30°、60°、90°逐渐增大,均有显著性差异,均P<0.05；后内侧束应变在膝关节0°最大,其次为90°位,再其次为60°位,30°位最小,0°与30°之间应变有显著性,p<0.05；30°与90°之间应变有显著性,p<0.05,其余各角度之间差异无显著差异,p>0.05。后外侧束应变在膝关节0°、30°、60°、90°位均无显著性差异,均p>0.05。
3.聚类分析：前内侧束与前外侧束归为一类,后内侧束与后外侧束归为一类。
结论1.PCL止点各区纤维束在膝关节屈伸过程中始终处于张力状态；
2.膝伸直位(0°)前内侧区纤维束和前外侧区纤维束应变小于后内侧区纤维束和后外侧区纤维束,屈曲位(30°、60°、90°)时大于后内侧区纤维束和后外侧区纤维束,说明前内侧区纤维束和前外侧区纤维束主要维持膝关节屈曲稳定性,后内侧区纤维束和后外侧区纤维束主要维持膝关节伸直稳定性；
3.屈膝0°至90°前内侧区纤维束和前外侧区纤维束应变变化较大,而后外侧区纤维束应变无明显变化。
4.前内侧区纤维束和前外侧区纤维束聚为一类；后内侧区纤维束和后外侧区纤维束聚为一类。
5.根据上述PCL止点各区纤维束的生物力学特点和聚类分析结果,提示PCL分为前、后两束较为合适。结合两束在PCL股骨止点一内一外的解剖特点将其分别定义为前外侧束和后内侧束。
目的探讨PCL部分断裂和完全断裂对膝关节内侧胫骨平台的生物力学影响,为PCL损伤后继发骨关节炎的防治提供理论依据。方法新鲜成人尸体膝关节标本12具,依照测试先后顺序分为PCL完整组、ALB切断组、PMB切断组和PCL完全切断组。在膝关节标本上施加0-1000N轴向载荷,分别测量各组膝关节0°、30°、60°、90°位,内侧胫骨平台前、中、后各部的应变,比较各组应变的差异。实验数据采用SPSS17.0统计软件进行统计学分析,检验水准α=0.05。
结果(1)0°位：①各级载荷下内侧胫骨平台前、中、后部均为压应变。②200N、400N载荷下,在前、中、后各部,PCL完整组和ALB切断组应变无明显差异,p>0.05；PMB切断组和全断组应变无明显差异,p>0.05。在前部和中部,PMB切断组和全断组应变绝对值明显大于PCL完整组和ALB切断组,p<0.05。而在后部,PMB切断组和全断组应变绝对值明显小于PCL完整组和ALB切断组,p<0.05。③600N、800N和1000N载荷下,在前、中、后各部,ALB切断组、PMB切断组和全断组之间应变无明显差异,p>0.05。在前部和中部,ALB切断组、PMB切断组和全断组应变绝对值均明显大于PCL完整组,p<0.05。在后部,ALB切断组、PMB切断组和全断组应变绝对值明显小于PCL完整组,p<0.05。
(2)30°位：①各级载荷下内侧胫骨平台前、中、后各部均为压应变。②200N、400N载荷下,在前、中、后各部,PCL完整组、ALB切断组和PMB切断组之间应变无明显差异,p>0.05。在前部和中部,PCL完整组、ALB切断组和PMB切断组的应变绝对值明显小于全断组,p<0.05。在后部,PCL完整组、ALB切断组和PMB切断组的应变绝对值明显大于全断组,p<0.05。③600N、800N和1000N载荷下,在前、中、后各部,PCL完整组和PMB切断组应变无明显差异,p>0.05；ALB切断组和全断组应变无明显差异,p>0.05。在前部和中部,PCL完整组和PMB切断组的应变绝对值明显小于ALB切断组和全断组,p<0.05。在后部,PCL完整组和PMB切断组的应变绝对值明显大于ALB切断组和全断组,p<0.05。
(3)60°和90°位：①各级载荷下内侧胫骨平台前部为拉伸应变,中、后部均为压应变。②200N、400N载荷下,在前、中、后各部,PCL完整组、ALB切断组和PMB切断组应变无明显差异,p>0.05。在前部和后部,PCL完整组、ALB切断组和PMB切断组应变绝对值均明显大于全断组,p<0.05；在中部,PCL完整组、ALB切断组和PMB切断组应变绝对值明显小于全断组,p<0.05；③600N、800N和1000N载荷下,在前、中、后各部,PCL完整组和PMB切断组应变无明显差异,p>0.05；ALB切断组和PCL全断组应变无明显差异,p>0.05。在前部和后部,PCL完整组和PMB切断组的应变绝对值明显大于ALB切断组和全断组,p<0.05。在中部,PCL完整组和PMB切断组的应变绝对值明显小于ALB切断组和全断组,p<0.05。
结论(1)在不同载荷和角度下,PCL完全断裂对内侧胫骨平台前部、中部和后部的应变均有影响。(2)200N、400N载荷下,在伸直位ALB断裂对内侧胫骨平台各部的应变无影响,PMB断裂对内侧胫骨平台各部的应变均有影响,在屈曲位(30°、60°、90°)单纯ALB或PMB断裂对内侧胫骨平台各部的应变均无影响,提示在小载荷下伸直位PMB起稳定作用,而在屈曲位ALB和PMB均有稳定作用。(3)600N、800N和1000N载荷下,PMB断裂在所有角度(0°、30°、60°、90°)对内侧胫骨平台各部的应变均无影响；ALB断裂在膝关节伸直位对内侧胫骨平台各部的应变均无影响,在屈曲位(30°、60°、90°)对内侧胫骨平台的应变均有影响,提示在大载荷下PMB稳定作用较小,ALB主要在屈曲位起稳定作用,在伸直位稳定作用较小
目的研究兔后交叉韧带断裂后不同时期内侧胫骨平台软骨组织结构的变化及MMP-13和TIMP-1的表达,探讨后交叉韧带断裂后内侧胫骨平台关节软骨退变的生物学机制。
方法48只雄性家兔随机分为四组,行后腿单侧PCL切断,对侧假手术自身对照。分别于造模4、8、16、24周各处死12只。观察内侧胫骨平台大体形态变化,取内侧胫骨平台软骨行HE染色、甲苯胺蓝染色和免疫组化检测MMP-13和TIMP-1的表达。
结果1.大体观察：在四个时间观测点上,实验组内侧胫骨平台软骨逐渐出现色泽改变、表面磨损、龟裂、溃疡及骨赘形成。2.HE染色和甲苯胺蓝染色：自第8周开始出现软骨表层不光滑、软骨细胞排列紊乱、软骨细胞增生肥大、基质染色不均等异常；从第4周至24周,实验组内侧胫骨平台软骨的Mankin评分随着时间推移而逐渐增高,各时间点间比较均有显著差异,p<0.05。3. MMP-13表达情况：实验组第4、8、16、24周MMP-13表达均明显高于对照组,p<0.05。对照组第4、8、16、24周之间MMP-13表达均无显著性差异,p>0.05。实验组第4、8、16、24周之间比较MMP-13表达均有显著性差异,p<0.05；且第4周最低,第8周最高,从第4周至24周,MMP-13表达呈先增高后降低趋势。4. TIMP-1表达情况：实验组第4、8、16周TIMP-1表达均高于对照组,均有显著性差异,P<0.05；第24周实验组与对照组TIMP-1表达无显著差异,P>0.05。对照组第4、8、16、24周之间比较TIMP-1表达均无显著性差异,P>0.05。实验组第8周和16周之间TIMP-1表达无显著性差异,P>0.05；其它各组之间均存在显著性差异,P<0.05；且第24周最低,第8周和第16周最高。
