CN106963517A - The fixing means of graft during cruciate ligaments of knee joint is rebuild - Google Patents

The fixing means of graft during cruciate ligaments of knee joint is rebuild Download PDF

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Publication number
CN106963517A
CN106963517A CN201710009323.0A CN201710009323A CN106963517A CN 106963517 A CN106963517 A CN 106963517A CN 201710009323 A CN201710009323 A CN 201710009323A CN 106963517 A CN106963517 A CN 106963517A
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China
Prior art keywords
tendon
expansion sleeve
guide pin
rebuild
bone
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Pending
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CN201710009323.0A
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Chinese (zh)
Inventor
刘玉宝
林福庆
赵清华
郭玉祥
林禄攀
邹瑞
蔡小林
温传阳
施中平
张帆
胡桂花
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Liuhe Nanjing District People's Hospital
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Liuhe Nanjing District People's Hospital
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Priority to CN201710009323.0A priority Critical patent/CN106963517A/en
Publication of CN106963517A publication Critical patent/CN106963517A/en
Pending legal-status Critical Current

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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/08Muscles; Tendons; Ligaments
    • A61F2/0811Fixation devices for tendons or ligaments
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/08Muscles; Tendons; Ligaments
    • A61F2/0811Fixation devices for tendons or ligaments
    • A61F2002/0847Mode of fixation of anchor to tendon or ligament
    • A61F2002/0858Fixation of tendon or ligament between anchor and bone, e.g. interference screws, wedges

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Rehabilitation Therapy (AREA)
  • Rheumatology (AREA)
  • Cardiology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Transplantation (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Prostheses (AREA)

Abstract

The present invention discloses a kind of fixing means of graft during cruciate ligaments of knee joint is rebuild, and comprises the following steps:(1) two ends for transplanting tendon are woven with wire and sutured, select two swell fixtures;(2) femoral bone tunnel is made;(3) tibial tunnel is made;(4) wire for transplanting tendon one end) is penetrated into band uropore guide pin, will be extracted with uropore guide pin and take wire one end out of, transplanting tendon is entered femoral bone tunnel and tibial tunnel;(5) tail end for being close to transplant tendon push-in expansion sleeve to expansion sleeve along femur bone road with instrument enters femur bone road, inserts screws into expansion sleeve and fixes;(6) tail end for being close to transplant tendon push-in expansion sleeve to expansion sleeve along tibial bone road with instrument enters tibial bone road, inserts screws into expansion sleeve and fixes.The fixing means of graft, is more beneficial for tendon-bone healing, can produce bigger fixing intensity, exogenous cell can be avoided to cause the low shortcoming of host immune response, transformation efficiency during the cruciate ligaments of knee joint of the present invention is rebuild.

