Strobel M J, Schulz M S
Orthopädische Gemeinschaftspraxis, Hebbelstrasse 14a, 94315 Straubing.
Orthopade. 2002 Aug;31(8):758-69. doi: 10.1007/s00132-002-0382-1.
ACL reconstruction using autogenous semitendinosus and gracilis tendons has become more popular in the past, mainly because of less frequent donor site morbidity and a high level of patient acceptance. Numerous tibial and femoral fixation techniques have been described, which differ considerably with respect to the site of fixation (cortical, tunnel, near the joint line) and biomechanical parameters. Most commonly used femoral fixation techniques include fixation buttons (EndoButton), interference screws (titanium or biodegradable), or transfixation techniques. For tibial fixation, biodegradable interference screws, often in combination with a tibial fixation button or a suture over a bone bridge, are used most commonly. Each fixation technique has specific disadvantages, which cannot be completely overcome even with a precise operative procedure. Therefore, combined fixation techniques (hybrid fixation) have been developed to enhance biological healing of the graft while simultaneously providing sufficient initial mechanical strength. Furthermore, an atraumatic graft harvest and preparation depending on the desired fixation technique is essential. Most fixation techniques exhibit less initial mechanical strength compared to bone-tendon-bone grafts, which should be considered in a moderate rehabilitation program.
过去，使用自体半腱肌和股薄肌腱进行前交叉韧带重建越来越普遍，主要是因为供区并发症较少且患者接受度高。已经描述了许多胫骨和股骨固定技术，这些技术在固定部位（皮质、隧道、关节线附近）和生物力学参数方面有很大差异。最常用的股骨固定技术包括固定纽扣（EndoButton）、挤压螺钉（钛合金或可生物降解的）或贯穿固定技术。对于胫骨固定，最常用的是可生物降解的挤压螺钉，通常与胫骨固定纽扣或骨桥上的缝线联合使用。每种固定技术都有特定的缺点，即使手术操作精确也无法完全克服。因此，已经开发出联合固定技术（混合固定），以促进移植物的生物愈合，同时提供足够的初始机械强度。此外，根据所需的固定技术进行无创的移植物获取和制备至关重要。与骨-肌腱-骨移植物相比，大多数固定技术的初始机械强度较低，在适度的康复计划中应予以考虑。
