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北京大学学报（医学版） ›› 2024, Vol. 56 ›› Issue (5): 868-873. doi: 10.19723/j.issn.1671-167X.2024.05.018

• 论著 • 上一篇    下一篇

前交叉韧带重建术后侧切动作的生物力学特征

任爽, 时会娟, 梁子轩, 张思, 胡晓青, 黄红拾*(), 敖英芳*()   

  1. 北京大学第三医院运动医学科，北京大学运动医学研究所，运动医学关节伤病北京市重点实验室，运动创伤治疗技术与器械教育部工程研究中心，北京 100191
  • 收稿日期:2021-06-09 出版日期:2024-10-18 发布日期:2024-10-16
  • 通讯作者: 黄红拾,敖英芳 E-mail:huanghs@bjmu.edu.cn;aoyingfang@163.com
  • 基金资助:
    国家自然科学基金(31900943);国家自然科学基金(31900961);北京大学医学部教育教学研究基金(2020YB44);北京大学第三医院优秀留学回国人员科研启动基金(BYSYLXHG2020007);北京大学医学部青年培育基金(BMU2021PY001)

Biomechanics during cutting movement in individuals after anterior cruciate ligament reconstruction

Shuang REN, Huijuan SHI, Zixuan LIANG, Si ZHANG, Xiaoqing HU, Hongshi HUANG*(), Yingfang AO*()   

  1. Department of Sports Medicine, Peking University Third Hospital; Institute of Sports Medicine of Peking University; Beijing Key Laboratory of Sports Injuries; Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing 100191, China
  • Received:2021-06-09 Online:2024-10-18 Published:2024-10-16
  • Contact: Hongshi HUANG, Yingfang AO E-mail:huanghs@bjmu.edu.cn;aoyingfang@163.com
  • Supported by:
    Supported by the National Natural Science Foundation of China(31900943);Supported by the National Natural Science Foundation of China(31900961);Education and Teaching Research of Peking University Health Science Foundation of China(2020YB44);Scientific Research Foundation for Returned Scholars of Peking University Third Hospital(BYSYLXHG2020007);Youth Training Fundation of Peking University Health Science Center(BMU2021PY001)

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摘要：

目的: 探究前交叉韧带(anterior cruciate ligament, ACL)重建术后12个月左右的患者在侧切动作过程中的生物力学特征，确定主要的异常生物力学特征及其机制。方法: 对16例ACL重建术后12个月左右的患者同步采集侧切动作过程中的运动学和动力学参数，计算膝关节的三维角度和三维力矩。应用配对t检验方法分析重建侧与未伤侧之间的生物力学特征差异。结果: 在侧切动作过程中，ACL重建侧的水平向后地面反作用力峰值(ACL重建侧0.380±0.071，未伤侧0.427±0.069，P = 0.003)和垂直向上地面反作用力峰值(ACL重建侧1.996±0.202，未伤侧2.110±0.182，P = 0.001)均显著小于未伤侧。与未伤侧相比，重建侧的膝关节屈曲角度较小(ACL重建侧38.3°±7.4°，未伤侧42.8°±7.9°，P < 0.001)，而外旋角度较大(ACL重建侧10.3°±2.4°，未伤侧7.7°±2.1°， P=0.008)。ACL重建侧的膝关节伸展力矩峰值(ACL重建侧0.092±0.031，未伤侧0.133±0.024，P < 0.001)和外旋力矩峰值(ACL重建侧0.005±0.004，未伤侧0.008±0.004，P=0.015)均显著小于未伤侧。结论: 在侧切动作过程中，ACL重建患者膝关节运动主要在矢状面和水平面内呈现不对称特征，重建侧呈现较小的屈膝角度、膝关节伸展力矩和外旋力矩和较大的膝关节外旋角度。

关键词: 前交叉韧带重建, 侧切动作, 生物力学, 术后康复

Abstract:

Objective: To evaluate knee biomechanics of patients about 12 months after anterior cruciate ligament (ACL) reconstruction during cutting and determine the abnormal biomechanical characteristics. Methods: Sixteen males about 12 months after ACL reconstruction were recruited for this study. Three-dimensional kinematic and kinetic data were collected during cutting movement. Knee joint angles and moments were calculated. Paired t-tests were used to compare the differences in knee biomechanics between the surgical leg and nonsurgical leg. Results: The peak posterior ground reaction force (surgical leg: 0.380±0.071; nonsurgical leg: 0.427±0.069, P = 0.003) and vertical ground reaction force (surgical leg: 1.996±0.202, nonsurgical leg: 2.110±0.182, P = 0.001) were significantly smaller in the surgical leg than in the nonsurgical leg. When compared with the uninjured leg, the surgical leg demonstrated a smaller knee flexion angle (surgical leg: 38.3°± 7.4°; nonsurgical leg: 42.8°± 7.9°, P < 0.001) and larger external rotation angle (surgical leg: 10.3°± 2.4°; nonsurgical leg: 7.7°± 2.1°, P = 0.008). The surgical leg also demonstrated a smaller peak knee extension moment (surgical leg: 0.092 ± 0.031; nonsurgical leg: 0.133 ± 0.024, P < 0.001) and peak knee external rotation moment (surgical leg: 0.005 ± 0.004; nonsurgical leg: 0.008 ± 0.004, P = 0.015) when compared with the nonsurgical leg. Conclusion: The individuals with ACL reconstruction mainly showed asymmetrical movements in the sagittal and horizontal planes. The surgical leg demonstrated a smaller peak knee flexion angle, knee extension moment, and knee external rotation moment, with greater knee external rotation angle.

Key words: Anterior cruciate ligament reconstruction, Side-cutting, Biomechanics, Postoperative rehabilitation

中图分类号: 

  • R686.5

图1

侧切动作测试示意图"

图2

地面反作用力曲线图"

表1

侧切动作支撑阶段膝关节角度和力矩"

Items ACLR leg Uninjured leg P
Peak values
    Peak flexion angle /(°) 38.3±7.4 42.8±7.9 <0.001*
    Peak abduction angle/(°) 5.4±2.9 5.0±2.4 0.145
    Peak external rotation angle /(°) 10.3±2.4 7.7±2.1 0.008*
    Peak extension moments (BW×BH) 0.092±0.031 0.133±0.024 <0.001*
    Peak abduction moments (BW×BH) 0.030±0.019 0.036±0.012 0.074
    peak external rotation moments (BW×BH) 0.005±0.004 0.008±0.004 0.015*
Characteristic at peak pGRF time
    Flexion angle/ (°) 29.8±9.9 35.5±9.5 0.004*
    Abduction angle/ (°) 2.3±3.8 1.6±3.5 0.349
    External rotation angle/(°) 4.7±2.6 1.4±3.7 0.003*
    Extension moments (BW×BH) 0.057±0.033 0.092±0.037 0.001*
    Abduction moments (BW×BH) 0.012±0.025 0.023±0.014 0.014*
    External rotation moments (BW×BH) 0.001±0.004 0.002±0.004 0.016*

图3

支撑阶段膝关节角度和力矩曲线图"

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ISSN 1671-167X
CN 11-4691/R
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