应用聚丙烯补片修补膝关节囊缺损的可行性研究 实验目的， 研究聚丙烯补片在修补兔膝关节囊缺损方面的作用，并以腘窝囊肿 （popliteal cyst）为例，初步探讨其在人膝关节囊缺损治疗中的可行性。 实验方法， 1. 选取 4 只实验用兔，制作成标准膝关节囊生物力学模型。在生物力 学实验机上进行拉伸实验，进行数据分析。 2.选取 8 只相同体重实验用兔，人为制造直径 3mm 膝关节囊缺损，待 其自然愈合。术后 1 个月进行生物力学测定，形成同一个体双侧肢体位移 应力曲线图。 3.实验用兔 30 只，均分为三组，人为制造单侧肢体膝关节囊缺损模型 并应用网状聚丙烯补片修补。 4．分别于术后 4 周、8 周、12 周处死三组实验用兔， 观察其运动功 能变化、修补后的愈合情况，并进行进行生物力学比较分析。 5.选择交通型腘窝囊肿病例 56 例，行囊肿切除及聚丙烯补片修补关节 囊后壁缺损手术治疗。术后口服消肿及镇痛药物，局部加压包扎 1 日，无 关节制动。术后每 3 个月随访，采用 lysolm 评分评价膝关节功能变化，以 彩色多普勒超声检查证实腘窝囊肿是否复发。 实验结果， 1. 实验用兔不同个体间，其膝关节囊模型最大弹性应力位移值差异较 II 大，但同一个体双侧膝关节囊最大应力变化无明显差异。 2.兔膝关节囊缺损自然愈合后，与同一个体对侧比较，弹性形变范围 内最大应力下降 25.1%±3.1%。 3.应用聚丙烯补片修补兔膝关节囊缺损后，对运动功能无明显影响， 局部未见排斥反应及粘连，不同组间最大应力增加幅度基本一致，实验侧 与健侧对比，最大应力增加 61.0%±5.7%。 4 全部入选腘窝囊肿病例，术后病理学检查，均证实腘窝囊肿诊断。 成功随访 54 例，平均随访时间 11.6 个月。lysolm 膝关节功能评分，平均 89.6 分，与术前比较，无下降。彩色多普勒超声检查，证实无腘窝囊肿复 发病例存在。 结论， 1、关节囊缺损自然愈合过程会导致关节囊强度下降。在本实验模型 中最大应力下降幅度为 25.1%±3.1%。 2、应用网状聚丙烯补片修补关节囊缺损，局部组织无粘连，未见其 对兔膝关节运动功能产生影响。 3、聚丙烯补片修补兔关节囊缺损，可以增加局部关节囊强度。与对 侧正常无缺损关节囊组织相比，其最大应力增加达 61.0%±5.7%。 4、在腘窝囊肿手术治疗中应用聚丙烯补片修补关节囊缺损，加强关 节囊强度，降低该病复发率。本实验 54 例病人中，平均随访 11.6 个月， 无复发病例，显著低于其它手术治疗方式。 5、在膝关节囊后壁缺损病例治疗中，应用网状聚丙烯补片修补，术 后 1 年内，未见其对膝关节活动功能造成影响。lysolm 膝关节功能评分， III 与术前比较，无下降。 6、应用聚丙烯补片修补关节囊缺损，不会导致关节运动功能损害， 并能增加关节囊强度，具有可行性。 关键词， 聚丙烯补片，关节囊，缺损，应力，腘窝囊肿，手术 IV Abstract A Research on the feasibility of polypropylene patch for Joint capsule defect Research Aims: The experiment aims to study the treatment effects of polypropylene patches in repair of rabbits’ knee joint capsule defects, and taking popliteal cyst as an example to explore its feasibility in the treatment of human knee joint capsule defects. Research Methods: 1. Choose 4 rabbits for experiment, and make the standard bio-mechanical models of knee joint capsule. Use Biomechanical machine for tensile tests, and analyze the data. 2. Select 8 rabbits of the same weight for experiment, and make the artificial knee joint capsule defects with the diameter of 3mm, let them heal naturally. Make the biomechanical tests 1 month after, and draw the two-sided body displacement stress curve of the same individual. 3. 30 rabbits are divided into three groups for experiments, and make artificial one-sided capsule defect models of knee joint, and then use mesh polypropylene patches for treatment. 4．Kill the three sets of rabbits after 4 weeks, 8 weeks, 12 weeks respectively, and observe their movementr function changes, healings and then analyze biomechanically. 5. Select 56 cases of popliteal cyst of traffic type, and cut the cyst and use V polypropylene patches to repair the capsule back wall defects with surgical treatment. Eat the medicine for swelling and pain release with partial compression bandage without the restriction of capsule movement. Visit after every 3 months. Use lysolm to evaluate the knee functions and color Doppler ultrasound to confirm whether popliteal cyst reoccurs. Research Results: 1. For different individual rabbits, the maximum displacement of the knee joint capsule model under stress varies greatly, but it is not the case for the same rabbit’s bilateral knee capsules. 2. After natural healing of the knee joint capsule, compared with the same individual’s other healthy side, its stress drops 25.1% ±3.1 within the maximum elastic deformation. 