交叉韧带重建手术中可吸收挤压螺钉的应用

目的探讨交叉韧带重建术中可吸收挤压螺钉的使用方法和疗效。方法总结53例交叉韧带重建病例使用可吸收挤压螺钉的情况，在术中、术后并发症、术后康复、膝关节功能状况等方面进行回顾性分析。结果三例出现韧带切割现象。两例股骨侧螺钉拧入后导引针无法拔出。一例挤压螺钉断裂。术后Lysholm评分平均92.4±4．1。结论交叉韧带重建术中使用可吸收挤压螺钉固定的方法固定牢固，术后恢复快，利于早期康复。     

重建前交叉韧带中Endo-Button和可吸收界面螺钉固定的对比

背景：应用腘绳肌肌腱重建前交叉韧带过程中仍有许多的争议及未知因素需进一步探讨和研究。 目的：比较分析腘绳肌肌腱重建前交叉韧带过程中股骨端分别使用Endo-Button系统和可吸收界面螺钉两种不同固定方式的疗效。 方法：选择45例在关节镜下使用4股自体腘绳肌腱进行前交叉韧带重建患者,实验组25例股骨端使用Endo-Button钢板固定,对照组20例使用可吸收界面螺钉固定。重建后用相同的方法进行康复锻炼。 结果与结论：经过6-21个月的随访,患者膝关节屈伸活动度均达正常范围。Lachman试验中实验组Ⅰ度阳性2例,对照组Ⅰ度阳性3例;轴移试验均阴性。两组重建后膝关节Lysholm评分均较治疗前明显改善,两组间差异无显著性意义。两组随访早期均有较高的骨道扩大发生率,但组间差异无显著性意义;对照组骨道增宽程度强于实验组(P < 0.05)。说明两组早期总体临床效果相近。     

关节镜下应用可吸收界面螺钉固定自体4股腘绳肌腱重建前交叉韧带

目的：探讨关节镜下应用可吸收界面螺钉固定自体4股腘绳肌腱重建前交叉韧带的临床效果.方法：对21例前交叉韧带断裂的患者,在关节镜下采用4股腘绳肌腱重建前交叉韧带,使用可吸收界面螺钉对移植物进行固定,术前、术后观察患者的症状,膝关节活动度、前抽屉试验、Lachman试验、轴移试验,按照Lysholm膝关节功能评分标准评价疗效.结果：本组未出现深静脉血栓或感染.术后随访6～18个月,膝关节屈曲平均130°,伸直0°;21例患者均无打软腿现象.前抽屉试验20例阴性,1例阳性（Ⅰ°）.Lachman试验20例阴性,1例阳性.轴移试验均为阴性.Lysholm评分从术前（48.3±4.6）分提高至（84.7±4.4）分,差异有统计学意义（t=2.91,P＜0.01）.结论：关节镜下应用可吸收界面螺钉固定自体4股腘绳肌腱重建前交叉韧带,是治疗前交叉韧带断裂的一种方法,具有手术操作较简单、固定可靠、费用较低、愈合率高等优点.     

全身振动训练对前交叉韧带重建后影响的Meta分析

目的：全身振动训练近年来被广泛运用于前交叉韧带重建后康复当中,然而其疗效仍存在争议。文章采用Meta分析方法,系统评价全身振动训练对前交叉韧带重建后的影响,以期为全身振动训练的临床应用提供循证医学证据。方法：计算机检索PubM ed、Embase、The Cochrane Library、Web of Science、EBSCO、中国知网、万方和维普数据库的相关文献,收集全身振动训练对前交叉韧带重建后患者影响的随机对照试验,检索时限均为各数据库建库至2022-07-16。结局指标包括股四头肌峰值力矩、腘绳肌峰值力矩、膝关节角度重现误差、Biodex偏移指数及Lysholm膝关节功能评分共5个连续性变量,采用Cochrane风险偏倚评估工具和Jadad量表对纳入的文献进行质量评价,应用RevMan 5.3软件对结局指标进行Meta分析。结果：(1)共纳入10项随机对照试验,包括372例前交叉韧带重建后患者,纳入文献整体质量较高。(2)Meta分析结果显示：与对照组相比,全身振动训练可以显著提升股四头肌峰值力矩(SMD=0.75,95%CI:0.20-1.30,P=0.008)和腘绳肌峰值...     