结论(1)PCL断裂后可导致内侧胫骨平台的软骨退变。(2)PCL断裂后MMP-13和TIMP-1表达增高,提示MMP-13和TIMP-1可能在软骨退变中起重要作用。
Along with the development of sports and communication, the incidence of injury of posterior cruciate ligaments (PCL) increases, of which a considerable portion are partial injury of PCL.Clinical results manifest that the incidence of catilage degeneration in the medial chamber of tibiofemoral joint is higher than normal, however, the machanism is unclear. It may be explained by a biomechanical mechanism or a biological one or both of them together.It is also unknown how the biomechanical mechanism or the biological mechanism act or whether partial injury of PCL could influence the catilage degeneration in the medial chamber of tibiofemoral joint.It is urgent to solve these questions so as to provide theoretical evidence for making proper plans for PCL injury and how to prevent catilage degeneration after PCL injury.Meanwhile,clinical data also shows that the PCL reconstruction has a high failure rate owing to the graft's stress concentration.Therefore, many researchers pay attention to the anatomy and function of PCL fiber bundles,but a lot of experts begin to realize that the PCL is not made of completely separate fiber bundles, but a fiber continuum, therefore,the functional research of PCL fiber becomes the hot spot.however,most of the contemporary research on the functional research of PCL fiber is through the gross observation of the tension mode of PCL fiber bundles or the measurement of distance between the insertions of each PCL fiber bundes, which can not reflect the subtle functional change of PCL fiber bundes or cause much damage to the anatomical structure of the knee.So it is necessary to design a experiment that can reflect the subtle functional change of PCL fiber bundes and destroy PCL and other structures of the knee as less as possible.
In our research the strain gages designed by ourselves would be placed on the surface of each PCL fiber bundle to measure the strain change on each fiber bundle.Then the data would be analysed by cluster analysis to classify the fiber bundles.Furthermore,we will measure the strain on the anterior,middle and posterior parts of the medial tibial plateau after cutting the partial or whole PCL. Meanwhile, the histological change and expression of MMP-13 and TIMP-1 in the medial tibial plateau cartilage of rabbits would be studied by HE staining, toluidine blue staining and immunohistochemical methods.
Objective:To investigate the biomechanical function and intrinsic correlation of the PCL bundles in order to provide biomechanical evidence for the later experimental research and clinical therapy.
