耻骨股韧带对髋关节稳定性的贡献：一项生物力学研究。
Contribution of the Pubofemoral Ligament to Hip Stability: A Biomechanical Study.
作者信息
Martin Hal D, Khoury Anthony N, Schröder Ricardo, Johnson Eric, Gómez-Hoyos Juan, Campos Salvador, Palmer Ian J
机构信息
Hip Preservation Center, Baylor Scott & White Health, Dallas, Texas, U.S.A..
Hip Preservation Center, Baylor Scott & White Health, Dallas, Texas, U.S.A.; Bioengineering Department, University of Texas at Arlington, Engineering Research Building, Arlington, Texas, U.S.A.
出版信息
Arthroscopy. 2017 Feb;33(2):305-313. doi: 10.1016/j.arthro.2016.07.025. Epub 2016 Oct 5.
PURPOSE
To determine the isolated function of the pubofemoral ligament of the hip capsule and its contribution to hip stability in external/internal rotational motion during flexion greater than 30° and abduction.
METHODS
Thirteen hips from 7 fresh-frozen pelvis-to-toe cadavers were skeletonized from the lumbar spine to the distal femur with the capsular ligaments intact. Computed tomographic imaging was performed to ensure no occult pathological state existed, and assess bony anatomy. Specimens were placed on a surgical table in supine position with lower extremities resting on a custom-designed polyvinylchloride frame. Hip internal and external rotation was measured with the hip placed into a combination of the following motions: 30°, 60°, 110° hip flexion and 0°, 20°, 40° abduction. Testing positions were randomized. The pubofemoral ligament was released and measurements were repeated, followed by releasing the ligamentum teres.
RESULTS
Analysis of the 2,106 measurements recorded demonstrates the pubofemoral ligament as a main controller of hip internal rotation during hip flexion beyond 30° and abduction. Hip internal rotation was increased up to 438.9% (P < .001) when the pubofemoral ligament was released and 412.9% (P < .001) when both the pubofemoral and teres ligament were released, compared with the native state.
CONCLUSIONS
The hypothesis of the pubofemoral ligament as one of the contributing factors of anterior inferior hip stability by controlling external rotation of the hip in flexion beyond 30° and abduction was disproved. The pubofemoral ligament maintains a key function in limiting internal rotation in the position of increasing hip flexion beyond 30° and abduction. This cadaveric study concludes previous attempts at understanding the anatomical and biomechanical function of the capsular ligaments and their role in hip stability.
CLINICAL RELEVANCE
The present study contributes to the understanding of hip stability and biomechanical function of the pubofemoral ligament.
目的
确定髋关节囊耻骨股韧带的独立功能及其在大于30°屈曲和外展时的内/外旋转运动中对髋关节稳定性的贡献。
方法
从7具新鲜冷冻的全骨盆至足尸体上获取13个髋关节，保留关节囊韧带，将其从腰椎至股骨远端进行骨骼化处理。进行计算机断层扫描成像以确保不存在隐匿性病理状态，并评估骨骼解剖结构。将标本仰卧放置在手术台上，下肢置于定制的聚氯乙烯框架上。通过将髋关节置于以下运动组合中来测量髋关节的内旋和外旋：髋关节屈曲30°、60°、110°以及外展0°、20°、40°。测试位置随机安排。松开耻骨股韧带并重复测量，随后松开圆韧带。
结果
对记录的2106次测量结果的分析表明，耻骨股韧带是髋关节在超过30°屈曲和外展时内旋的主要控制因素。与原始状态相比，松开耻骨股韧带时髋关节内旋增加高达438.9%（P <.001），同时松开耻骨股韧带和圆韧带时髋关节内旋增加412.9%（P <.001）。
结论
耻骨股韧带通过控制髋关节在超过30°屈曲和外展时的外旋而成为髋关节前下稳定性的促成因素之一这一假设未得到证实。耻骨股韧带在限制髋关节超过30°屈曲和外展时的内旋位置方面发挥着关键作用。这项尸体研究总结了以往对关节囊韧带的解剖和生物力学功能及其在髋关节稳定性中作用的研究尝试。
临床意义
本研究有助于理解髋关节稳定性以及耻骨股韧带的生物力学功能。
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