挤压螺钉固定自体髌韧带移植重建后交叉韧带的生物力学研究

目的评价挤压螺钉固定自体骨-髌韧带-骨(bone-patellar-bone,B-PT-B)移植重建后交叉韧带(posterior cruciate ligament,PCL)术提供的膝关节胫骨后移刚度和强度,为手术后康复计划的制定提供依据.方法对正常和挤压螺钉固定自体B-PT-B移植重建PCL术后等状态的新鲜尸体标本,进行膝关节屈曲15°、30°、90°位胫骨后移刚度和屈膝90°位胫骨后移强度测试.结果挤压螺钉固定自体B-PT-B移植重建PCL术后,各膝关节屈曲角度时胫骨后移刚度明显大于正常状态,以90°时最为明显;胫骨后移强度则明显小于正常状态,约为其25%.结论挤压螺钉固定自体B-PT-B移植重建PCL术后早期不宜负重,功能锻炼膝关节屈曲不超过90°.     

挤压螺钉固定自体髌韧带移植重建后交叉韧带的生物力学研究

目的:评价挤压螺钉固定自体骨-髌韧带-骨(bone-patellar-bone,B-PT-B)移植重建后交叉韧带(posterior cruciate ligament,PCL)术提供的膝关节胫骨后移刚度和强度,为手术后康复计划的制定提供依据。方法:对正常和挤压螺钉固定自体B-PT-B移植重建PCL术后等状态的新鲜尸体标本,进行膝关节屈曲15°。30°、90°位胫骨后移刚度和屈膝90°位胫骨后移强度测试。结果:挤压螺钉固定自体B-PT-B移植重建PCL术后,各膝关节屈曲角度时胫骨后移刚度明显大于正常状态,以90°时最为明显;胫骨后移强度则明显小于正常状态,约为其25％。结论:挤压螺钉固定自体B-PT-B移植重建PCL术后早期不宜负重,功能锻炼膝关节屈曲不超过90°。     

Guo绳肌腱结嵌压固定法重建交叉韧带的临床应用与生物力学研究

目的探讨Guo绳肌腱结嵌压固定法重建交叉韧带的可行性。方法对52例陈旧性前、后交叉韧带损伤患者在关节镜下行双股Guo绳肌腱中间打结，嵌入瓶颈状股骨隧道内固定，胫骨端采用肌腱编织缝合在骨桥上打结固定，重建交叉韧带。其中前交叉韧带25例，前、后十字韧带同时重建15例，后交叉韧带12例。生物力学实验采用猪膝关节。股骨端固定分为肌腱结嵌入组(n=13)和骨-髌腱-骨(B-PT-B)介面螺钉固定组(B-PT-B介面钉组，n=11)。胫骨端固定分为肌腱编织缝合线在骨桥打结组(n=7)、肌腱编织缝合介面螺钉组(n=8)。进行最大拔出强度、最大位移和固定刚度等力学实验。结果术后随访49例，平均14．6个月，Lanchman试验阴性46例，阳性3例。术后Lysholm评分由术前56．7分提高到92．8分。按膝关节疗效评定标准，优46例，良3例。生物力学实验最大拔出强度：肌腱结嵌入组高于B-PT-B介面钉组；固定刚度肌腱结嵌入组小于B-PT-B介面钉组；最大位移肌腱结嵌入组大于B-PT-B介面钉组。胫骨端固定抗拉强度和刚度骨桥打结组优于介面螺钉组。结论Guo绳肌腱结嵌压固定重建交叉韧带生物力学抗拉强度能满足生理需求，方法可行；可克服位移因素，降低韧带松弛率，提高疗效。     

