Gerich J G, Cassim A, Lattermann C, Lobenhoffer H P, Tscherne H
Unfallchirurgische Klinik, Medizinische Hochschule Hannover.
Unfallchirurg. 1998 Mar;101(3):204-8. doi: 10.1007/s001130050255.
The endoscopic single incision technique for ACL reconstruction with a femoral half-tunnel may lead to a graft/tunnel mismatch and subsequent protrusion of the block from the tibial tunnel. The typical tibial fixation with an interference screw is not possible in these cases. Fixation with staples in a bony groove inferior to the tunnel outlet can be used as an alternative technique. Current literature does not provide biomechanical data of both fixation techniques in a human model. This study was performed to evaluate primary biomechanical parameters of this technique compared to a standard interference screw fixation of the block. 55 fresh-frozen human cadaver knee joints of a younger age (mean age: 44 years) were used. Grafts were harvested from the patellar tendon midportion with bone blocks of 25 mm length and 9 mm width. A 10 mm tibial tunnel was drilled from the anteromedial cortex to the center of the tibial insertion of the ACL. 3 different sizes of interference screws (7 x 30, 9 x 20 and 9 x 30 mm) were chosen as a standard control procedure (n = 40). For tibial bone-block fixation the graft was placed through the tunnel, the screw was then inserted on the cancellous or the cortical surface respectively. 15 knees were used for staple fixation. A groove was created inferior to the tunnel outlet with a chisel. The bone block was fixed in this groove with 2 barbed stainless steel staples. Tensile testing in both of the groups was carried out under axial load parallel to the tibial tunnel in a Zwick-testing-machine with a velocity of 1 mm/sec. Dislocation of the graft and stiffness were calculated at 175 N load. Maximum load to failure using interference screws varied between 506 and 758 N. Load to failure using staples was 588 N. Dislocation of the graft ranged between 3.6 and 4.7 mm for interference screw fixation and was 4.2 mm for staples. With both fixation techniques, the recorded failure loads were sufficient to withstand the graft loads which are to be expected during the rehabilitation period. Staple fixation of the bone block outside of the tunnel resulted in fixation strength comparable to interference screw fixation.
采用股骨半隧道的内镜下单切口技术进行前交叉韧带重建可能会导致移植物与隧道不匹配，进而使骨块从胫骨隧道中突出。在这些情况下，无法采用典型的带袢钢板固定于隧道出口下方的骨槽内可作为一种替代技术。目前的文献并未提供在人体模型中这两种固定技术的生物力学数据。本研究旨在评估该技术与骨块标准带袢钢板固定相比的主要生物力学参数。使用了55个年龄较轻（平均年龄：44岁）的新鲜冷冻人体尸体膝关节。移植物取自髌腱中部，带有长度为25mm、宽度为9mm的骨块。从胫骨前内侧皮质向ACL胫骨止点中心钻一个10mm的胫骨隧道。选择3种不同尺寸的带袢钢板（7×30、9×20和9×30mm）作为标准对照程序（n = 40）。对于胫骨骨块固定，将移植物穿过隧道，然后分别将螺钉插入松质骨或皮质骨表面。15个膝关节用于带袢钢板固定。用凿子在隧道出口下方制作一个骨槽。用2根带倒刺的不锈钢带袢钢板将骨块固定在这个骨槽内。两组均在Zwick试验机上以1mm/秒的速度在平行于胫骨隧道的轴向载荷下进行拉伸试验。在175N载荷下计算移植物的位移和刚度。使用带袢钢板固定时的最大破坏载荷在506至758N之间。使用带袢钢板固定时的破坏载荷为588N。带袢钢板固定时移植物的位移在3.6至4.7mm之间，带袢钢板固定时为4.2mm。采用这两种固定技术时，记录的破坏载荷足以承受康复期间预期的移植物载荷。在隧道外对骨块进行带袢钢板固定，其固定强度与带袢钢板固定相当。
