关节镜下联合应用Rigidfix、Endobutton和Intrafix系统固定腘绳肌腱重建前交叉韧带

背景:关节镜下前交叉韧带重建是治疗膝关节前交叉韧带损伤的金标准,但在肌腱的固定方式方面仍有分歧。目的:观察联合运用Rigidfix、Endobutton和Intrafix系统在关节镜下进行自体腘绳肌腱重建前交叉韧带的临床效果。方法:选取2009-05/2010-05在郑州大学第一附属医院关节外科应用Rigidfix、Endobutton和Intrafix系统行关节镜下自体腘绳肌腱重建前交叉韧带的患者30例,该组患者关节镜下均证实为膝关节前交叉韧带损伤断裂。其中男22例,女8例,年龄16~45岁。将患者股骨端用Endobutton、Rigidfix固定,胫骨端用Intrafix固定,观察术后近期疗效,以Lysholm评分、IKDC评分评价膝关节功能。结果与结论:对30例患者随访5~17个月(平均12个月),随访期间无严重并发症发生,所有患者患膝关节活动度正常,平均Lysholm评分和IKDC评分分别由术前的(50.0±6.0)分和(49.5±5.5)分提高到术后的(85.5±3.5)分和(87.0±2.5)分(P<0.05)。说明联合应用Rigidfix、Endobutton和Intrafix系统进行自体腘绳肌腱重建前交叉韧带的方法具有近期疗效佳、移植物固定可靠、并发症少等优点,能够达到良好的临床康复效果。     

Arthroscopic Direct Anterior‐to‐Posterior Suture Suspension Fixation for the Treatment of Posterior Cruciate Ligament Tibial Avulsion Fracture

ObjectivesA posterior cruciate ligament (PCL) avulsion fracture of the tibial attachment site is a specific type of PCL injury that is difficult and unpleasant to manage. The objective of this study is to report the preliminary results of a newly developed technique: arthroscopic endobutton‐suture fixation using a single tibial tunnel.MethodsFrom January 2016 to January 2018, 120 patients with PCL avulsion fracture who met our criteria were recruited. Sixty cases were treated by arthroscopic direct anterior‐to‐posterior suture suspension fixation (endobutton‐suture group), and 60 cases were treated by arthroscopic screw‐suture fixation (screw‐suture group). All radiographic studies were recorded. The curative effect was evaluated by the range of motion (ROM), KT‐2000, International Knee Documentation Committee (IKDC) scores, Tegner activity scale, and Lysholm scoring system. For statistical analysis the Student t‐test was used.ResultsThe average follow‐up duration was 24 months. Findings and difficulties in surgery are the following. The lax anterior cruciate ligament is one of the diagnostic criteria. The anatomic location of PCL avulsion fractures is deep and surrounded by nerves and vessels; thus, operating through this region is difficult. After each tunnel drilling, the debris at the edge of opening needs to be cleaned to avoid obscuring the operator''s vision or wearing the sutures. In endobutton‐suture group, ROM improved from 0° preoperatively to 140.0° ± 5.6° at the last follow‐up (P < 0.001). The postoperative KT‐2000 arthrometric data at 90 N were available for all patients. The IKDC score was 23.6 ± 2.6 and 91.4 ± 4.1 pre‐ and postoperatively, respectively. The Tegner score improved from 1.2 ± 0.6 to 7.3 ± 2.3 (p < 0.001). The median Lysholm knee score increased from 40.4 ± 5.2 preoperatively to 90.1 ± 10.1 postoperatively (p < 0.001). The operative time was shorter in the endobutton‐suture group (p < 0.001). The Lysholm knee score in the endobutton‐suture group was lower than that in the endobutton‐suture group (3.1 ± 1.2 vs. 4.2 ± 1.8, p < 0.01). No significant complications were noted in the study.ConclusionsThe arthroscopic direct anterior‐to‐posterior suture suspension fixation is a simple and reliable method that not only provides better clinical outcomes, but also fixes avulsion fragments of any size.     