自体腘绳肌腱双束与单束重建前交叉韧带效果的Meta分析

背景：选择双束还是单束自体腘绳肌腱重建前交叉韧带,目前仍存在很大争议。 目的：系统评价自体腘绳肌腱双束与单束重建前交叉韧带的临床疗效。 方法：计算机检索PubMed、Cochrane library、Springerlink、CNKI、CBM等数据库,收集自体腘绳肌腱双束对比单束重建前交叉韧带的临床随机对照试验,采用Jadad量表对所纳入研究的方法学质量进行评价,并提取数据资料,使用RevMan 5.0软件对数据进行Meta分析。 结果与结论：纳入临床随机对照试验15篇,共1 008例患者符合纳入标准,Meta分析结果显示：双束重建与单束重建后KT测量值的差异有显著性意义[WMD=-0.51,95%CI(-0.74,-0.28),P < 0.000 1];重建后轴移试验阴性的差异有显著性意义[RR=1.27,95%CI(1.11,1.45),P=0.000 3];重建后Lysholm膝关节评分的差异有显著性意义[WMD=-2.10,95%CI(-3.65,-0.55),P=0.008];重建后IKDC分级评分的差异无显著性意义[RR=1.04,95%CI(0.99,1.06),P=0.10]。双束自体腘绳肌腱重建前交叉韧带对于恢复膝关节稳定性优于单束重建,而对于恢复膝关节功能两者疗效差异不大。     

肌内效贴对前交叉韧带重建后康复疗效的Meta分析

目的：一些研究显示肌内效贴在提升前交叉韧带重建后患者肌肉力量、改善关节稳定性、减轻疼痛及水肿方面具有积极效应，然而现有研究关于肌内效贴的临床疗效存在相互矛盾的结果。文章采用Meta分析方法，系统评价肌内效贴对前交叉韧带重建术后康复疗效的影响。方法：应用计算机检索PubMed、Web of Science、Embase、The Cochrane Library、EBSCO、中国知网、万方、维普数据库，搜集有关肌内效贴对前交叉韧带重建后患者影响的随机对照试验，检索时限均从各数据库建库至2022-12-06，结局指标包括股四头肌力量、腘绳肌力量、膝关节肿胀、膝关节活动度、Lysholm膝关节功能评分、目测类比评分6个连续型变量。运用EndNote X9.1筛选文献，采用Cochrane风险偏倚评估工具和Jadad量表评估纳入文献质量，采用RevMan 5.3软件进行Meta分析。结果：(1)共纳入6项随机对照试验，包括252例前交叉韧带重建后患者，其中对照组126例，肌内效贴组126例；(2)Meta分析结果显示，与对照组相比，肌内效贴组患者腘绳肌力量显著增加[SMD=0.68,95%CI(...     

可吸收螺钉固定的并发症及预防

背景：在一些四肢特殊部位,可吸收螺钉已取代金属螺钉,取得了良好的固定效果,但是,也出现了一些并发症。有关可吸收螺钉固定的并发症原因和预防措施的文献较少。 目的：分析可吸收螺钉固定并发症的发生率、原因和预防措施。 方法：回顾性分析113例患者使用236枚可吸收螺钉或螺棒固定治疗临床资料,其中,四肢骨折92例,韧带重建21例,前者除4例胫骨干骨折外,其余均是近关节松质骨骨折。 结果与结论：所有患者均随访12-48个月,平均20个月,并发症的总体发生率为10.6%。固定失败5例(失败率4.4%),其中,3例移位较轻,2例移位明显,与适应证选择不当、骨质疏松、攻丝过度及术后活动过早过多等有关。有局部不良反应7例(发生率6.2%),其中,较轻2例(1.8%),较重5例(4.4%);早期反应4例(3.5%),中晚期反应3例(2.7%),主要与材料成分、螺钉穿破关节、螺钉帽外露骨过多等有关。说明可吸收螺钉固定并发症与可吸收材料成分、适应证选择不当、未按手术规范操作和术后活动过早过多等多种因素有关。     