Description

The fixing means of graft during cruciate ligaments of knee joint is rebuild
Technical field
Rebuild the present invention relates to the technical field of the medicine equipment in organism, more particularly to a kind of cruciate ligaments of knee joint The fixing means of middle graft.
Background technology
Anterior cruciate ligament of knee joint (anterior cruciate ligament, ACL) be the important static(al) of knee joint and One of dynamic property rock-steady structure, can prevent shin bone reach, hyperextension and excessively rotation, prevent that the correlation after knee joint unstability is concurrent Disease.ACL damages are common disease, frequently-occurring disease, the numerous teenagers of major concern, are one of most common diseases in population of adolescent. The ACL damage incidences of disease are very high, the particularly crowd of more than 16 years old, according to epidemiology survey, and the incidence of disease of ACL fractures is about 0.035%.In recent years, with "sport for all" popularization and increasing teenager participates in sports, such disease Incidence of disease more and more higher and focus mostly in common Young crowd.The treatment of ACL damages brings serious financial burden, And China has nearly 100,000,000 ACL damages and ACL to damage caused Osteoarthritis and millions of fortune for locking into ACL damages Mobilize and between twenty and fifty sports enthusiast, treat such disease and consume very huge manpower, financial resources, material resources.And this cost Amplified by inappropriate treatment.
Occur instability of knee, increase joint other structures damage probability, acceleration meniscus and articular cartilage after ACL damages Regression, cause serious chronic ache and joint function disturbance, daily routines and the quality of life of patient had a strong impact on, to green grass or young crops Juvenile patients bring huge pain and mental burden.ACL Reconstructions are fixed in bone road using transplanting tendon, are substituted just The function of normal anterior cruciate ligament, is treatment ACL damage most efficient methods.The fixation of graft is most important during ACL is rebuild Link, is also most weak link, and domestic and foreign scholars did a variety of researchs.Good being fixed on can meet postoperative morning in the recent period Phase motion, muscular training and the requirement born a heavy burden, knee Stability is maintained before graft obtains biological healing, at a specified future date then have Help promote graft and symphysis.The quality that graft is fixed depends on the selection of fixing means.
The selection of fixing means because graft selection and surgical technic selection it is different and different.But ultimate aim one Do not changed directly, the fixation of tendon graft is to recover the mechanical characteristic of autologous tendon as far as possible, also to reach the biology of tendon bone Healing.So ACL fixation need to meet following condition:Enough resisting pull out forces are first had to, secondly need to recover and maintain knee to close The stability of section, finally will also have enough strength to prevent ligament from being slided intra-articular.Anterior cruciate ligament after reconstruction is main Biomechanics characteristic be intensity and stiffness.Intensity is to instigate graft to produce the load permanently shifted, and stiffness refers to graft The tension force or displacement produced under certain load.
Extrusion screw fixed system is mainly to be extruded tendon with the frictional force of osseous tunnel generation to fix tendon by screw. This fixed form makes graft contraction in length, there is bigger stiffness, the stability for rebuilding patella is improved, however, smaller Interference screw enough mechanical forces can not be provided, and the screw being relatively large in diameter can cut suture and graft cause it is fixed not Surely, tendon intensity is transplanted caused by interference screw cutting extruding to decline and rupture of tendon failure occur.
It is indirectly fixed to refer to the method that fixture fixed position is located at outside tendon-bone has a common boundary, but due to graft and bone tunnel There is certain space between road, therefore in knee joint flexion and extension, graft can occur perpendicular to tunnel axle as rain brush Swing, i.e., " rain brush effect ";Or the expansion moving of direction of principal axis is occurring along osseous tunnel for graft, i.e., " bungee jumping effect ".This two Biological healing processes of the athletic meeting destruction graft in osseous tunnel are planted, while being also to cause osseous tunnel to expand most common original Therefore one.
The healing of transplanting tendon and osseous tunnel inwall be fibr tissue formation connection between tendon-bone interface, new bone formation, bone to Grown into tendon, partial mold transformation process.BMP-2, which has, makes undifferentiated mesenchymal cell directed differentiation be into cartilage Cell and Gegenbaur's cell, and induced synthesis cartilage and bone tissue.Due to tendon-bone interface lack blood vessel, if without growth because Son, even if the damage of very little can not well be healed.Studied be reported in internal in-situ rebuild damage ACL can not reach To good effect.Repairing effect can be improved to a certain extent using extruding metal screw when ACL is rebuild, but due at this stage The various defects existed after metallic screw implantation, clinic can not be still applied to well at present.
The content of the invention
The technical problem to be solved in the present invention is that:The technical problem existed for prior art, the present invention provides one The fixing means of graft during cruciate ligaments of knee joint is rebuild is planted, tendon-bone healing is more beneficial for, bigger fixing intensity can be produced, Exogenous cell can be avoided to cause the low shortcoming of host immune response, transformation efficiency.