膝十字韧带移植重建术中韧带末端缝合固定的生物力学研究及临床应用

目的研究膝十字韧带移植重建术中韧带末端缝合固定的方法及固定强度。方法将24条带髌骨的髌韧带标本分为3组,对其末端分别采用Krackow双锁边缝合法缝合2针、3针,缝合材料为Ethilon缝线及直径0.4mm钢丝,对样本分别进行拉伸力学检测以比较强度,探讨最佳的缝合针数和方法并应用于临床。结果Krackow双锁边缝合法缝合2针,缝合点固定强度超过钢丝材料的破坏强度;用缝线缝合2针的强度达到80N以上,超过缝线材料的破坏强度;将第一针贯穿韧带缝合,不降低固定强度。根据实验结果,将改良的Krackow双锁边缝合法临床应用17例,加速了术后早期康复,取得良好效果。结论Krackow双锁边缝合法缝合2针或3针的固定强度差别不大,差异无显著性意义,第一针贯穿韧带,可减少缝线裸露但不降低固定强度,均超过缝合材料破坏强度。若想增加固定强度,应从改进缝合材料强度和增加缝线数目着手,此缝合法临床应用可加速康复,固定可靠。     

肌腱结嵌压固定法重建前交叉韧带生物力学实验研究

目的探讨绳肌腱结嵌压固定法重建前交叉韧带(ACL)影响初始固定效果的相关因素及对策。方法采用猪膝关节模拟重建ACL不同术式,即绳肌腱结股骨隧道嵌压固定和胫骨端肌腱编织缝合骨桥打结固定法,与骨-髌腱-骨两端界面螺钉固定法,比较其生物力学初始固定最大拔出载荷、抗拉刚度和位移等生物力学指标。结果最大抗拉载荷肌腱结组与正常ACL组接近,无显著性差异;肌腱结组大于骨-髌腱-骨界面螺钉固定组。抗拉载荷在100N和400N时的位移两组无显著性差异。胫骨端肌腱编织缝合骨桥上打结固定组最大抗拉载荷大于BPTB界面螺钉固定组和肌腱编织缝合后界面螺钉固定组。抗拉刚度正常ACL组>骨-髌腱-骨组>绳肌腱结组。最大位移正常ACL<髌腱骨组<肌腱结组。结论绳肌腱结嵌压固定法抗拉强度和刚度完全可以满足重建后ACL的生理需求;术中克服位移因素,是有效防止ACL重建术后松弛的关键。     

镁铝合金界面螺钉骨腱固定重建前交叉韧带的实验研究——猪胫骨骨腱固定的生物力学分析

目的探讨镁铝合金界面螺钉固定对骨-腱-骨重建的前交叉韧带(ACL)的初始力学特性。方法在20个猪的胫骨标本应用骨-髌腱进行ACL重建。按不同材料制成的界面螺钉分成3组:镁铝合金组8个标本、钛合金组和聚乳酸组各6个标本。在MTS机进行疲劳(1000次25~150N循环)及最大负荷试验。结果所有界面螺钉固定的骨-髌腱均能顺利完成循环负载。疲劳试验前后镁铝合金、钛合金和聚乳酸界面螺钉固定的复合体伸长度分别为(1.71±0.37)mm,(2.14±0.92)mm和(1.36±0.58)mm,各组间没有显著性差别(P=0.135);抗拉刚度分别为(121.01±28.94)N/mm、(92.64±11.52)N/mm和(119.93±26.55)N/mm,各组间没有显著性差别(P=0.091);最大载荷分别为(522.68±82.87)N、(441.22±86.30)N和(674.10±191.12)N,各组间具有显著性差别(P=0.016)。所有失效方式为2种,即韧带在体部的断裂和骨块从隧道中滑出,3种材料界面螺钉的失效方式无显著性差别(P=0.513)。结论镁铝合金界面螺钉固定对骨-腱-骨重建的前交叉韧带的初始力学强度能达到临床要求。     

关节镜下3种移植物重建膝关节前交叉韧带的临床效果

目的 应用自体骨-1/3髌腱-骨(B-PT-B)、异体腘绳肌腱(ST/G)和LARS韧带进行关节镜下重建前交叉韧带(ACL),比较不同移植物的临床疗效.方法 选择3种不同移植物分别对92例ACL损伤患者行关节镜下重建ACL,术后积极康复锻炼.结果 各组膝关节Lysholm评分在术后3、9、18个月均较术前改善.异体ST/G组术后3个月Lysholm评分低于另外两组(P＜0.05),术后9、18个月与自体B-PT-B组比较差异无统计学意义(P＞0.05).术后3、9、18个月LARS组Lysholm评分明显高于另外两组(P＜0.05).结论 3种不同移植物均能明显改善膝关节功能,近期LARS韧带改善优于自体B-PT-B和异体ST/G.     