关节镜下Endobutton系统固定胭绳肌腱解剖重建膝前交叉韧带21例临床分析

目的：探讨关节镜下Endobutton系统配合可吸收界面螺钉固定股薄、半腱肌腱解剖重建膝前交叉韧带的治疗效果。方法：2009年6月-2012年3月关节镜下Endobutton系统固定股薄、半腱肌腱单束解剖重建膝前交叉韧带21例。采用Lyshohn关节评分评价疗效。结果：21例患者全部得到随访,随访时间3～18个月,平均9个月。Lysholm评分从术前51分提高到术后的91分。lachmanTest和前抽屉试验术前21例均为阳性,术后19例阴性、2例弱阳性。结论：关节镜下Endobutton系统配合可吸收界面螺钉固定股薄、半腱肌腱解剖重建膝前交叉韧带,临床疗效确切,创伤小,手术时间短,并发症少,康复快,是一种疗效可靠的手术治疗方法。     

空心加压螺钉与动力髋螺钉治疗股骨颈骨折术后股骨头坏死相关并发症的Meta分析

目的 应用Meta分析评价空心加压螺钉与动力髋螺钉治疗股骨颈骨折对术后股骨头坏死及相关并发症的影响。方法 计算机检索 PubMed、Cochrane Library、Web of Science、CNKI等医学文献数据库所有关于空心加压螺钉与动力髋螺钉治疗股骨颈骨折的随机对照研究或回顾性对照研究文献,截止到2018年10月。采用RevMan 5.3软件进行统计分析。结果 共7篇文献 纳入标准,其中RCT3篇,CCT4篇,Meta 分析结果显示,股骨头坏死率与两种内固定方式无显著差异（OR=0.71,     

关节镜下经胫骨隧道入路与前内侧入路重建前交叉韧带效果的Meta分析

背景：一些随机对照研究试图回答关节镜下经胫骨骨道入路与前内侧入路重建前交叉韧带疗效优劣问题,得出结论各不相同。 目的：关节镜下经胫骨骨道入路与前内侧入路重建前交叉韧带疗效Meta分析。 方法：计算机检索PubMed、Embase、Cochrane图书馆及中国生物医学数据库、维普信息数据库、万方数据库,手工检索相关的中英文骨科杂志。收集关节镜下经胫骨骨道入路与前内侧入路重建前交叉韧带的对照试验,并评价纳入研究的方法学质量。统计软件用Cochrane协作网提供的RevMan 5.0。 结果与结论：共纳入7个研究。Meta分析表明,与胫骨骨道入路相比,前内侧入路制作的股骨隧道的长度较短[RR 3.91,95%CI(1.49,6.34)]、[RR 12.73,95%CI(11.91,13.55)]、股骨隧道冠状面骨道角度较垂直[RR 18.18,95%CI(17.10,19.25)]、胫骨矢状面胫骨隧道位置较靠前[RR 6.16,95%CI(5.23,7.10)]、术后膝关节Lysholm功能评分高[RR 6.16,95%CI(-3.59,-2.63)],差异有显著性意义。分析结果说明,关节镜下通过前内侧入路比经胫骨隧道入路重建前交叉韧带更接近解剖重建,修复疗效更好。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

Bioabsorbable interference screws can be used with less tunnel widening in anatomic rectangular tunnel anterior cruciate ligament reconstruction with a bone–patellar-tendon–bone graft

BackgroundThe purpose of this study was to investigate postoperative tunnel widening after rectangular tunnel bone–patellar-tendon–bone graft anterior cruciate ligament reconstruction using newer-generation bioabsorbable interference screws.MethodsForty-six patients who had undergone primary rectangular tunnel bone–patellar-tendon–bone graft anterior cruciate ligament reconstruction using MILAGRO bioabsorbable interference screws (DePuy Synthes, Warsaw, IN, USA) for femoral fixation and for whom computed tomography was performed at two weeks and one year postoperatively were included in this prospective study. To assess the tunnel widening, the cross-sectional area of the femoral tunnel aperture (compared between two weeks and one year postoperatively) was assessed using computed tomography. Cyst formation, postoperative screw breakage, screw migration, and graft migration were also evaluated using computed tomography one year postoperatively.ResultsMean tunnel widening was 1.9%, and the cross-sectional area of the femoral tunnel aperture was not significantly different between two weeks and one year postoperatively. Postoperative cyst formation, screw breakage, screw migration, and graft migration were not observed in any patient.ConclusionsAfter rectangular tunnel bone–patellar-tendon–bone graft anterior cruciate ligament reconstruction using bioabsorbable interference screws for femoral fixation, tunnel widening was not observed via computed tomography analysis at two weeks and one year postoperatively.     