Methods:12 fresh cadaveric knees from adult human beings were used. Selected the bilateral anterior part of the PCL femoral insertion and the bilateral posterior part of the PCL tibial insertion as the measurement parts which respectively correspond to:anteromedial area fiber bundle (anteromedial bundle)、anterolateral area fiber bundle (anterolateral bundle)、posteromedial area bundle (posteromedial bundle) and posterolateral area bundle (posterolateral bundle). The strain on the PCL bundles was measured when the knees were applied with 1000N axial loading force in 0°、30°、60°、90°positions. The bundles were functional classified by cluster analysis.
Results:1.In 0°position, the strain on the posteromedial and posterolateral bundles was significantly larger than the anteromedial and anterolateral bundles (P<0.05), while there was no significant difference between the posteromedial and posterolateral bundles (P>0.05) and so did the anteromedial and anterolateral bundles (P>0.05); In 30°、60°nd 90°position, the strain on the anteromedial and anterolateral bundles was significantly larger than the posteromedial and posterolateral bundles (P<0.05), while there was no significant difference between the anteromedial and anterolateral bundles (P>0.05) and so did the posteromedial and posterolateral bundles (P>0.05).2.The strain on the anteromedial and anterolateral bundles gradually increased by degrees as the knee flexed from 0°to 90°and all the difference were significant (P <0.05). The strain on the posteromedial bundle was largest in 0°position while smallest in 30°position and the difference between 0°and 30°position were significan (P<0.05);The strain in 90°position was larger than in 30°position and the differences were significant (P<0.05); There were no significant differences between the strain of any other two positions (P>0.05). There were no significant changes of the strain on the posterolateral bundle among different angles (P>0.05).3.Cluster analysis classfied the anteromedial and anterolateral bundle as one class and the posteromedial and posterolateral bundles as the other class.
Conclusion:1.A11 the four area fiber bundles of PCL maintain certain tension during the whole range of motion.
2. The posteromedial and posterolateral area bundles mainly maintain stability of the knee in extended positions while the anteromedial and anterolateral area fiber bundles mainly maintain stability of the knee in flexed positions.
3. The strain on the anteromedial and anterolateral area fiber bundles vary drastically while strain on posterolateral area bundles change littlely during the whole range of motion.
4. Cluster analysis classfied the anteromedial and anterolateral bundle as one class and the posteromedial and posterolateral bundles as the other class.
5.With Combined consideration of the biomechanical property, cluster analysis results and the relative position at the femoral insertion of the four area fiber bundles of PCL,PCL may be classified into the anterolateral functional fiber bundle and the posteromedial functional fiber bundle.
Objective:To investigate the biomechanical influences of partial and total PCL rupture on the medial tibial plateau and provide theoretic evidence for prevention and cure of osteoarthritis.
Methods:12 fresh cadaveric knees from adult human beings were divided into PCL intact group(12 samples)、ALB broken group(6 samples)、PMB broken group(6 samples) and PCL totally broken group(6 samples). The knees were applied with 0-1000N axial loading force when they flexed to 0°、30°、60°、and 90°.The strain on the anterior, middle and posterior part of the medial tibial plateau were respectively measured and analysed.
Results:1. In 0°position:①Strain on the anterior,middle and posterior parts were all compressive.②With 200N and 400N axial loading, on all the anterior,middle and posterior parts,strain between PCL intact group and ALB broken group and strain between PMB broken group and PCL totally broken group were neither significantly different(P>0.05),while the absolute value of strain in PMB broken group and PCL totally broken group were significantly larger than PCL intact group and ALB broken group on the anterior and middle parts(P<0.05) and were significantly smaller than PCL intact group and ALB broken group on the posterior part(P<0.05).③With 600N、800N and 1000N axial loading, on all the anterior,middle and posterior parts, the differences among ALB broken group, PMB broken group and PCL totally broken group were not significant(P>0.05),while the absolute value of strain in all these three groups were significantly larger than PCL intact group on the anterior and middle parts (P<0.05) and were significantly smaller than PCL intact group on the posterior part(P<0.05).
2. In 30°position:①Strain on the anterior,middle and posterior parts were all compressive.②With 200N and 400N axial loading, on all the anterior,middle and posterior parts, the differences among PCL intact group,ALB broken group and PMB broken group were all not significant(P>0.05),while the absolute value of strain in all these three groups were significantly smaller than PCL totally broken group on the anterior and middle parts (P<0.05) and were significantly larger than PCL totally broken group on the posterior part(P<0.05).③With 600、800N and 1000N axial loading, on all the anterior,middle and posterior parts, strain between PCL intact group and PMB broken group and strain between ALB broken group and PCL totally broken group were neither significantly different(P>0.05), while the absolute value of strain in ALB broken group and PCL totally broken group were significantly larger than PCL intact group and PMB broken group on the anterior and middle parts (P<0.05) and were significantly smaller than PCL intact group and PMB broken group on the posterior parts(P<0.05).
