Lim Hong Chul, Bae Ji Hoon, Wang Joon Ho, Bae Tae Soo, Kim Cheol Woong, Hwang Jin Ho, Yoon Ji Yeol
Department of Orthopaedic Surgery, Korea University College of Medicine, Guro Hospital, Seoul, South Korea.
Arthroscopy. 2009 Mar;25(3):250-6. doi: 10.1016/j.arthro.2008.10.015. Epub 2008 Dec 18.
The purpose of this study was to evaluate the biomechanical properties of 4 different graft fixation constructs on the tibial side of the posterior cruciate ligament with reconstruction by use of an Achilles tendon graft.
Biomechanical testing of 4 different fixation techniques was performed on 20 human cadaveric tibias and Achilles tendons. Cross-pin fixation with bone blocks (group A), interference screw fixation with bone blocks (group B), cross-pin fixation of soft tissue with backup fixation (group C), and interference screw fixation of soft tissue with backup fixation (group D) were tested. The tibia-graft fixation complex was cyclically loaded between 50 N and 250 N at 1 Hz for 1,000 cycles. After cycling, the amount of graft displacement was determined by measuring the change in grip-to-grip distance. The complex was then loaded to failure at 1 mm/s, and maximum failure load, stiffness, and mode of failure were determined.
Group C had a higher maximum failure load and stiffness than groups A and B (P < .05 and P < .001, respectively) but poor results for displacement (P < .05 and P < .05, respectively). The failure modes were bone block fracture, graft laceration, or cross-pin fracture in the cross-pin groups and graft pullout in the interference screw groups.
Our study suggests that maximum failure load and stiffness of hybrid fixation for Achilles tendon graft are comparable to those of both single calcaneal bone plug fixation methods that we studied. However, tendon graft displacement was significantly greater regardless of fixation method when compared with bone plug fixation.
Hybrid fixation for soft-tissue graft on the tibial fixation site provides comparable biomechanical properties of bone-to-bone fixation.
本研究旨在评估采用跟腱移植物重建后交叉韧带时，4种不同移植物固定结构在胫骨侧的生物力学特性。
对20具人类尸体的胫骨和跟腱进行4种不同固定技术的生物力学测试。测试了带骨块的交叉销钉固定（A组）、带骨块的干涉螺钉固定（B组）、带辅助固定的软组织交叉销钉固定（C组）和带辅助固定的软组织干涉螺钉固定（D组）。胫骨-移植物固定复合体在50 N至250 N之间以1 Hz的频率循环加载1000次。循环加载后，通过测量夹具间距离的变化来确定移植物的位移量。然后将复合体以1 mm/s的速度加载至破坏，并确定最大破坏载荷、刚度和破坏模式。
C组的最大破坏载荷和刚度高于A组和B组（分别为P < .05和P < .001），但位移结果较差（分别为P < .05和P < .05）。交叉销钉组的破坏模式为骨块骨折、移植物撕裂或交叉销钉骨折，干涉螺钉组的破坏模式为移植物拔出。
我们的研究表明，跟腱移植物混合固定的最大破坏载荷和刚度与我们研究的两种单跟骨骨栓固定方法相当。然而，与骨栓固定相比，无论采用何种固定方法，肌腱移植物的位移都明显更大。
胫骨固定部位软组织移植物的混合固定提供了与骨-骨固定相当的生物力学特性。