Tibial bone tunnel widening is reduced by polylactate/hydroxyapatite interference screws compared to metal screws after ACL reconstruction with hamstring grafts

Composite interference screws containing calcium phosphate for anterior cruciate ligament graft fixation could improve implant/bone integration and thereby reduced tunnelwidening and graft slippage. The present study investigated the effect of polylactate/hydroxyapatite interference screw (HA/PLLA) screw used for tibial graft fixation on tunnel widening and clinical outcomes compared with a metal interference screw. We hypothesized less tibial tunnelwidening with HA/PLLA screws compared to metal screws. Hundred patients with HA/PLLA screw tibial fixation was compared with 100 patients with metal screw tibial fixation. Tibial tunnel widening was measured on AP and lateral radiographs taken at 12 months follow-up. Clinical outcome was assessed by objective and subjective international Knee Documentation Committee (IKDC) scores, Noyes Sports Activity and Occupational Rating scores and KT-1000 knee laxity measurements. Tibial tunnel widening at the level of the metal screw group was 36% and 38% on AP and lateral radiographs respectively. Tunnel widening was lower in the HA/PLLA group with mean tunnel widening of 30% and 32% (p = 0.012 and 0.018) on AP and lateral radiographs respectively. No differences were found for any of the clinical scores or for anterior knee laxity. The use of a polylactate/hydroxyapatite interference screw resulted in less tibial tunnel widening than a metal screw around the screw but did not affect clinical outcome or objective knee laxity.     

Ligament graft initial fixation strength using biodegradable interference screws

The objective of this study was to evaluate the initial fixation strength of three types of biodegradable interference screws [an Endo Fix, 7 x 25 mm polyglycolic acid, non-self-tapping (Acufex); a biodegradable interference screw, 7 x 23 mm poly-L-lactic acid, self-tapping (Arthrex); a Bioscrew, 7 x 25 mm poly-L-lactic acid, self-tapping (Linvatec)] in comparison to a titanium interference screw (Linvatec, 7 x 25 mm) in anterior cruciate ligament reconstruction using a bone-patellar tendon-bone graft. Porcine lower limbs were used. To control for specimen related bias, bone mineral density of each tibia was measured. All specimens were loaded to failure. Failure mode was determined by visual analysis. The maximum load to failure [mean (SD)] was 785 (87) N (titanium screw), 555 (60) N (Acufex), 592 (211) N (Arthrex), and 844 N (Linvatec). The primary fixation strength of the titanium screw and the Linvatec screw was significantly higher (p < 0.05) than the primary fixation strength of the Arthrex screw and the Acufex screw. There was no difference in bone mineral density between the groups. With respect to primary fixation strength, all biodegradable screws were strong enough to allow accelerated rehabilitation. From this point of view the biodegradable screws may be a reasonable alternative to titanium interference screws.     

The effect of screw taper on interference fit during load to failure at the soft tissue/bone interface

The effect of screw geometry on the pullout strength of an anterior cruciate ligament reconstruction is well documented. The effect of a truly tapered screw has not been previously investigated. Thirty bovine knees in right and left knee pairs were collected. Superficial digital flexors from the hind legs of sheep were harvested to form a quadruple tendon graft. For each knee pair, one tendon graft was fixed using a tapered screw (n=15) and the other with a non-tapered screw (n=15). Interference screws were manufactured from stainless steel, and apart from the tapered or non-tapered profile were identical. The screws were inserted into a tibial tunnel already containing the tendon graft. The interference fit was tested by extensile load to failure tests. The insertion torque of the screws and first sign of load to failure (by pullout) of the interference fit were recorded. Results were analysed using paired t-tests. The results indicated that tapered screws have significantly higher resistance to interference failure (p=0.007) and insertion torque (p<0.001) than non-tapered screws. The improved biomechanical performance of tapered screws demonstrated in this study may translate into superior clinical results, particularly at the tibial attachment of hamstring anterior cruciate ligament reconstruction, and also of hamstring fixation to the medial femoral condyle for patella instability.     

A clinical review of bioabsorbable interference screws and their adverse effects in anterior cruciate ligament reconstruction surgery

Bioabsorbable material screws are widely used in various surgical specialties. One popular application is their use as interference screws in anterior cruciate ligament (ACL) reconstruction surgery. Despite their routine use, a major concern with bioabsorbable materials in surgery has been the incidence of adverse events. Various case reports, series reports and studies in the past years have reported complications specific to the use of bioabsorbable interference screws intra operatively and at different time periods post operatively. The aim of this literature review is to summarize the clinical studies where bioabsorbable screws have been used in ACL reconstruction surgery and in particular to highlight any specific complications and adverse effects related to the use of these materials.     

