ACL重建术中联合使用RetroButton微钢板和光面同种异体皮质骨挤压钉的初步疗效观察

Preliminary clinical outcome of the femur RetroButton combined with glaze allergenic cortical press-fit bolt fixation in ACL reconstruction

目的对ACL重建术中联合使用RetroButton微钢板和光面同种异体皮质骨挤压钉进行股骨侧移植物固定的疗效进行初步观察。方法选取ACL断裂患者10名,采用标准膝关节镜下ACL重建术式,经前内侧入路定位和钻取股骨骨隧道,经取腱切口钻取胫骨隧道。股骨侧采用RetroButton微钢板固定后,从股骨隧道关节内入口置入光面同种异体皮质骨挤压钉;胫骨侧固定从隧道关节外入口置入可吸收界面钉,并用门型钉进行加强。通过X线平片、CT扫描、轴移试验以及Lachman试验对术后临床疗效进行观察。结果通过3～6个月随访,所有患者的轴移试验和Lachman试验均转为阴性;通过X线平片和CT扫描测量股骨隧道,均未出现明显扩大,且挤压钉已部分吸收。结论联合使用RetroButton微钢板和光面同种异体皮质骨挤压钉对股骨侧移植物进行混合固定,在ACL术后3～6个月能有效防止股骨隧道的扩大;加之光面同种异体骨挤压钉所具有的骨诱导作用,其在理论上具有促进腱骨愈合进程的功能。

Objective To investigate the preliminary clinical outcome of the femur RetroButton combined with glaze allogenic cortical press-fit bolt fixation in ACL reconstruction. Methods A series of 10 patients suffered from ACL ruptures underwent standard procedures of arthroscopic ACL reconstruction. The femoral tunnels were located and drilled through the anterior-medial approach, and the tibial tunnels were located and drilled through the incisions of harvesting grafts. For the femur graft fixation, glaze allergenic cortical press-fit bolt was inserted from the entrance in femoral tunnels joint after RetroButton fixation. For the tibia graft fixation, the absorbable interference screw was used which was strengthened by a portal-shape screw. The clinical outcomes were evaluated by x-ray, CT and ACL diagnosis tests, including pivot and Lachman tests. Results Results of the pivot and Lachman tests of all patients showed to be negative at 3-6 months after surgery. Through X-ray and CT scan, we found that the femoral tunnel of the patients were not enlarged and part of the cortical press-fit bolt had been absorbed. Conclusions The combined femur graft fixation of RetroButton and glaze allergenic cortical press-fit bolt can effectively prevent the enlargement of the femoral tunnels at 3 to 6 months postoperatively. In addition, the glaze allergenic cortical press-fit bolt can promote the tendon-bone healing process because of the osteoinductive effects.