3.In 60°nd 90°positions:①Strain on the anterior part was tensile while strain on the middle and posteror parts were compressive.②With 200N and 400N axial loading, on all the anterior, middle and posterior parts, the differences among PCL intact group,ALB broken group and PMB broken group were all not significant(P>0.05),while the absolute value of strain in all these three groups were significantly larger than PCL totally broken group on the anterior and posterior parts (P<0.05) and were significantly smaller than PCL totally broken group on the middle part(P<0.05).③With 600N、800N and 1000N axial loading, on all the anterior,middle and posterior parts, strain between PCL intact group and PMB broken group and strain between ALB broken group and PCL totally broken group were neither significantly different(P>0.05), while the absolute value of strain in ALB broken group and PCL totally broken group were significantly smaller than PCL intact group and PMB broken group on the anterior and posterior parts (P<0.05) and were significantly larger than PCL intact group and PMB broken group on the middle parts(P<0.05).
Conclusion:1.PCL total rupture may cause abnormal load on all parts of the medial tibial plateau with any axial loading in all the positions.
2.With 200N and 400N axial loading, in extended positions ALB rupture may not cause abnormal load on any part of the medial tibial plateau,while PMB rupture may cause abnormal load on all parts of the medial tibial plateau;In flexed positions, neither ALB nor PMB isolated rupture may cause abnormal load on any part of the medial tibial plateau.It suggests that With low axial loading PMB act as the stabilizer in extended position, while in flexed positions both ALB and PMB play a role as the stabilizer.
3. With 600N、800N and 1000N axial loading, PMB rupture may not cause abnormal load on any part of the medial tibial plateau in any position and ALB ruptre may not cause abnormal load on any part of the medial tibial plateau in extended position while cause abnormal load on all parts of the medial tibial plateau in flexed positions.It suggests that With large axial loading PMB play little stabilizing role in any position and ALB mainly act as a stabilizer in flexed positions.
Objective:To explore whether PCL rupture could cause cartilage degenaration of medial tibial plateau and the biological mechanism for cartilage degenaration and further provide theoretical evidence for clinical diagnosis and therapy of osteoarthritis by studying changes in tissue structure and expression of MMP-13 and TIMP-1 in the medial tibial plateau cartilage after the PCL of rabbits were cut.
Methods:48 male rabbits were randomly divided into four groups. All underwent unilateral PCL cut in posterior leg and the contralataral as the control randomly.HE staining, toluidine blue staining and immunohistochemical methods were carried out.Changes in tissue structure and expression of MMP-13 and TIMP-1 in the medial tibial plateau cartilage were observed and analyzed at 4、8、16、24 weeks after the PCL of rabbits were severed.
Results:1.Gross observation:As the time went on, the color change,decreased gloss,the abrased surface and even ulcer and osteophyte occurred on medial tibial plateau cartilage.2.HE staining and toluidine blue staining:The rough surface,cell hypertrophy,cell hyperplasia,cell cluster,abnormal cell disposition and inequable staining occurred one after another since since 8 weeks after operation.Since 8 weeks the Mankin score of medial tibial plateau cartilage in experimental groups was significently higher than the control group(p<0.05). In experimental groups,the Mankin score increased continuously from 4 weeks to 24 weeks after operation and the difference was significant(p<0.05) while the Mankin score in contral group change little(P>0.05).3. MMP-13 expression:All the experimental groups had higher MMP-13 expression than that in control groups (P<0.05). In experimental groups, MMP-13 expressed significantly lower in 4-week group than that in 8、16、24-week groups (p<0.05) and expressed significantly higher in 8-week group than that in 4、16、24-week groups(p<0.05). There were no signifigant differences among the control groups (P>0.05).4. TIMP-1 expression:In 4、8、16-week groups the experimental groups had higher TIMP-1 expression than that in control groups (P<0.05) while in 24-week group there was no signifigant differences between the experimental group and the control group(P>0.05). In experimental groups, TIMP-1 expressed significantly lower in 24-week group than that in 4、8、16-week groups (p<0.05);There was no signifigant differences between 8-week group and 16-week group(P>0.05).TIMP-1 expressed significantly higher in 8-week group and 16-week group than that in 4、24-week groups (p<0.05). There were no signifigant differences among the control groups(P>0.05).
Conclusion:1.PCL rupture may cause cartilage degeneration on the medial tibial plateau.
2.The increased expression Of MMP-13 and TIMP-1 suggest that MMP-13 and TIMP-1 may participate in cartilage degeneration on the medial tibial plateau after PCL rupture.