Tibial plateau fracture after anterior cruciate ligament reconstruction: Role of the interference screw resorption in the stress riser effect

We report a case of tibial plateau fracture after previous anterior cruciate ligament (ACL) reconstruction using patellar tendon autograft and bioabsorbable screws 4 years previously. The fracture occurred through the tibial tunnel. The interference screw had undergone complete resorption and the tunnel widening had increased. The resorption of the interference screw did not simultaneously promote and foster the growth of surrounding bone tissue. Therefore, the area of reactive tissue left by the screw resorption in an enlarged bone tunnel may lead to vulnerability of the tibial plateau. Stress risers would occur following ACL reconstruction if either resorption is not complete or bony integration is not complete.     

Reduced bone tunnel enlargement post hamstring ACL reconstruction with poly-L-lactic acid/hydroxyapatite bioabsorbable screws

Bone tunnel enlargement following anterior cruciate ligament (ACL) reconstruction can complicate revision surgery. This study compared postoperative tibial tunnel widening in patients who underwent arthroscopically assisted, single-incision, four-strand hamstring ACL reconstruction using a poly-L-lactic acid/hydroxyapatite blend (PLLA+HA) bioabsorbable interference screw for tibial fixation, with those in whom a plain poly-L-lactic acid (PLLA) screw was used. Thirty-four patients (13 with PLLA+HA tibial interference screw fixation and 21 with plain PLLA tibial interference screws) underwent a spiral CT scan to assess maximum tibial tunnel cross-sectional area at an average of 28.7 months follow-up. An assessment of tunnel wall sclerosis adjacent to the screw (cortication) was also made. The two groups were well matched for age, sex and graft diameters. Mean tibial tunnel enlargement in patients with PLLA+HA screws was 29.9% at average 30.9 months follow-up compared with 46% in patients with plain PLLA screw at an average 26.5 months follow-up (p=0.03). The tunnel wall adjacent to the screw appeared corticated in only 21% of patients with PLLA+HA screws (p=0.02) compared with 73% of patients with PLLA screws. The blending of HA with PLLA appears to reduce postoperative tunnel widening, and the reduced tunnel wall sclerosis seen postoperatively may indicate improved screw incorporation.     

Bio-interference screw cyst formation in anterior cruciate ligament reconstruction--10-year follow up

PurposeThis study used serial MRI to assess the absorption of a poly l-lactide Bioabsorbable interference screw used in the anterior cruciate ligament reconstruction with a 4-strand hamstring technique.MethodsA consecutive series of ten patients undergoing anterior cruciate ligament reconstruction a 4-strand hamstring technique were assessed with magnetic resonance imaging (MRI) scans at 1, 2, 4, 7 and 10 years postoperatively.ResultsNo resorption had occurred after 4 years in any of the patients. By 7 years screw absorption was complete in seven patients and had progressed in three. New cyst formation occurred in 3 patients between 5 and 7 years. Half the patients displayed small fluid collections within the tibial tunnels. At 10 years all screws were fully absorbed; however cyst formation was common, including the development of a new cyst in the period between 7 and 10 years in one patient. None of the patients had instability, persistent effusions, or clinically detectable adverse reactions to the screws.ConclusionsThis study has shown that poly l-lactide bioabsorbable screws take longer to resorb than initial in vitro data suggested. It is unclear whether ganglion formation within the tibial tunnel is related to screw resorption or the hamstring graft. The theoretical advantages of bioabsorbable screws must be weighed against these findings.     

Reconstruction of the anterior cruciate ligament using poly-L-lactide interference screws or titanium screws: a comparative study.

In the present clinical trial, interference screws, made of poly-L-lactic acid and applied in 46 knees, were compared to titanium screws employed in 45 knees for reconstructing the anterior cruciate ligament using bone-patellar tendon-bone. An identical surgical technique was applied to both groups; and neither group disclosed apparent side effects such as synovitis caused by hydrolysis of the PLLA or abnormal biochemical findings in the blood. There was no significant difference in the postoperative outcome between the two groups.