Endobutton固定新技术在异体B-PT-B重建ACL手术中的应用

目的 探讨膝前交叉韧带(ACL)重建中骨-腱-骨(B-PT-B)移植物股骨端用Endobutton进行有效、快速内固定物的技术.方法 对15例膝ACL断裂(均为单侧完全断裂),应用异体B-PT-B重建ACL,股骨端应用Endobutton内固定,胫骨骨栓应用可吸收挤压螺钉固定.结果 术后膝关节前抽屉试验、轴移试验和La...     

急性完全性前交叉韧带损伤的膝关节镜下早期重建治疗

目的　探讨膝关节镜下对急性完全性前交叉韧带 (ACL)断裂的早期重建治疗 ,以尽早恢复膝关节稳定性。　方法　ACL急性断裂早期在关节镜下应用挤压螺钉固定骨 髌腱 (中 1/ 3) 骨复合体自体移植重建ACL ,止点重建或缝合修复治疗内侧副韧带断裂。　结果　 1998年 2月～ 1999年 3月共治疗急性完全性ACL断裂合并内侧副韧带断列患者 10例 ,术后平均随访 10个月 ,近期效果良好。　结论　急性ACL损伤早期可以在关节镜下完成重建 ,手术创伤小 ,治疗及时 ,可同时处理合并损伤 ,能早期恢复膝关节稳定性和运动功能。     

关节镜下骨-髌腱-骨移植物重建前交叉韧带

目的探讨关节镜下挤压螺钉固定骨-髌腱-骨(BPB)移植重建前交叉韧带(ACL)的临床疗效。方法2003年4月～2004年7月,关节镜下界面螺钉固定BPB移植重建ACL41例。术中取髌韧带偏内切口,修整预张切取的BPB,建立骨隧道,界面螺钉屈膝45°固定植入BPB两端骨块,同时处理合并伤,术后早期功能锻炼。结果随访4～14个月,平均7个月。术前改良Lysholm评分(55.3±7.5)分,术后改良Lysholm评分(90.5±6.5)分,与术前相比差异有显著性(P<0.05)。按改良Lysholm评分标准,优28例,良13例,优良率100%。结论关节镜下界面螺钉固定BPB移植重建ACL是一种疗效可靠的方法。     

腘绳肌腱结嵌压固定法重建交叉韧带的临床应用与生物力学研究

目的探讨腘绳肌腱结嵌压固定法重建交叉韧带的可行性。方法对52例陈旧性前、后交叉韧带损伤患者在关节镜下行双股腘绳肌腱中间打结,嵌入瓶颈状股骨隧道内固定,胫骨端采用肌腱编织缝合在骨桥上打结固定,重建交叉韧带。其中前交叉韧带25例,前、后十字韧带同时重建15例,后交叉韧带12例。生物力学实验采用猪膝关节。股骨端固定分为肌腱结嵌入组(n=13)和骨髌腱骨(B PT B)介面螺钉固定组(B PT B介面钉组,n=11)。胫骨端固定分为肌腱编织缝合线在骨桥打结组(n=7)、肌腱编织缝合介面螺钉组(n=8)。进行最大拔出强度、最大位移和固定刚度等力学实验。结果术后随访49例,平均14 6个月,Lanchman试验阴性46例,阳性3例。术后Lysholm评分由术前56 7分提高到92 8分。按膝关节疗效评定标准,优46例,良3例。生物力学实验最大拔出强度肌腱结嵌入组高于B PT B介面钉组;固定刚度肌腱结嵌入组小于B PT B介面钉组;最大位移肌腱结嵌入组大于B PT B介面钉组。胫骨端固定抗拉强度和刚度骨桥打结组优于介面螺钉组。结论腘绳肌腱结嵌压固定重建交叉韧带生物力学抗拉强度能满足生理需求,方法可行;可克服位移因素,降低韧带松弛率,提高疗效。     