本研究拟应用自行设计的电阻应变片,采用微侵袭的方法将其置入膝关节PCL起止点各纤维束表面,对PCL各纤维束的应变变化进行测量并结合聚类分析统计学方法进行功能分束；采用生物力学测试方法,观察PCL完全断裂或部分断裂对内侧胫骨平台前部、中部和后部的应变变化影响。同时本研究将从组织学和分子生物学的角度对PCL断裂后内侧胫骨平台软骨的组织学改变及MMP-13和TIMP-1的表达变化进行研究,以探讨PCL断裂后是否会导致内侧胫骨平台软骨退变及其可能的发生机制。
目的通过测量后交叉韧带各束在膝关节屈伸过程中的生物力学变化,探讨其相应的功能及分类,为后续实验及临床工作提供理论依据。
方法12具新鲜成人尸体膝关节标本,依据PCL在膝关节中的空间位置将PCL分为：前内侧区纤维束(前内侧束)、前外侧区纤维束(前外侧束)、后内侧区纤维束(后内侧束)、后外侧区纤维束(后外侧束)。在膝关节标本上施加1000N轴向载荷下,分别测试膝关节0°、30°、60°、90°状态下PCL各纤维束应变。比较各束应变的差异,采用样品聚类方法进行分类。
结果1.膝关节0°位,后内侧束、后外侧束应变明显大于前内侧束和前外侧束,差异有显著性,p<0.05；后内侧束与后外侧束应变无显著性差异,p>0.05；前内侧束与前外侧束无显著性差异,p>0.05。膝关节300位、60°位和90°位时,前外侧束、前内侧束应变大于后外侧束、后内侧束,差异有显著性,p<0.05；前外侧束与前内侧束应变无显著性差异,p>0.05；后外侧束与后内侧束无显著性差异,p>0.05。2.前内侧束和前外侧束应变变化一致,依序0°、30°、60°、90°逐渐增大,均有显著性差异,均P<0.05；后内侧束应变在膝关节0°最大,其次为90°位,再其次为60°位,30°位最小,0°与30°之间应变有显著性,p<0.05；30°与90°之间应变有显著性,p<0.05,其余各角度之间差异无显著差异,p>0.05。后外侧束应变在膝关节0°、30°、60°、90°位均无显著性差异,均p>0.05。
3.聚类分析：前内侧束与前外侧束归为一类,后内侧束与后外侧束归为一类。
结论1.PCL止点各区纤维束在膝关节屈伸过程中始终处于张力状态；
2.膝伸直位(0°)前内侧区纤维束和前外侧区纤维束应变小于后内侧区纤维束和后外侧区纤维束,屈曲位(30°、60°、90°)时大于后内侧区纤维束和后外侧区纤维束,说明前内侧区纤维束和前外侧区纤维束主要维持膝关节屈曲稳定性,后内侧区纤维束和后外侧区纤维束主要维持膝关节伸直稳定性；
3.屈膝0°至90°前内侧区纤维束和前外侧区纤维束应变变化较大,而后外侧区纤维束应变无明显变化。
4.前内侧区纤维束和前外侧区纤维束聚为一类；后内侧区纤维束和后外侧区纤维束聚为一类。
5.根据上述PCL止点各区纤维束的生物力学特点和聚类分析结果,提示PCL分为前、后两束较为合适。结合两束在PCL股骨止点一内一外的解剖特点将其分别定义为前外侧束和后内侧束。
目的探讨PCL部分断裂和完全断裂对膝关节内侧胫骨平台的生物力学影响,为PCL损伤后继发骨关节炎的防治提供理论依据。方法新鲜成人尸体膝关节标本12具,依照测试先后顺序分为PCL完整组、ALB切断组、PMB切断组和PCL完全切断组。在膝关节标本上施加0-1000N轴向载荷,分别测量各组膝关节0°、30°、60°、90°位,内侧胫骨平台前、中、后各部的应变,比较各组应变的差异。实验数据采用SPSS17.0统计软件进行统计学分析,检验水准α=0.05。
结果(1)0°位：①各级载荷下内侧胫骨平台前、中、后部均为压应变。②200N、400N载荷下,在前、中、后各部,PCL完整组和ALB切断组应变无明显差异,p>0.05；PMB切断组和全断组应变无明显差异,p>0.05。在前部和中部,PMB切断组和全断组应变绝对值明显大于PCL完整组和ALB切断组,p<0.05。而在后部,PMB切断组和全断组应变绝对值明显小于PCL完整组和ALB切断组,p<0.05。③600N、800N和1000N载荷下,在前、中、后各部,ALB切断组、PMB切断组和全断组之间应变无明显差异,p>0.05。在前部和中部,ALB切断组、PMB切断组和全断组应变绝对值均明显大于PCL完整组,p<0.05。在后部,ALB切断组、PMB切断组和全断组应变绝对值明显小于PCL完整组,p<0.05。
(2)30°位：①各级载荷下内侧胫骨平台前、中、后各部均为压应变。②200N、400N载荷下,在前、中、后各部,PCL完整组、ALB切断组和PMB切断组之间应变无明显差异,p>0.05。在前部和中部,PCL完整组、ALB切断组和PMB切断组的应变绝对值明显小于全断组,p<0.05。在后部,PCL完整组、ALB切断组和PMB切断组的应变绝对值明显大于全断组,p<0.05。③600N、800N和1000N载荷下,在前、中、后各部,PCL完整组和PMB切断组应变无明显差异,p>0.05；ALB切断组和全断组应变无明显差异,p>0.05。在前部和中部,PCL完整组和PMB切断组的应变绝对值明显小于ALB切断组和全断组,p<0.05。在后部,PCL完整组和PMB切断组的应变绝对值明显大于ALB切断组和全断组,p<0.05。
(3)60°和90°位：①各级载荷下内侧胫骨平台前部为拉伸应变,中、后部均为压应变。②200N、400N载荷下,在前、中、后各部,PCL完整组、ALB切断组和PMB切断组应变无明显差异,p>0.05。在前部和后部,PCL完整组、ALB切断组和PMB切断组应变绝对值均明显大于全断组,p<0.05；在中部,PCL完整组、ALB切断组和PMB切断组应变绝对值明显小于全断组,p<0.05；③600N、800N和1000N载荷下,在前、中、后各部,PCL完整组和PMB切断组应变无明显差异,p>0.05；ALB切断组和PCL全断组应变无明显差异,p>0.05。在前部和后部,PCL完整组和PMB切断组的应变绝对值明显大于ALB切断组和全断组,p<0.05。在中部,PCL完整组和PMB切断组的应变绝对值明显小于ALB切断组和全断组,p<0.05。
结论(1)在不同载荷和角度下,PCL完全断裂对内侧胫骨平台前部、中部和后部的应变均有影响。(2)200N、400N载荷下,在伸直位ALB断裂对内侧胫骨平台各部的应变无影响,PMB断裂对内侧胫骨平台各部的应变均有影响,在屈曲位(30°、60°、90°)单纯ALB或PMB断裂对内侧胫骨平台各部的应变均无影响,提示在小载荷下伸直位PMB起稳定作用,而在屈曲位ALB和PMB均有稳定作用。(3)600N、800N和1000N载荷下,PMB断裂在所有角度(0°、30°、60°、90°)对内侧胫骨平台各部的应变均无影响；ALB断裂在膝关节伸直位对内侧胫骨平台各部的应变均无影响,在屈曲位(30°、60°、90°)对内侧胫骨平台的应变均有影响,提示在大载荷下PMB稳定作用较小,ALB主要在屈曲位起稳定作用,在伸直位稳定作用较小
