내측 반월 연골판 후각 부착부 파열에서 각기 다른 봉합술을 시행한 후 봉합 효과에 대한 생역학적 연구

Abstract

목적: 본 연구는 내측 반월연골판 후각 부착부 파열에서 봉합술을 시행하였을 때 봉합 효과에 대한 돼지 무릎을 이용한 생역학적 연구로, 정상 무릎, 후각 부착부 파열, 파열에 대해서 세 가지 각기 다른 봉합술을 시행하고 난 후의 내측 반월연골판과 경골 고평부 사이의 최고 접촉 압력 및 접촉 면적을 비교 평가하여, 봉합술이 후각 부착부 파열에서 효과적인 술식인지와 어떤 봉합술이 우수한 지에 대해서 연구하였다.

대상 및 방법: 신선한 돼지 무릎 7개를 대상으로, 각 무릎마다 정상 상태, 내측 반월연골판 후각 부착부 파열 상태, 단순 끌어내기 봉합술 상태, 변형 Mason-Allen 끌어내기 봉합술 상태, FastfixTM 360을 이용한 all-inside 봉합술 상태를 만들었다. 반월연골판과 경골 고평부 사이에 접촉 압력 센서를 삽입하고 센서에 부하가 가해지지 않는 시점을 기준으로 1000N의 압축 부하를 가한 후, 최고 접촉 압력과 접촉 면적을 측정하였다. 모든 값은 무릎이 0o, 30o, 60o, 90o 의 4가지 굴곡 상태에서 측정되었으며, 각각의 굴곡 상태에서 위의 다섯 가지 반월연골판 후각 부착부 상태에 따라서 측정된 값들을 비교 평가하였다.

결과: 최고 접촉 압력은 후각 부착부 파열 시 정상 상태 보다 유의하게 상승하였다. 봉합술을 시행하면 후각 부착부 파열 상태보다 세 가지 봉합술 모두에서 최고 접촉 압력이 유의하게 감소하였지만 정상 상태에는 이르지 못하였다. 변형 Mason-Allen 끌어내기 봉합술이 가장 적게 상승하였으며 다음으로 단순 끌어내기 봉합술, all-inside 봉합술 순이었지만, 세가지 봉합술의 최고 접촉 압력값은 통계적으로 유의한 차이가 없었다. 접촉 면적은 후각 부착부 파열 시 정상 상태보다 유의하게 감소하였다. 봉합술을 시행하면 후각 부착부 파열 상태보다는 세 가지 봉합술 모두에서 접촉 면적이 유의하게 증가하였지만, 정상 상태로 완전히 회복되지는 못하였다. 변형 Mason-Allen 끌어내기 봉합술이 가장 많이 회복되었으며, 다음으로는 단순 끌어내기 봉합술, all-inside 봉합술 순이었다. 60o 굴곡 각도를 제외하고는 변형 Mason-Allen 끌어내기 봉합술이 단순 끌어내기 봉합술 및 all-inside 봉합술 보다는 유의하게 우수하였고, 단순 끌어내기 봉합술은 90o 굴곡 각도에서 all-inside 봉합술보다 유의하게 우수하였다.