关节镜下联合应用Rigidfix、Endobutton和Intrafix系统固定腘绳肌腱重建前交叉韧带

背景：关节镜下前交叉韧带重建是治疗膝关节前交叉韧带损伤的金标准,但在肌腱的固定方式方面仍有分歧。目的：观察联合运用Rigidfix、Endobutton和Intrafix系统在关节镜下进行自体腘绳肌腱重建前交叉韧带的临床效果。方法：选取2009-05/2010-05在郑州大学第一附属医院关节外科应用Rigidfix、Endobutton和Intrafix系统行关节镜下自体腘绳肌腱重建前交叉韧带的患者30例,该组患者关节镜下均证实为膝关节前交叉韧带损伤断裂。其中男22例,女8例,年龄16~45岁。将患者股骨端用Endobutton、Rigidfix固定,胫骨端用Intrafix固定,观察术后近期疗效,以Lysholm评分、IKDC评分评价膝关节功能。结果与结论：对30例患者随访5~17个月(平均12个月),随访期间无严重并发症发生,所有患者患膝关节活动度正常,平均Lysholm评分和IKDC评分分别由术前的(50.0±6.0)分和(49.5±5.5)分提高到术后的(85.5±3.5)分和(87.0±2.5)分(P < 0.05)。说明联合应用Rigidfix、Endobutton和Intrafix系统进行自体腘绳肌腱重建前交叉韧带的方法具有近期疗效佳、移植物固定可靠、并发症少等优点,能够达到良好的临床康复效果。     

Endobutton钢板结合克氏针固定治疗锁骨远端骨折

<正>2010年1月~2013年8月,笔者应用Endobutton钢板结合克氏针治疗21例锁骨远端骨折,临床疗效满意,报道如下。1材料与方法1.1病例资料本组21例,男15例,女6例,年龄26~68岁。Neer分型:Ⅰ型6例,Ⅱ型11例,Ⅲ型4例。左侧8例,右侧13例。受伤至手术时间3~10     

三重固定纽扣钢板解剖重建陈旧性Ⅲ度肩锁关节脱位

目的探讨三重固定纽扣钢板解剖重建喙锁韧带治疗陈旧性Ⅲ度肩锁关节脱位的手术方法及临床疗效。方法 2009年1月-2010年6月,对14例陈旧性Ⅲ度肩锁关节脱位行三重固定纽扣钢板解剖重建喙锁韧带治疗。男10例,女4例;年龄26～52岁,平均38.5岁。致伤原因:交通事故伤7例,摔伤5例,砸伤2例。左侧9例,右侧5例。受伤至手术时间29～75 d,平均49d。肩锁关节有不同程度压痛,关节主、被动活动明显受限,X线片示肩锁关节完全脱位。按Allman分型标准,均为Ⅲ度完全性脱位。结果术后切口均Ⅰ期愈合,无血管、神经损伤及感染等早期并发症发生。患者均获随访,随访时间13～30个月,平均18.3个月。术后1周1例患者发生复位部分丢失,X线片检查见肩锁关节半脱位,未给予特殊处理,其余患者无再脱位或其他相关并发症发生。末次随访时,根据美国肩肘外科协会(ASES)评分标准,获(90.8±4.1)分,与术前的(65.3±4.4)分比较,差异有统计学意义(t=-17.57,P=0.00);Constant-Murley评分为(91.7±3.9)分,与术前的(71.5±4.6)分比较,差异有统计学意义(t=-75.02,P=0.00)。简明肩关节功能测试问卷(SST)的肯定答案为7～12个,平均9.7个。结论三重固定纽扣钢板解剖重建喙锁韧带可有效治疗陈旧性Ⅲ度肩锁关节脱位,早期疗效满意。     

肩锁关节脱位研究：如何达到解剖复位和持续性稳定及关节微动

文题释义： 肩锁关节脱位：肩锁关节是由锁骨远端和肩峰外侧缘向内2.0-3.0 cm部分组成的微动关节,是肩胛骨活动的支点。由于肩锁关节位于皮下,易被看出局部高起,双侧对比较明显,可有局部疼痛、肿胀及压痛;伤肢外展或上举均较困难,前屈和后伸运动亦受限,局部疼痛加剧,检查时肩锁关节处可摸到一个凹陷,可摸到肩锁关节松动。 肩锁关节脱位分型：最常用的是Rockwood分型系统,其将肩锁关节脱位分为6型,其中Ⅰ、Ⅱ型多采用保守治疗,Ⅳ-Ⅵ型多采用手术治疗,Ⅲ型的治疗尚存争议。 背景：肩锁关节脱位的治疗方式繁多,尚无统一标准,其治疗效果受损伤机制、脱位类型、治疗方式的选择及术后锻炼等多方面影响。 目的：归纳总结目前肩锁关节脱位的研究进展。 方法：由第一作者用计算机检索PubMed数据库(2010至2019年),万方数据库(2010至2019年),以“Acromioclavicular;Dislocation;Diagnosis;Therapy; Anatomical reconstruction ;Endobutton;Internal Fixators”为英文检索词,“肩锁关节;脱位;诊断;治疗;解剖重建;Endobutton;骨科植入物”为中文检索词,排除重复性研究,共检索到2 187篇文献,最后保留55篇文献进行归纳总结 结果与结论：目前对于Rockwood Ⅰ、Ⅱ型肩锁关节脱位多采取保守治疗,Ⅳ-Ⅵ型多采取手术治疗,Ⅲ型的治疗尚存争议,为了最大限度地发挥功能,建议年轻和对功能要求高的患者采取积极手术治疗。目前,非手术治疗以吊带固定为主,手术治疗越来越趋向于微创解剖重建喙锁韧带,如关节镜辅助下Endobutton技术,虽能获得良好的短期疗效,但尚需大样本长期随访研究证实其在临床应用中的价值。肩锁关节脱位的治疗仍需进一步的研究,期望寻找一种既能解剖复位,获得持续性稳定,又能保证肩锁关节微动的治疗方法。 ORCID: 0000-0002-6856-190X(房燚) 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     