目的研究兔后交叉韧带断裂后不同时期内侧胫骨平台软骨组织结构的变化及MMP-13和TIMP-1的表达,探讨后交叉韧带断裂后内侧胫骨平台关节软骨退变的生物学机制。
方法48只雄性家兔随机分为四组,行后腿单侧PCL切断,对侧假手术自身对照。分别于造模4、8、16、24周各处死12只。观察内侧胫骨平台大体形态变化,取内侧胫骨平台软骨行HE染色、甲苯胺蓝染色和免疫组化检测MMP-13和TIMP-1的表达。
结果1.大体观察：在四个时间观测点上,实验组内侧胫骨平台软骨逐渐出现色泽改变、表面磨损、龟裂、溃疡及骨赘形成。2.HE染色和甲苯胺蓝染色：自第8周开始出现软骨表层不光滑、软骨细胞排列紊乱、软骨细胞增生肥大、基质染色不均等异常；从第4周至24周,实验组内侧胫骨平台软骨的Mankin评分随着时间推移而逐渐增高,各时间点间比较均有显著差异,p<0.05。3. MMP-13表达情况：实验组第4、8、16、24周MMP-13表达均明显高于对照组,p<0.05。对照组第4、8、16、24周之间MMP-13表达均无显著性差异,p>0.05。实验组第4、8、16、24周之间比较MMP-13表达均有显著性差异,p<0.05；且第4周最低,第8周最高,从第4周至24周,MMP-13表达呈先增高后降低趋势。4. TIMP-1表达情况：实验组第4、8、16周TIMP-1表达均高于对照组,均有显著性差异,P<0.05；第24周实验组与对照组TIMP-1表达无显著差异,P>0.05。对照组第4、8、16、24周之间比较TIMP-1表达均无显著性差异,P>0.05。实验组第8周和16周之间TIMP-1表达无显著性差异,P>0.05；其它各组之间均存在显著性差异,P<0.05；且第24周最低,第8周和第16周最高。
结论(1)PCL断裂后可导致内侧胫骨平台的软骨退变。(2)PCL断裂后MMP-13和TIMP-1表达增高,提示MMP-13和TIMP-1可能在软骨退变中起重要作用。
Along with the development of sports and communication, the incidence of injury of posterior cruciate ligaments (PCL) increases, of which a considerable portion are partial injury of PCL.Clinical results manifest that the incidence of catilage degeneration in the medial chamber of tibiofemoral joint is higher than normal, however, the machanism is unclear. It may be explained by a biomechanical mechanism or a biological one or both of them together.It is also unknown how the biomechanical mechanism or the biological mechanism act or whether partial injury of PCL could influence the catilage degeneration in the medial chamber of tibiofemoral joint.It is urgent to solve these questions so as to provide theoretical evidence for making proper plans for PCL injury and how to prevent catilage degeneration after PCL injury.Meanwhile,clinical data also shows that the PCL reconstruction has a high failure rate owing to the graft's stress concentration.Therefore, many researchers pay attention to the anatomy and function of PCL fiber bundles,but a lot of experts begin to realize that the PCL is not made of completely separate fiber bundles, but a fiber continuum, therefore,the functional research of PCL fiber becomes the hot spot.however,most of the contemporary research on the functional research of PCL fiber is through the gross observation of the tension mode of PCL fiber bundles or the measurement of distance between the insertions of each PCL fiber bundes, which can not reflect the subtle functional change of PCL fiber bundes or cause much damage to the anatomical structure of the knee.So it is necessary to design a experiment that can reflect the subtle functional change of PCL fiber bundes and destroy PCL and other structures of the knee as less as possible.
