Nagarkatti D G, McKeon B P, Donahue B S, Fulkerson J P
University of Connecticut School of Medicine, Department of Orthopaedic Surgery, Farmington, USA.
Am J Sports Med. 2001 Jan-Feb;29(1):67-71. doi: 10.1177/03635465010290011601.
In this study of bioabsorbable screw fixation of free tendon grafts used in anterior cruciate ligament reconstruction, we performed load-to-failure and cyclic loading of tendon fixation in porcine bone. Bone density measurements from dual photon absorptometry scans were obtained to correlate bone density with fixation failure. The average density of porcine bone (1.42 g/cm2) was similar to that of young human bone (1.30 g/cm2) and significantly higher than that of elderly human cadaveric bone specimens (0.30 g/cm2). Cyclic loading was performed on free tendon grafts fixed with a bioabsorbable screw alone and on grafts fixed with a bioabsorbable screw and an anchor (polylactic acid ball or cortical bone disk). Stiffness of fixation increased substantially with the addition of a cortical bone disk anchor or polylactic acid ball compared with the interference screw alone. Tensile fixation strength of central quadriceps free tendon and hamstring tendon grafts were significantly superior in porcine bone of density similar to young human bone than in elderly human cadaveric bone. The bioabsorbable interference screw yielded loads at failure comparable with traditional bone-tendon-bone and hamstring tendon fixation when controlled for bone density. The addition of a cortical bone disk anchor provided the most optimal fixation of free tendon with the bioabsorbable screw and reduced slippage with cyclic loading to a very low level.
在这项关于生物可吸收螺钉固定用于前交叉韧带重建的游离肌腱移植物的研究中，我们对猪骨中的肌腱固定进行了破坏载荷和循环加载测试。通过双能光子吸收法扫描获得骨密度测量值，以将骨密度与固定失败相关联。猪骨的平均密度（1.42克/立方厘米）与年轻人类骨的平均密度（1.30克/立方厘米）相似，且显著高于老年人类尸体骨标本的平均密度（0.30克/立方厘米）。对仅用生物可吸收螺钉固定的游离肌腱移植物以及用生物可吸收螺钉和锚（聚乳酸球或皮质骨盘）固定的移植物进行循环加载测试。与单独使用干涉螺钉相比，添加皮质骨盘锚或聚乳酸球后，固定刚度显著增加。在密度与年轻人类骨相似的猪骨中，中央股四头肌游离肌腱和腘绳肌腱移植物的拉伸固定强度明显优于老年人类尸体骨中的固定强度。当控制骨密度时，生物可吸收干涉螺钉在破坏时产生的载荷与传统骨-肌腱-骨和腘绳肌腱固定相当。添加皮质骨盘锚可实现生物可吸收螺钉对游离肌腱的最优化固定，并将循环加载时的滑动减少到非常低的水平。
