• 医学文献
  • 知识库
  • 评价分析
  • 全部
  • 中外期刊
  • 学位
  • 会议
  • 专利
  • 成果
  • 标准
  • 法规
  • 临床诊疗知识库
  • 中医药知识库
  • 机构
  • 作者
热搜词:
换一批
论文 期刊
取消
高级检索

检索历史 清除

医学文献 >>
  • 全部
  • 中外期刊
  • 学位
  • 会议
  • 专利
  • 成果
  • 标准
  • 法规
知识库 >>
  • 临床诊疗知识库
  • 中医药知识库
评价分析 >>
  • 机构
  • 作者
热搜词:
换一批

腘绳肌腱移植股骨与胫骨端可吸收横钉固定法重建前交叉韧带

RIGIDfixTM tibial and femur cross pin system used for hamstring grafted anterior cruciate ligament reconstruction

摘要:

目的 探讨腘绳肌腱移植股骨与胫骨端Rigid Fix固定重建前交叉韧带的疗效.方法 交叉韧带损伤32例,男18例,女14例.平均年龄28岁(20~45岁),运动损伤24例,交通伤8例.受伤到手术时间平均3.6个月(2.5~6个月).术前均行膝关节MRI和X线检查.关节镜检查发现ACL在股骨止点断裂19例,胫骨止点13例,合并内侧半月板损伤3例,股骨内侧软骨损伤4例.取自体半腱肌腱和股薄肌腱移植,肌腱预张力后编织缝合为5股18例,4股14例.肌腱直径为7~8 mm.在胫骨髁间定位并建立胫骨隧道,于股骨髁间窝10:30~11:00点处定位,打入导针并钻取股骨隧道,深度30 mm.在Rigid Fix导向器的引导下,钻取股骨横钉孔,并留置2枚导管.将导向杆顶置入胫骨隧道内口平软骨下骨,钻取胫骨横钉孔,留置导管2枚.将肌腱牵入骨隧道,由近向远分别击入股骨端横钉2枚.伸直膝关节拉紧肌腱击入胫骨端横钉2枚,肌腱尾端缝线在胫骨骨桥上打结固定.结果 术后随访平均16个月,膝关节稳定,功能良好.Lysholm功能评分,术前平均62.5分,终末随访平均达94.5分,术后提高32分.Rulermetr测试胫骨位移<2 mm 28例,4 mm 4例;Lachman试验阴性30例,弱阳性2例.按膝关节疗效评定标准,优30例,良2例.结论 腘绳肌腱移植股骨与胫骨端均采用Rigid Fix横钉固定重建ACL,避免了肌腱切割和隧道扩大,肌腱与隧道全方位紧密接触,有利于腱骨愈合,方法可行.

更多
abstracts:

Objective To evaluate the curative effect of RIGIDfixTM tibial and femur cross pin system used for hamstring grafted reconstruction of anterior cruciate ligament (ACL) in arthroscopy. Methods Thirty two cases with ACL ruptures were reconstructed arthroscopically with hamstring grafts and the grafts fixed with RIGIDfix cross-pin on both femoral and tibial sides. They included 18 males and 14 females with a mean age of 28 (20-45) years old; the mean time from injury to operation was 3.6 (2.5-6) months. And each knee was checked by MRI and X-ray preoperatively. Through arthroscopy, we found 19 ACL ruptured from femoral attachment point, 13 from tibiat point, 3 cases combined with medial meniscus injury and 4 cases with articular cartilage injury of medial femoral condyle.After semitendinosus or gracilis harvesting, the hamstring grafts were pre-tensioned and woven, the diameter of 4 or 5 strands grafts was 7-8 mm. To position and drill tibial tunnel on ACL stump of tibial crest, and to drill femoral tunnel at 10:00 to 11 o'clock of femoral intercondylar fossa transtibial with knee flexed to 90 degree, the depth of femoral tunnel was 30 mm. The RIGIDfix guide was inserted through tibial tunnel up into the femoral tunnel to drill the sleeve and interlocking Trocar across the lateral femur and keep the two sleeves fixed to the lateral femur. Insert RIGIDfix guide into the tibial tunnel, keeping the top of guide 2-3 mm beneath the endostoma of tibial tunnel, drill the sleeve and interlocking Trocar across the lateral tibia and keep the two sleeve fixed to the lateral tibia. The graft was pulled into the tunnel (the 30 mm mark on the graft should be at the edge of femoral hole) to insert the RIGIDfix cross pins from femoral tunnel to tibial tunnel, while inserting the second, third, fourth cross pin, the graft should be kept under tension. Then a knot was tied through tibial bony bridge using the Enthibend thread switched to the end of tendon grafts. We finally observed the tension of tendon grafts and the impingement of fossa intercondylica under arthroscopy.Results With a 16-month follow-up evaluation, all of the patients' injured knees were stable and the average Lysholm knee score increased from 62.5 to 94.5. Rulermetr device values were less than 2 mm of sagittal displacement in 28 patients and 4 mm in 4. Postoperative Lachman was negative in 30 patients and weakly positive in 2. According to the IKI)C scores, 30 patients reported normal function, 2 reported nearly normal function and none reported abnormal or severely abnormal function. Conclusion The grafting method of fixing both femur and tibia sides with absorbable cross pins is feasible. In this way, the graft is stabilized to allow for reconstruction. A surgeon should refrain from dissecting the tendon and enlarging the tunnel so as to promote the healing of tendon and bone.

More
作者: 刘玉杰 [1] 李海峰 [1] 王俊良 [1] 王志刚 [1] 李众利 [1] 魏民 [1] 蔡谞 [1] 朱娟丽 [1]
期刊: 《中华医学杂志》2009年89卷29期 2034-2037页 MEDLINEISTICPKUCSCD
分类号: R6
栏目名称: 关节镜微创骨科手术
DOI: 10.3760/cma.j.issn.0376-2491.2009.29.005
发布时间: 2009-10-16
基金项目:
国家科技支撑计划
  • 浏览:287
  • 下载:236

加载中!

相似文献

  • 中文期刊
  • 外文期刊
  • 学位论文
  • 会议论文

加载中!

加载中!

加载中!

加载中!

扩展文献

特别提示:本网站仅提供医学学术资源服务,不销售任何药品和器械,有关药品和器械的销售信息,请查阅其他网站。

  • 客服热线:4000-115-888 转3 (周一至周五:8:00至17:00)

  • |
  • 客服邮箱:yiyao@wanfangdata.com.cn

  • 违法和不良信息举报电话:4000-115-888,举报邮箱:problem@wanfangdata.com.cn,举报专区

官方微信
万方医学小程序
new翻译 充值 订阅 收藏 移动端

官方微信

万方医学小程序

使用
帮助
Alternate Text
调查问卷