Fan Huaqiang, Wang Jian, Fu Yangpan, Dong Huixiang, Wang Jianxiong, Tang Cong, Huang Changming, Shi Zhanjun
Department of Orthopedic Surgery, Nanfang Hospital, Southern Medical University Guangdong 510515, China.
Department of Orthopedic Surgery, The 174th Hospital of PLA Xiamen 361003, China.
Int J Clin Exp Med. 2014 Nov 15;7(11):4597-606. eCollection 2014.
Our study aims to evaluate the safeness and feasibility that Rigid-fix cross pin system was used for hamstring graft anterior cruciate ligament (ACL) reconstruction in the tibial fixation site. In this study, eleven adult conservative cadaver knees were performed using the Rigid-fix Cross Pin device in the tibial fixation site for modeling the ACL reconstruction. The guide rod top was put through the tibial tunnel at the three horizontal positions: equal pace to articular facet (group A), the plane 5 mm below articular facet (group B), and the plane 10 mm below articular facet (group C). We gave four rotation positions to the cross-pin guide: 0°, 30°, 45°, 60° slope, referring to the parallel line of the posterior border of tibial plateau. We recorded the iatrogenic damages incidence, in the four different slope angle in the three groups, and then compare the incidence using Chi-Square test. Our results suggested that the incidence of chondral injury of tibial plateau in group B and group C was significantly lower compared to group A (χ (2) A-B = 27.077, χ (2) A-C 45.517, P = 0.000); However, there was no significant difference for the incidence penetrating the medial condyle of tibial plateau among the three groups (χ (2) = 5.733, P = 0.057); The highest incidence of injuring ligamentum transversum is in group A with 72.7%, especially at the 60° slope angle. In summary, our study suggested that in order to achieve the satisfactory clinical effect for the Rigid-fix system used in the tibia end fixation of ACL reconstruction surgery, the guide rod top should be put at the 5 mm below articular facet with a slope that parallel to the tibial medial plane at 30°-60° slope angle.
我们的研究旨在评估在胫骨固定部位使用刚性固定交叉销系统进行腘绳肌腱移植前交叉韧带(ACL)重建的安全性和可行性。在本研究中,对11个成年保守尸体膝关节在胫骨固定部位使用刚性固定交叉销装置进行ACL重建建模。将导杆顶端在三个水平位置穿过胫骨隧道:与关节面平齐(A组)、关节面下方5mm平面(B组)和关节面下方10mm平面(C组)。以胫骨平台后缘平行线为参照,将交叉销导向器设置四个旋转位置:0°、30°、45°、60°倾斜度。记录三组中四个不同倾斜角度下的医源性损伤发生率,然后采用卡方检验比较发生率。我们的结果表明,B组和C组胫骨平台软骨损伤发生率显著低于A组(χ(2)A - B = 27.077,χ(2)A - C = 45.517,P = 0.000);然而,三组中穿透胫骨内侧髁的发生率无显著差异(χ(2)= 5.733,P = 0.057);A组损伤横韧带的发生率最高,为72.7%,尤其是在60°倾斜度时。总之,我们的研究表明,为了在ACL重建手术的胫骨端固定中使用刚性固定系统获得满意的临床效果,导杆顶端应置于关节面下方5mm处,倾斜度与胫骨内侧平面平行,倾斜角度为30° - 60°。