中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (18): 2878-2883.doi: 10.12307/2023.397

• 骨科植入物 orthopedic implant • 上一篇    下一篇

关节镜下双袢钛板悬吊重建膝关节前交叉韧带的稳定性

吴铭杰,李  亮,张晓强,罗志平,吴家昌,桑宏勋   

  1. 南方医科大学深圳医院骨科中心,广东省深圳市   518101
  • 收稿日期:2022-06-22 接受日期:2022-07-25 出版日期:2023-06-28 发布日期:2022-09-17
  • 通讯作者: 桑宏勋,博士,教授,主任医师,博士生导师,南方医科大学深圳医院骨科中心,广东省深圳市 518101
  • 作者简介:吴铭杰,男,1985年生,2011年广东医科大学毕业,主治医师,主要从事数字骨科、创伤与关节外科专业的研究。
  • 基金资助:
    国家自然科学基金面上项目(81871767),项目负责人:桑宏勋;深圳市基础研究重点项目(JCYJ20200109150641992),项目负责人:桑宏勋;深圳市科创委深港联合资助项目A类(SGDX20201103095600002),项目负责人:桑宏勋;广东省医学科研基金项目(B2021174),项目负责人:吴铭杰;深圳市宝安区基础研究(医疗卫生类)项目(2021JD237),项目负责人:吴铭杰

Stability of anterior cruciate ligament reconstructed by double-loop titanium plate suspension under arthroscopy

Wu Mingjie, Li Liang, Zhang Xiaoqiang, Luo Zhiping, Wu Jiachang, Sang Hongxun   

  1. Department of Orthopedics, Shenzhen Hospital, Southern Medical University, Shenzhen 518101, Guangdong Province, China
  • Received:2022-06-22 Accepted:2022-07-25 Online:2023-06-28 Published:2022-09-17
  • Contact: Sang Hongxun, MD, Professor, Chief physician, Doctoral supervisor, Department of Orthopedics, Shenzhen Hospital, Southern Medical University, Shenzhen 518101, Guangdong Province, China
  • About author:Wu Mingjie, Attending physician, Department of Orthopedics, Shenzhen Hospital, Southern Medical University, Shenzhen 518101, Guangdong Province, China
  • Supported by:
    National Natural Science Foundation of China (General Program), No. 81871767 (to SHX); Shenzhen Key Basic Research Project, No. JCYJ20200109150641992 (to SHX); Shenzhen-Hong Kong Joint Funding Project of Shenzhen Science and Technology Commission Category A, No. SGDX20201103095600002 (to SHX); Guangdong Medical Research Fund Project, No. B2021174 (to WMJ); Shenzhen Baoan District Basic Research (Medical and Health) Project, No. 2021JD237 (to WMJ)

摘要:

文题释义:
悬吊钛板:通过特制钛板和高强线环以悬吊方式将移植物进行固定的装置,称之为悬吊钛板,由钛板、缝线及线圈组成,适用于骨科重建术中韧带与肌腱或骨的固定。
全内双袢钛板重建技术:即利用一种可翻转的逆行倒打钻由内向外建立胫骨和股骨隧道,将编织后的肌腱两端分别用带袢钛板固定,经牵引线牵引后将肌腱移植物拉入骨隧道中,利用带袢钛板收紧线收紧肌腱,使胫骨、股骨两端带袢钛板分别悬吊于胫骨、股骨两端骨皮质。

背景:前交叉韧带断裂的患者多数需通过手术重建膝关节稳定性,但在重建过程中骨道的定位、移植物选择及固定方法等方面仍存在争议。
目的:探讨双袢钛板悬吊全内技术重建前交叉韧带的安全性及疗效。
方法:回顾分析2019年1月至2021年5月接受关节镜自体肌腱前交叉韧带重建65例患者的临床资料,根据手术方式分为2组:双悬吊组30例自体移植肌腱只取半腱肌腱,进行全内技术双袢钛板悬吊重建前交叉韧带;常规手术组35例自体移植肌腱取半腱肌腱及股薄肌腱,采用胫骨护套及胫骨可吸收锥形螺钉固定。比较两组患者手术时长、编织后移植肌腱长度及直径;术后目测类比评分及膝关节稳定性(KT2000);膝关节功能评分:国际膝关节文献委员会 (IKDC)膝关节评估表评分、Lysholm评分、Tegner评分;围术期相关并发症等指标。
结果与结论:①两组患者手术时长、围术期目测类比评分、膝关节功能评分及稳定性测定比较差异均无显著性意义(P > 0.05);②常规手术组肌腱编织后移植物长度及直径均大于双悬吊组(P < 0.05);③结果说明,关节镜下全内技术双袢钛板悬吊重建前交叉韧带能获得与常规手术组一样的功能及膝关节稳定性,且双悬吊组保留股薄肌功能,保留胫骨更多骨量,临床应用安全有效。

https://orcid.org/0000-0001-7600-1323 (吴铭杰)

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程

关键词: 关节镜下, 前交叉韧带重建, 全内技术, 肌腱移植

Abstract: BACKGROUND: Most patients with anterior cruciate ligament fracture need surgical reconstruction of knee stability, but there are still controversies in the location of bone canal, graft selection and fixation method during reconstruction.  
OBJECTIVE: To investigate the safety and efficacy of double suspension titanium plate for anterior cruciate ligament reconstruction.
METHODS: The clinical data of 65 patients undergoing arthroscopic anterior cruciate ligament reconstruction with autogenous tendon from January 2019 to May 2021 were retrospectively analyzed. They were divided into two groups. In the double suspension group (n=30), only the semitendinosus tendon was obtained from the autologous tendon transplantation, and the anterior cruciate ligament was reconstructed by the whole-internal technique double-loop titanium plate suspension. In the conventional surgery group (n=35), the semitendinosus and gracilis tendons were obtained from autologous graft tendon, and fixed with tibial sheath and tibial absorbable conical screws. Operation duration, length and diameter of grafted tendon after braiding were compared between the two groups. Postoperative visual analogue scale score, knee stability (KT2000), knee function score: International Knee Documentation Committee score, Lysholm score, Tegner score; perioperative complications and other indicators were analyzed.  
RESULTS AND CONCLUSION: (1) There were no statistically significant differences in surgical duration, perioperative visual analogue scale score, knee function score and stability between the two groups (P > 0.05). (2) Graft length and diameter after tendon braiding were longer in the conventional surgery group than those in the double suspension group (P < 0.05). (3) These results suggested that reconstruction of anterior cruciate ligament by double-loop titanium plate suspension under arthroscopy can achieve the same function and stability of knee joint as that of the conventional surgery group, and the function of gracilis muscle and more tibial bone mass are retained in the double suspension group, which is safe and effective in clinical application.

Key words: arthroscopy, anterior cruciate ligament reconstruction, all-inside technique, tendon graft

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