前十字韧带重建中的移植物位置偏移

目的 计算可吸收界面螺钉导致的移植物偏离隧道位移,探讨其对前十字韧带重建产生的影响.方法 19个新鲜尸体膝关节标本,随机选取5个,采用7 mm、8 mm、9 mm界面螺钉固定自体肌腱,测定偏移距离.另外14个膝关节分为等长组和解剖组,等长组膝关节测量界面螺钉固定后及校正位置的移植物拉长距离;解剖组膝关节于膝关节生物力学测试仪上分别测定ACL完整组、ACL缺失组、偏移组和校正组在134 N前向负荷下膝关节屈曲0°、15°、30°、60°和90°位的胫骨前向位移.结果 (1)肌腱偏移:直径7mm、8 mm、9mm的界面螺钉分别使移植物偏移(2.36±0.11)mm、(2.72±0.06)mm、(3.00±0.06)mm.(2)等长性:初始拉长小于3 mm,偏移拉长大于3 mm,校正拉长小于3 mm.(3)生物力学:屈膝0°、15°位,ACL完整组与偏移组、校正组差异无统计学意义.屈膝30°、60°、90°位ACL完整组与其他各组比较差异均有统计学意义,屈膝30°、60°位偏移组与校正组比较差异有统计学意义.结论 无论等长重建还是解剖重建,界面螺钉均影响移植物的股骨隧道口位置.前十字韧带重建预先校正股骨隧道口位置,移植物基本会处于预先的理想位置.

Abstract：

Objective To investigate the impact of graft position shift on anterior cruciate ligament reconstruction induced by femoral fixation of interference screw. Methods Nineteen fresh cadaveric knees were used and assigned to three groups. 1) Study of graft position shift: 5 knees were randomly selected, interference screws of 7 mm, 8 mm and 9 mm were used in autologous tendon fixation, then the graft position shift were measured. 2) Study of isometry: 7 knees were randomly divided into the isometric reconstruction group (D group). In the D group, Retrobutton, interference screw and interference screw in location-corrected bone tunnel were used respectively as fixation. The isometry of grafts was evaluated. 3) Study of tibia anterior translation: 7 knees were randomly divided into the anatomic reconstruction group (J group). In the J group,the tibia anterior translation was measured in four different conditions in the same joint: intact knee joint,knee joint without ACL, ACL anatomic reconstruction by interference screw fixation, and ACL anatomic reconstruction by interference screw fixation with corrected bone tunnel location. Results 1) With 7 mm, 8mm and 9 mm interference screw fixation, graft position shift were (2.36±0.11) mm, (2.72±0.06) mm and (3.00±0.06) mm respectively. 2) Graft length change: graft length change in Retrobutton group and corrected bone tunnel group were less than 3 mm, while graft length change in those fixed with interference screw were stretched in more than 3 mm. 3) Study of tibia anterior translation: there was no difference among the intact group, the anatomic group and the corrected group at 0° and 15°. However, the difference was found between the intact group and other groups at 30°、60° and 90° of flexion, as well as between these two reconstructed methods at 20° joint flexion (P＜0.05). Conclusion In both isometric and anatomic ACL reconstruction with interference screw, the graft is pushed tightly toward the femoral tunnel wall, which shifts the graft away from the desired position. In our study we find out that the corrected location of the femoral bone tunnel significantly improves the isometry of ACL reconstruction and anatomic reconstruction.     

Current practice variations in the management of anterior cruciate ligament injuries in Croatia

AIM: To investigate current preferences and opinions on the diagnosis, treatment and rehabilitation of patients with anterior cruciate ligament (ACL) injury in Croatia.METHODS: The survey was conducted using a questionnaire which was sent by e-mail to all 189 members of the Croatian Orthopaedic and Traumatology Association. Only respondents who had performed at least one ACL reconstruction during 2011 were asked to fill out the questionnaire.RESULTS: Thirty nine surgeons responded to the survey. Nearly all participants (95%) used semitendinosus/gracilis tendon autograft for reconstruction and only 5% used bone-patellar tendon-bone autograft. No other graft type had been used. The accessory anteromedial portal was preferred over the transtibial approach (67% vs 33%). Suspensory fixation was the most common graft fixation method (62%) for the femoral side, followed by the cross-pin (33%) and bioabsorbable interference screw (5%). Almost all respondents (97%) used a bioabsorbable interference screw for tibial side graft fixation.CONCLUSION: The results show that ACL reconstruction surgery in Croatia is in step with the recommendations from latest world literature.     