纽扣带袢钢板内固定治疗肩锁关节脱位短期临床疗效

目的观察纽扣带袢钢板内固定治疗肩锁关节脱位的短期临床疗效。方法采用纽扣带袢钢板内固定治疗TossyⅢ型肩锁关节脱位15例,应用2块薄型金属固定纽扣钢板,该固定装置包括2块固定纽扣钢板和2根爱昔邦缝合线。其中1块固定纽扣钢板定位于锁骨,另1块固定纽扣钢板翻转到喙骨的下表面,维持间隙的复位。结果15例术后随访10-18（12．2±1．5）个月,按Karlson肩关节评定标准对术后肩关节功能情况进行评价：优13例。良2例。结论采用纽扣带袢钢板内固定治疗肩锁关节脱位术后并发症少、可早期功能锻炼、肩关节功能恢复好、无需二次手术取钉。短期的疗效研究证明这一技术对于固定肩锁关节是一种安全、有效的方法之一。     

Efficacy of Transosseous Tunnel Placement for Triple Endobutton Plate in Acromioclavicular Joint Reconstruction: A Three‐Dimensional Printing Guide Design Technology

ObjectiveExplore an accurate transosseous tunnel drilling method based on three‐dimensional (3D) printing technology for acromioclavicular joint reconstruction (ACD), design a guide design, and evaluate its accuracy.MethodsUsing Mimics software to reconstruct 100 cases of acromioclavicular joint computed tomography (CT) data. In design 2, the non‐collinear tunnel is superimposed on the 3D model, and a virtual drilling is performed between the clavicle and the coracoid using a triple inner gusset. Then, in the Geomagic Studio software model, an elliptical plane is calculated and extracted as a guide design for precise drilling. Then put the design and the 3D shoulder model together for 3D printing. Ten lengths were measured, and the effects of the virtual model, the actual model, and the guide rail design were compared.ResultsWe successfully compared 10 parameters of 3D virtual model and actual model. There was no significant difference between actual and virtual bone tunnels in 10 measurements (P > 0.05).ConclusionsThe accuracy of ACD combined with 3D printing guidance design technology in the transosseous tunnel of adult shoulder is reliable.     

Anterior Cruciate Ligament Rehabilitation

Abstract

On November 28, 1994 this 35 year old male tore his right anterior cruciate ligament while playing basketball. The semitendinosis tendon was used as a graft for the anterior cruciate ligament. Six weeks after accelerated rehabilitation, the patient was ambulating without an assistive device and also without a knee brace for activities of daily living.     

Biomechanical analysis of endobutton versus screw fixation after Lisfranc ligament complex sectioning

BackgroundOur goal was to compare diastasis after endobutton and screw fixation after Lisfranc ligament complex sectioning.MethodsTwenty-four (12 pairs) fresh-frozen cadaveric feet were assigned to endobutton or screw fixation and loaded to 343 N. Displacement (first–second metatarsal bases) was measured in intact feet and after ligament sectioning (Lisfranc, medial–intermediate cuneiform ligaments), fixation, and 10,000 cycles.ResultsThe mean change in diastasis for endobutton and screw fixation under initial loading was 1.0 mm (95% CI, 0.2–1.9 mm) and 0.0 mm (95% CI, ?0.4 to 0.4 mm), respectively (p = 0.017). After cyclic loading, diastasis decreased (mean, ?0.7 mm, 95% CI, ?1.2 to ?0.1 mm) in the endobutton group but was unchanged in the screw group (p = 0.035).ConclusionsDiastasis after endobutton fixation was significantly greater than after screw fixation under initial loading but did not increase further after cyclic loading.