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目的 探究踝关节下胫腓联合前韧带断裂和全部断裂对踝关节生物力学的影响. 方法 选用6具成年健康新鲜踝关节,建立3组模型:A组:踝关节内、外侧韧带及下胫腓联合完好作为正常组;B组:把A组下胫腓联合前韧带切断,作为下胫腓联合部分损伤组;C组:把B组标本下胫腓联合完全切断;作为下胫腓联合完全断裂组;把6具踝关节按A→C顺序分别入组并置入电子压力传感器,置于生物力学机上分别在背伸10°、内翻20°、外翻20°、跖屈20°、中立位5种状态下加载,记录和比较各组标本踝关节的峰值压力,以及峰值压力主要部位. 结果 在各种状态下应力A组＜B组＜C组,三组间两两比较差异均有统计学意义(P＜0.05).B、C组在中立位、背伸10°位、跖屈20°位主要受力位置较A组有向外增大趋势,C组较B组更为明显. 结论 下胫腓联合前韧带断裂和下胫腓联合完全韧带断裂会增加踝关节应力,后者增加更为明显;而且两种情况下受力主要位置有向外增大趋势,后者增大更明显.

Objective To explore the impact of partial or complete rupture of the tibiofibular syndesmosis on the biomechanical properties of the ankle joint.Methods Six fresh cadaveric specimens of adult ankle were used for creation of 3 models of tibiofibular syndesmosis.In model A,the medial and lateral ligaments of the ankle joint and the tibiofihular syndesmosis were intact.In model B,only the anterior lower tibiofibular ligament was broken.In model C,all inferior tibiofibular ligaments were broken.The 3 models were tested with an electronic pressure sensor in a BOSE material testing machine respectively at 5 positions:10° dorsal extension,20° inversion,20° eversion,20° plantar flexion,and neutral position.The peak values and locations of the compressive stresses of the 3 models at 5 positions were recorded.All the data were collected and analyzed using IBM SPSS 22.0 statistical software.Results Model A exhibited the smallest average stress at all the 5 positions,followed by model B and model C,with significant differences between groups (P ＜ 0.05).The locations of main compressive stress at the neutral position,10° dorsal extension,and 20° plantar flexion in model B and model C tended to expand outwards compared with model A,especially in model C.Conclusions Rupture of the anterior lower tibiofibular ligament and inferior tibiofibular ligaments may increase the compressive stress on the ankle joint,especially rupture of the inferior tibiofibular ligaments.The location of main compressive stress tends to expand outwards when the anterior lower tibiofibular ligament and inferior tibiofihular ligaments are broken,especially the inferior tibiofibular ligaments.