3. Polypropylene patches are applied after the capsule of knee joint defects in rabbits, and there is no significant influence on rabbits’ movement functions. No excluded response and adhesion appear. For different groups, the maximum stress rise almost the same around 61.0%±5.7%, the experimented side compared with the healthy side. 4. All the cases are chosen as popliteal cyst cases. With the pathological tests after surgery, all are proved to be popliteal cyst. The average visit time is 11.6 months within the 56 successful cases. The average score by lysolm is 89.6, with no falling compared with the data before the surgery. Color Doppler ultrasound tests show that there is no popliteal cyst reoccurrence. VI Results: 1.The natural healing process will lower the intensity of joint capsule. In the experiment, the maximum stress drops 25.1%±3.1%. 2. Applying polypropylene patches in repair of knee joint capsule defects makes no partial tissue adhesion or impact on the movement function of rabbits ' knee joint. 3. Applying polypropylene patches in repair of knee joint capsule defects can increase the intensity of local joint capsule, compared with the other normal side, the maximum stress can increase reached 61.0%±5.7%. 4. Applying polypropylene patches in repair of popliteal cyst can increase the intensity of joint capsule, reduces the reoccurrence rate. Within the 54 patiences ， the average visiting frequency is 11.6 months. There is no reoccurrence, which is much lower than other kinds of surgeries. 5、Applying polypropylene patches in repair of the defects in the knee joint back wall, there is no influence on the activities of knee joint one year after the surgery. Lysolm shows no decrease compared with the conditions of knee joints before surgery. Applying polypropylene patches in repair of knee joint capsule defects makes no damage to movement functions, and can increase the intensity of the capsule, which is feasible. VII Key words， polypropylene patches，joint capsule, defect, stress, popliteal cyst, surgery. VIII 目 录 引 言 .........................................................1 第 1 章 综 述 .................................................2 1.1 膝关节囊缺损与腘窝囊肿的研究进展 .......................2 1.1.1 腘窝囊肿的发生机理研究 ............................2 1.1.2 腘窝囊肿治疗的研究进展 ............................3 1.2 临床应用聚丙烯补片的研究进展 ...........................4 1.2.1 腹股沟疝发生机理 与腘窝囊肿基本一致 ...............4 1.2.2 腹股沟疝治疗的研究进展 ............................5 1.2.3 聚丙烯补片在其它组织缺损中的应用研究...............6 1.3 研究思路 ..............................................6 第 2 章应用聚丙烯补片修补兔膝关节囊缺损的生物力学研究 ..........8 2.1 材料及实验准备 .........................................8 2.1.1 实验仪器 ..........................................8 2.1.2 实验材料...........................................8 2.1.3 实验准备 ..........................................9 2.2 实验方法...............................................13 2.2.1 不同个体膝关节囊模型生物力学测定..................13 2.2.2 膝关节囊缺损自然愈合模型的生物力学测定............13 2.2.3 应用网状聚丙烯补片修补关节囊缺损..................13 2.2.4 修补关节囊缺损后各组间观察及生物力学测定..........15 IX 2.2.5 实验数据的统计处理 ..............................16 2.3 实验结果 ..............................................16 2.3.1 不同个体膝关节囊模型生物力学分析 .................16 2.3.2 膝关节囊缺损自然愈合模型的生物力学分析............17 2.3.3 聚丙烯补片修补后观察结果..........................18 2.3.4 聚丙烯补片修补后生物力学分析......................20 2.4 讨论 ..................................................22 第 3 章 应用聚丙烯补片修补治疗腘窝囊肿的临床