Contzen H
Berufsgenossenschaftliche Unfallklinik Frankfurt am Main.
Polim Med. 1993;23(1-2):13-8.
Generally used notion of "augmentation" does not present the protective effect of the ligament which has been sutured or reconstructed by the autogenic implant. "Protection" seems to be more proper notion presenting better the fulfilled function. Cruciate ligament, sutured or reconstructed by the autogenic implant from the 1/3 of the patellar ligament, is submitted to time specified healing and rebuilding processes, lasting over 1 year. Synthetic implants application creates undoubtedly protection of mentioned above rebuilding processes from functional overloading. Implants made from the resorbable materials don't fulfill the protective role for such a long period of time. That's why the non-resorbable materials implants application becomes indispensable. We keep using the polyester woven prosthesis (TREVIRA HOCHFEST) with 200 mu mesh. This kind of ligament can be strictly connected, by means of the real augmentation, with the structure it protects and can be fixed in the bones from both distal and proximal end. It is possible also to fix it following the "over the top" method in the proximal portion. For the reconstruction of ligaments with the augmentation there is a need for the synthetic prosthesis with extensibility similar to the normal cruciate ligament extensibility. In the protective plastic operation following the "over the top" method relatively stiff implants should be applied to obtain the protective "stress shield". That's why our company's offer of the cruciate ligaments implants Trevira is so varied. We use implants of 1 mm thick and of various widths: for the ligaments prosthesis--8 mm, for the so called protective plastics--5 mm and for the augmentation--3 mm of width.
一般使用的“增强”概念并未体现出通过自体植入物缝合或重建的韧带的保护作用。“保护”似乎是更恰当的概念,能更好地体现所实现的功能。由髌韧带1/3处的自体植入物缝合或重建的交叉韧带,要经历特定时间的愈合和重建过程,持续超过1年。合成植入物的应用无疑为上述重建过程提供了免受功能过载的保护。由可吸收材料制成的植入物在如此长的时间内无法发挥保护作用。这就是不可吸收材料植入物的应用变得不可或缺的原因。我们一直使用200目网眼的聚酯编织假体(特卫强高强度型)。这种韧带可通过真正的增强与它所保护的结构紧密相连,并可从远端和近端固定在骨骼中。也可以在近端部分采用“过顶”方法进行固定。对于用增强物重建韧带,需要一种伸展性与正常交叉韧带伸展性相似的合成假体。在采用“过顶”方法的保护性整形手术中,应使用相对较硬的植入物以获得保护性的“应力屏蔽”。这就是我们公司提供的交叉韧带植入物特卫强种类如此多样的原因。我们使用厚度为1毫米、不同宽度的植入物:韧带假体宽度为8毫米,所谓的保护性整形用宽度为5毫米,增强用宽度为3毫米。