Comparison of bone-patellar tendon-bone interference screw fixation and hamstring transfemoral screw fixation in anterior cruciate ligament reconstruction.

While bone-patellar tendon-bone (BPTB) interference screw anterior cruciate ligament (ACL) reconstruction is a biomechanically sound construct, alternative techniques have been developed secondary to potential donor site morbidity. This study evaluates a system designed to address this problem that involves a transfemoral screw fixation device and stapling of hamstring tendons. Seven pairs of cadaveric knees underwent ACL reconstruction using either BPTB interference screw technique or semitendinosus gracilis (STG) transfemoral screw fixation and stapling. Tensile testing was performed. There was no significant difference between the two fixation types with regard to stiffness, maximum load to failure, elongation, energy to failure and yield load, displacement, and energy.     

The comparison of functional results of anterior cruciate ligament injuries treated with semitendinosus tendon and central one-third of patellar tendon autografts

The results of ACL reconstructions with autologus grafts taken from semitendinosus tendon and patellar ligament are presented. There were 78 patients in four groups. Patient age ranged from 15 to 47 years. The period of observation varied from 1 to 10 years, average 3.5. The first group consisted of 28 people treated with single semitendinosus tendon graft. In the second group there were 12 patients with acute ACL injuries treated by reinsertion of torn ligament attachment augmented by semitendinosus tendon. The third group of 18 persons had an ACL reconstruction with central one-third of patellar ligament fastened with thread loops on bone screws or staples. The last group of 20 patients had ACL reconstruction with central one-third of patellar ligament autograft. All patients were prospectively evaluated according to the Hospital for Special Surgery and the Lysholm and Gillquist scales. The statistical analysis clearly reveals the best results in the fourth group of patients, who had graft fixation with interference screws. Received: 4 April 2001/Accepted: 23 April 2001     

Biomechanical comparisons of anterior cruciate ligament: reconstruction procedures with flexor tendon graft

An experimental study was conducted to compare the biomechanical characteristics of six currently available anterior cruciate ligament (ACL) reconstruction procedures with flexor digitorum profundus tendons. Forty porcine knees were divided into eight groups, of 5 knees each. In groups A, B, C, and D, the flexor tendon graft was fixed with sutures and an Endobutton, with 20-mm-wide polyester tapes and staples, with 10-mm-wide polyester tapes and an Endobutton, and with bone plugs and interference screws, respectively. In group E, the graft was fixed using a combined procedure of those in groups B and D. In group F, the graft was directly fixed with interference screws. In groups G and H, the bone-patellar tendon-bone graft was fixed with interference screws, and sutures, respectively. Each femur-graft-tibia complex specimen was tested with a tensile tester by anteriorly translating the tibia until failure. This study demonstrated that the biomechanical properties of the femur-graft-tibia complex reconstructed with the flexor tendon graft were significantly affected by synthetic fixation devices. Regarding the average maximal load of the groups with the flexor tendon graft, group B had the highest (893 N) and group C had the second highest (770 N). Groups E and A were in the third rank. Group F had the second lowest (312 N), and Group D had the lowest (230 N). The maximal load of group B was significantly greater (P < 0.01) than that of group G (656 N) with the bone-patellar tendon-bone grafts. As to clinical relevance, this study indicated that the flexor tendon graft can be an alternative substitute for the bone-patellar tendon-bone graft for ACL reconstruction, if we understand the biomechanical characteristics of each reconstruction procedure. Received: January 21, 2000 / Accepted: June 8, 2000     