In our research the strain gages designed by ourselves would be placed on the surface of each PCL fiber bundle to measure the strain change on each fiber bundle.Then the data would be analysed by cluster analysis to classify the fiber bundles.Furthermore,we will measure the strain on the anterior,middle and posterior parts of the medial tibial plateau after cutting the partial or whole PCL. Meanwhile, the histological change and expression of MMP-13 and TIMP-1 in the medial tibial plateau cartilage of rabbits would be studied by HE staining, toluidine blue staining and immunohistochemical methods.
Objective:To investigate the biomechanical function and intrinsic correlation of the PCL bundles in order to provide biomechanical evidence for the later experimental research and clinical therapy.
Methods:12 fresh cadaveric knees from adult human beings were used. Selected the bilateral anterior part of the PCL femoral insertion and the bilateral posterior part of the PCL tibial insertion as the measurement parts which respectively correspond to:anteromedial area fiber bundle (anteromedial bundle)、anterolateral area fiber bundle (anterolateral bundle)、posteromedial area bundle (posteromedial bundle) and posterolateral area bundle (posterolateral bundle). The strain on the PCL bundles was measured when the knees were applied with 1000N axial loading force in 0°、30°、60°、90°positions. The bundles were functional classified by cluster analysis.
Results:1.In 0°position, the strain on the posteromedial and posterolateral bundles was significantly larger than the anteromedial and anterolateral bundles (P<0.05), while there was no significant difference between the posteromedial and posterolateral bundles (P>0.05) and so did the anteromedial and anterolateral bundles (P>0.05); In 30°、60°nd 90°position, the strain on the anteromedial and anterolateral bundles was significantly larger than the posteromedial and posterolateral bundles (P<0.05), while there was no significant difference between the anteromedial and anterolateral bundles (P>0.05) and so did the posteromedial and posterolateral bundles (P>0.05).2.The strain on the anteromedial and anterolateral bundles gradually increased by degrees as the knee flexed from 0°to 90°and all the difference were significant (P <0.05). The strain on the posteromedial bundle was largest in 0°position while smallest in 30°position and the difference between 0°and 30°position were significan (P<0.05);The strain in 90°position was larger than in 30°position and the differences were significant (P<0.05); There were no significant differences between the strain of any other two positions (P>0.05). There were no significant changes of the strain on the posterolateral bundle among different angles (P>0.05).3.Cluster analysis classfied the anteromedial and anterolateral bundle as one class and the posteromedial and posterolateral bundles as the other class.
Conclusion:1.A11 the four area fiber bundles of PCL maintain certain tension during the whole range of motion.
2. The posteromedial and posterolateral area bundles mainly maintain stability of the knee in extended positions while the anteromedial and anterolateral area fiber bundles mainly maintain stability of the knee in flexed positions.
3. The strain on the anteromedial and anterolateral area fiber bundles vary drastically while strain on posterolateral area bundles change littlely during the whole range of motion.
4. Cluster analysis classfied the anteromedial and anterolateral bundle as one class and the posteromedial and posterolateral bundles as the other class.
5.With Combined consideration of the biomechanical property, cluster analysis results and the relative position at the femoral insertion of the four area fiber bundles of PCL,PCL may be classified into the anterolateral functional fiber bundle and the posteromedial functional fiber bundle.
Objective:To investigate the biomechanical influences of partial and total PCL rupture on the medial tibial plateau and provide theoretic evidence for prevention and cure of osteoarthritis.
Methods:12 fresh cadaveric knees from adult human beings were divided into PCL intact group(12 samples)、ALB broken group(6 samples)、PMB broken group(6 samples) and PCL totally broken group(6 samples). The knees were applied with 0-1000N axial loading force when they flexed to 0°、30°、60°、and 90°.The strain on the anterior, middle and posterior part of the medial tibial plateau were respectively measured and analysed.
Results:1. In 0°position:①Strain on the anterior,middle and posterior parts were all compressive.②With 200N and 400N axial loading, on all the anterior,middle and posterior parts,strain between PCL intact group and ALB broken group and strain between PMB broken group and PCL totally broken group were neither significantly different(P>0.05),while the absolute value of strain in PMB broken group and PCL totally broken group were significantly larger than PCL intact group and ALB broken group on the anterior and middle parts(P<0.05) and were significantly smaller than PCL intact group and ALB broken group on the posterior part(P<0.05).③With 600N、800N and 1000N axial loading, on all the anterior,middle and posterior parts, the differences among ALB broken group, PMB broken group and PCL totally broken group were not significant(P>0.05),while the absolute value of strain in all these three groups were significantly larger than PCL intact group on the anterior and middle parts (P<0.05) and were significantly smaller than PCL intact group on the posterior part(P<0.05).
