前内侧入路Rigidfix固定重建前交叉韧带损伤软骨的解剖学研究

目的 探讨国人经前内侧入路行 Rigidfix横穿钉内固定系统重建前交叉韧带(ACL)的操作过程中发生股骨关节面软骨损伤的可能性. 方法选取9具防腐成人膝关节标本,男5具,女4具;左膝6具,右膝3具,平均死亡年龄为34.8岁(26～45岁).在标本上采用Rigidfix内固定系统分别于水平位0、45°、90°模拟ACL重建术,并统计3个角度横穿钉导入口与股骨外髁关节软骨面的位置关系. 结果 Rigidfix股骨导向器位于水平位90°时,9个样本均有发生医源性软骨损伤(100%).Rigidfix股骨导向器位于水平位45°时,9个样本中有6个发生医源性软骨损伤(66.7%).Rigidfix股骨导向器位于水平位0°时,9个样本中仅有2个发生医源性软骨损伤(22.2%). 结论在使用Rigidfix 横穿钉内固定系统行前内侧入路重建ACL时,均有损伤股骨关节面软骨的危险,因此不建议Rigidfix系统经前内侧入路确定股骨隧道内口.

The risk of chondral injury during the Rigidfix femoral fixation via the anteromedial portal to reconstruct the anterior cruciate ligament

Objective To evaluate the risk of chondral injury during anterior cruciate ligament (ACL) reconstruction using a double cross-pin femoral fixation device via the anteromedial portal in Chinese cadavers. Methods Nine specimens of the knee (6 left ones and 3 right ones) were taken from 5 male and 4 female conservative cadavers of Chinese adult. The average age of the cadavers were 34.8 (26 to 45)years old. Femoral tunnel drilling and cross-pin guide insertion were performed using the Rigidfix Cross Pin device through the anteromedial portal. The ACL reconstructions were simulated at 3 entrance points of the cross-pin (0°, 45° and 90° relative to the horizontal plane) . The risks of chondral injury were statistically analyzed when the cross-pin entrance point was at the 3 different positions relative to the femoral chondral surface. Results The incidence of chondral injury was 100% when the Rigidfix cross-pin guide was at 90° relative to the horizontal plane. When the Rigidfix cross-pin guide was at 45° and 0° the incidences of chondral injury were 66. 7% and 22. 2% respectively. Conclusion Since there is always a risk of chondral injury when the Rigidfix cross-pin device is used to reconstruct ACL via the anteromedial portal, the anteromedial portal is not recommended for the ACL reconstruction using Rigidfix femoral fixation.