关节镜下同种异体髌韧带重建膝关节内韧带损伤的临床研究

目的探讨关节镜下异体髌韧带重建膝关节内韧带损伤的治疗效果。方法应用异体髌韧带重建膝关节内韧带损伤33例。其中单纯前交叉韧带损伤20例;单纯后交叉韧带损伤6例;同时损伤6例;部分损伤1例。结果本组全部得到随访。前抽屉试验阳性:术前27膝,术后2膝。后抽屉试验阳性:术前12膝,术后2膝。Lachman征阳性:术前26膝,术后2膝。全部患者主动屈曲达全范围为6～18周,平均12周。Lysholm评分单纯前交叉韧带组术前平均48.6分,术后89.5分,优良率95%。单纯后交叉韧带组术前平均35.8分,术后81.2分,优良率83%。前后交叉韧带组术前平均26.7分,术后69.1分,优良率83%。结论关节镜下异体髌韧带重建膝关节内损伤韧带是治疗膝关节内韧带损伤的有效方法。     

关节镜下前十字韧带重建术术中失误原因的分析与对策

目的 回顾性分析前十字韧带(anterior cnltiale ligament，AcL）重建术中的各种失误并提出解决办法．为临床治疗提供参考．方法 自1995年1月～2002年6月对194例陈旧性ACL损伤患者行关节镜下ACL重建术。固定方法包括88例Kurosaka挤压螺钉固定和106例Aesculap内扣式缝线钢板固定．其中86例使用自体中1/3骨-髌韧带-骨移植．19例应用异体髌韧带移植．89例为自体半腱肌腱与股薄肌腱移植。结果 36例发生术中失误．其中2例不可挽救。术中失误的原因可分为隧道问题，移植物问题、固定问题等。术中最常见的失误是导针位置和方向不佳．与移植物和固定方式选择无关。Aesculap内扣式缝线钢板法固定自体半腱肌腱与股薄肌腱修复ACL时最常遇到的问题是取下的移植物过短或分叉。结论 只有掌握各种ACL重建方法的操作要点并加以灵活运用才能减少和正确处理各种术中失误。     

影响前交叉韧带重建术疗效因素的临床研究

目的比较前交叉韧带重建的不同手术时机以及是否合并关节内损伤等因素对临床疗效的影响。方法选择前交叉韧带重建手术病例79例进行临床随访。根据手术距受伤时间不同分组,分析组间合并损伤情况。根据是否合并半月板或内侧副韧带损伤分组,分析各组间手术前后膝关节功能的差别。结果术后Lysholm评分与Tegner分级均明显提高,髌前疼痛发生率15.15%,早期手术组合并内侧副韧带损伤发生率较高（P〈0.05）,早期与晚期手术的半月板损伤发生率无统计学差异。不同手术时期术后Lysholm评分和Tegner分级无显著性差异（P〉0.05）。合并半月板损伤或内侧副韧带损伤对临床结果的统计分析,两者均无显著性差异。结论不同手术时机短期内未造成临床结果差异。建议早期重建前交叉韧带,同时对合并的侧副韧带和半月板损伤进行处理,以保护关节软骨,重建膝关节稳定性。     

三种不同移植物重建前交叉韧带的疗效分析

目的 观察及比较关节镜下自体四股半腱肌肌腱、深低温同种异体骨-腱-骨(B-PT-B)复合体、LARS人工韧带重建膝前交叉韧带(ACL)的临床疗效.方法 对55例膝ACL断裂患者行关节镜下ACL重建术,根据重建ACL的材料来源分为自体四股半腱肌肌腱组(20例)、深低温同种异体B-PT-B复合体组(20例)、LABS人工韧带组(15例),并对3组在股四头肌肌力、关节稳定性、Lysholm膝关节功能评分等方面进行对比研究.结果 术后3个月股四头肌肌力恢复情况:LARS人工韧带组较自体组、异体组恢复快,而自体组与异体组无明显差异;术后3个月膝关节稳定性:LARS人工韧带组较自体组、异体组好,自体组与异体组无明显差异,Lysholm评分:自体组(86.3±4.1)分与异体组(88.6±3.8)分无明显差异,但LARS人工韧带组(95.4±4.2)分明显高于前2组(P＜0.05).术后12个月,3组股四头肌肌力恢复情况、膝关节稳定性、功能评分差异无统计学意义(P＞0.05).结论 关节镜下同种异体韧带、LAPS人工韧带重建膝ACL疗效满意,可作为自体材料的良好替代物,但患者所承担费用较高;LARS人工韧带可在术后早期进行膝关节功能活动.