2. In 30°position:①Strain on the anterior,middle and posterior parts were all compressive.②With 200N and 400N axial loading, on all the anterior,middle and posterior parts, the differences among PCL intact group,ALB broken group and PMB broken group were all not significant(P>0.05),while the absolute value of strain in all these three groups were significantly smaller than PCL totally broken group on the anterior and middle parts (P<0.05) and were significantly larger than PCL totally broken group on the posterior part(P<0.05).③With 600、800N and 1000N axial loading, on all the anterior,middle and posterior parts, strain between PCL intact group and PMB broken group and strain between ALB broken group and PCL totally broken group were neither significantly different(P>0.05), while the absolute value of strain in ALB broken group and PCL totally broken group were significantly larger than PCL intact group and PMB broken group on the anterior and middle parts (P<0.05) and were significantly smaller than PCL intact group and PMB broken group on the posterior parts(P<0.05).
3.In 60°nd 90°positions:①Strain on the anterior part was tensile while strain on the middle and posteror parts were compressive.②With 200N and 400N axial loading, on all the anterior, middle and posterior parts, the differences among PCL intact group,ALB broken group and PMB broken group were all not significant(P>0.05),while the absolute value of strain in all these three groups were significantly larger than PCL totally broken group on the anterior and posterior parts (P<0.05) and were significantly smaller than PCL totally broken group on the middle part(P<0.05).③With 600N、800N and 1000N axial loading, on all the anterior,middle and posterior parts, strain between PCL intact group and PMB broken group and strain between ALB broken group and PCL totally broken group were neither significantly different(P>0.05), while the absolute value of strain in ALB broken group and PCL totally broken group were significantly smaller than PCL intact group and PMB broken group on the anterior and posterior parts (P<0.05) and were significantly larger than PCL intact group and PMB broken group on the middle parts(P<0.05).
Conclusion:1.PCL total rupture may cause abnormal load on all parts of the medial tibial plateau with any axial loading in all the positions.
2.With 200N and 400N axial loading, in extended positions ALB rupture may not cause abnormal load on any part of the medial tibial plateau,while PMB rupture may cause abnormal load on all parts of the medial tibial plateau;In flexed positions, neither ALB nor PMB isolated rupture may cause abnormal load on any part of the medial tibial plateau.It suggests that With low axial loading PMB act as the stabilizer in extended position, while in flexed positions both ALB and PMB play a role as the stabilizer.
3. With 600N、800N and 1000N axial loading, PMB rupture may not cause abnormal load on any part of the medial tibial plateau in any position and ALB ruptre may not cause abnormal load on any part of the medial tibial plateau in extended position while cause abnormal load on all parts of the medial tibial plateau in flexed positions.It suggests that With large axial loading PMB play little stabilizing role in any position and ALB mainly act as a stabilizer in flexed positions.
Objective:To explore whether PCL rupture could cause cartilage degenaration of medial tibial plateau and the biological mechanism for cartilage degenaration and further provide theoretical evidence for clinical diagnosis and therapy of osteoarthritis by studying changes in tissue structure and expression of MMP-13 and TIMP-1 in the medial tibial plateau cartilage after the PCL of rabbits were cut.
Methods:48 male rabbits were randomly divided into four groups. All underwent unilateral PCL cut in posterior leg and the contralataral as the control randomly.HE staining, toluidine blue staining and immunohistochemical methods were carried out.Changes in tissue structure and expression of MMP-13 and TIMP-1 in the medial tibial plateau cartilage were observed and analyzed at 4、8、16、24 weeks after the PCL of rabbits were severed.
Results:1.Gross observation:As the time went on, the color change,decreased gloss,the abrased surface and even ulcer and osteophyte occurred on medial tibial plateau cartilage.2.HE staining and toluidine blue staining:The rough surface,cell hypertrophy,cell hyperplasia,cell cluster,abnormal cell disposition and inequable staining occurred one after another since since 8 weeks after operation.Since 8 weeks the Mankin score of medial tibial plateau cartilage in experimental groups was significently higher than the control group(p<0.05). In experimental groups,the Mankin score increased continuously from 4 weeks to 24 weeks after operation and the difference was significant(p<0.05) while the Mankin score in contral group change little(P>0.05).3. MMP-13 expression:All the experimental groups had higher MMP-13 expression than that in control groups (P<0.05). In experimental groups, MMP-13 expressed significantly lower in 4-week group than that in 8、16、24-week groups (p<0.05) and expressed significantly higher in 8-week group than that in 4、16、24-week groups(p<0.05). There were no signifigant differences among the control groups (P>0.05).4. TIMP-1 expression:In 4、8、16-week groups the experimental groups had higher TIMP-1 expression than that in control groups (P<0.05) while in 24-week group there was no signifigant differences between the experimental group and the control group(P>0.05). In experimental groups, TIMP-1 expressed significantly lower in 24-week group than that in 4、8、16-week groups (p<0.05);There was no signifigant differences between 8-week group and 16-week group(P>0.05).TIMP-1 expressed significantly higher in 8-week group and 16-week group than that in 4、24-week groups (p<0.05). There were no signifigant differences among the control groups(P>0.05).
Conclusion:1.PCL rupture may cause cartilage degeneration on the medial tibial plateau.
2.The increased expression Of MMP-13 and TIMP-1 suggest that MMP-13 and TIMP-1 may participate in cartilage degeneration on the medial tibial plateau after PCL rupture.
引文
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