결론: 내측 반월연골판 후각 부착부 파열에서 단순 끌어내기 봉합술, 변형 Mason-Allen 끌어내기 봉합술 및 all-inside 봉합술을 시행하면 파열 상태와 비교하였을 때, 최고 접촉 압력은 유의하게 감소하고, 접촉 면적은 유의하게 증가하였다. 세 가지 봉합술에서 변형 Mason-Allen 끌어내기 봉합술이 가장 우수한 양상이었으며 단순 끌어내기 봉합술, all-inside 봉합술 순이었지만, 세 가지 봉합술 모두 정상 상태로 회복되지는 않았다. 결과적으로 내측 반월연골판 후각 부착부 파열에서는 가능하면 변형 Mason-Allen 끌어내기 봉합술을 시행하는 것이 바람직할 것으로 사료된다. |Purpose: This biomechanical study was designed to investigate the effectiveness of different repair methods for medial meniscus posterior root tear (MMPRT) in porcine knees. Three different repair methods were applied to MMPRT and their effectiveness was evaluated by changes in peak contact pressure (PCP) and contact area (CA) before and after surgery to find the best method that would result in the most favorable outcome. Methods: Five different testing conditions, intact knee, MMPRT, simple pullout repair, modified Mason-Allen (mM-A) pullout repair, all-inside repair using FastfixTM 360 were applied to seven porcine knees. The PCPs and CAs between meniscus and tibia plateau were assessed under 1000N compression load at four different flexion angles (0o, 30o, 60o, 90o) before and after MMPRT and after repairing MMPRT by each methods, and measurements at same flexion angle were compared. Result: The PCPs in MMPRT was significantly increased compared to intact knee. The PCPs after repair were significantly decreased compared to MMPRT in all three methods. However, any of them could not restore PCP to the level of intact knee. The all-inside repair showed greatest increase among three repair conditions and the mM-A pullout repair showed the least increase. However, no significant difference was found between three repair conditions in PCPs. The CAs in MMPRT significantly decreased compared to intact knee. The CAs after repair were significantly increased compared to MMPRT in all three methods. However, any of them could not restore CA to the level of intact knee. The mM-A pullout repair showed the least decrease and all-inside repair showed the greatest decrease among three repair conditions. The mM-A pullout repair showed significantly superior outcome compared to other repair conditions, excluding at 60o flexion angle. Simple pullout repair showed significantly better outcome than all-inside repair at 90o flexion angle. Conclusion: In MMPRT, repair conditions including simple pullout repair, mM-A pullout repair, and all-inside repair, showed significantly decreased PCPs and increased CAs between meniscus and tibia plateau, compared to those of MMPRT. However, all outcomes could not restore to the level of intact knee. The mM-A pullout repair presented the most superior outcomes among three different repair methods, thus, the mM-A pullout repair method should be recommended in MMPRT repair.; Purpose: This biomechanical study was designed to investigate the effectiveness of different repair methods for medial meniscus posterior root tear (MMPRT) in porcine knees. Three different repair methods were applied to MMPRT and their effectiveness was evaluated by changes in peak contact pressure (PCP) and contact area (CA) before and after surgery to find the best method that would result in the most favorable outcome. Methods: Five different testing conditions, intact knee, MMPRT, simple pullout repair, modified Mason-Allen (mM-A) pullout repair, all-inside repair using FastfixTM 360 were applied to seven porcine knees. The PCPs and CAs between meniscus and tibia plateau were assessed under 1000N compression load at four different flexion angles (0o, 30o, 60o, 90o) before and after MMPRT and after repairing MMPRT by each methods, and measurements at same flexion angle were compared. Result: The PCPs in MMPRT was significantly increased compared to intact knee. The PCPs after repair were significantly decreased compared to MMPRT in all three methods. However, any of them could not restore PCP to the level of intact knee. The all-inside repair showed greatest increase among three repair conditions and the mM-A pullout repair showed the least increase. However, no significant difference was found between three repair conditions in PCPs. The CAs in MMPRT significantly decreased compared to intact knee. The CAs after repair were significantly increased compared to MMPRT in all three methods. However, any of them could not restore CA to the level of intact knee. The mM-A pullout repair showed the least decrease and all-inside repair showed the greatest decrease among three repair conditions. The mM-A pullout repair showed significantly superior outcome compared to other repair conditions, excluding at 60o flexion angle. Simple pullout repair showed significantly better outcome than all-inside repair at 90o flexion angle. Conclusion: In MMPRT, repair conditions including simple pullout repair, mM-A pullout repair, and all-inside repair, showed significantly decreased PCPs and increased CAs between meniscus and tibia plateau, compared to those of MMPRT. However, all outcomes could not restore to the level of intact knee. The mM-A pullout repair presented the most superior outcomes among three different repair methods, thus, the mM-A pullout repair method should be recommended in MMPRT repair.