In order to solve the above technical problems, technical scheme proposed by the present invention is:
The fixing means of graft, comprises the following steps during a kind of cruciate ligaments of knee joint is rebuild:
(1) two ends for transplanting tendon are woven with wire and sutured, select two swell fixtures;
(2) femoral bone tunnel:The direction of 2 points of 120 ° of knee sprung, 10 points of the right knee of selection or left knee, is positioned using femur Device, apart from femoral-posterior condyles cartilage wall 6mm;
(3) guide pin is squeezed into the former femoral attachment centres of ACL, femur bone road is made of drill bit along guide pin direction;
(4) tibial tunnel:Go down on one's knees 90 °, select in front of lateral meniscus anterior angle level, posterior cruciate ligament of knee, through inner side Xiyan Otch ligament tibia locator, is inserted in guide pin;
(5) along guide pin direction use with step (3) identical drill bit, tibial bone road is made;
(6) wire of transplanting tendon one end in step (1) is penetrated into band uropore guide pin, the other end is fixed on step (3) In guide pin, will be extracted with uropore guide pin and take wire one end out of, make transplanting tendon enter femoral bone tunnel and tibial tunnel;
(7) tail end for being close to transplant tendon push-in expansion sleeve to expansion sleeve along femur bone road with instrument enters femur bone road, Expansion sleeve is inserted screws into fix;
(8) tail end for being close to transplant tendon push-in expansion sleeve to expansion sleeve along tibial bone road with instrument enters tibial bone road, Expansion sleeve is inserted screws into fix.
In the above method, it is preferable that the swell fixture is absorbable expansion screw.
In the above method, it is preferable that the absorbable expansion screw passes through absorption process and nanometer hydroxyapatite by BMP-2 The sustained-release micro-spheres that carrier is combined and is prepared into using multi-emulsion method composite polyethylene levorotatory lactide are combined and are made.
In the above method, it is preferable that the transplanting tendon behaviour work tendon, goose tendon or from body Hams.
In the above method, it is preferable that the guide pin in the step (3) is band nostril guide pin.
In the above method, it is preferable that the drill bit is hollow boring bit.
The fixing means of graft during the cruciate ligaments of knee joint of the present invention is rebuild, when ACL is rebuild, expansion sleeve is in bone road It is temporarily fixed to transplant tendon, expansion sleeve expansion extruding fixed transplanting tendon when being screwed into screw.Expand extrusion process in screw not with Tendon is contacted, it is to avoid the cutting of suture and graft, the contact area of tendon and bone road wall is also add in addition, is more beneficial for Tendon-bone healing and the bigger fixing intensity of generation, that is, embody directly fixed advantage, turn avoid indirectly fixed deficiency. When ACL is rebuild, there is mesenchymal stem cells MSCs in knee joint cavity, Synovial Mesenchymal Stem Cells and chondroprogenitors etc. can , can be by using absorbable expansion screw and growth factor to migrate to tendon bone intersection and induce seed cell for bone tissue Such cell is gone back to the nest to tendon bone intersection, repairs damage ACL.The fixation of graft during the cruciate ligaments of knee joint of the present invention is rebuild Method, having can avoid exogenous cell from causing the low shortcoming of host immune response, transformation efficiency.
Embodiment
Embodiment below in conjunction with the present invention is described in detail.It should be appreciated that tool described herein Body embodiment is merely to illustrate and explain the present invention, and is not intended to limit the invention.
For the ease of description, space relative terms can be used herein, such as " ... on ", " ... top ", " ... upper surface ", " above " etc., for describing such as a device or feature and other devices or the locus of feature Relation.It should be appreciated that space relative terms are intended to include using or operating in addition to the orientation described by device In different azimuth.If for example, device is squeezed, being described as " above other devices or construction " or " in other devices Or on construction " device after will be positioned as " below other devices or construction " or " in other devices or construct it Under ".Thus, exemplary term " in ... top " can include " in ... top " and " in ... lower section " two kinds of orientation.Should Device can also other different modes positioning (being rotated by 90 ° or in other orientation), it is and relative to space used herein above Respective explanations are made in description.
Embodiment 1
The fixing means of graft, comprises the following steps during the cruciate ligaments of knee joint of the present invention is rebuild:
(1) two ends for transplanting tendon are woven with wire and sutured, select two absorbable expansion screws, absorbable expansion spiral shell Nail is combined with nanometer hydroxyapatite carrier by absorption process by BMP-2 and uses multi-emulsion method composite polyethylene levorotatory lactide The sustained-release micro-spheres being prepared into are combined and are made, and transplant tendon from body Hams.
(2) femoral bone tunnel:The direction of 2 points of 120 ° of knee sprung, 10 points of the right knee of selection or left knee, is positioned using femur Device, apart from femoral-posterior condyles cartilage wall 6mm.
(3) band nostril guide pin is squeezed into the former femoral attachment centres of ACL, femur bone is made of hollow boring bit along guide pin direction Road.
(4) tibial tunnel:Go down on one's knees 90 °, 7mm in front of lateral meniscus anterior angle level, posterior cruciate ligament of knee is selected, through inner side knee Eye otch ligament tibia locator, is inserted in guide pin from the sleeve pipe of locator.
(5) along guide pin direction use with step (3) identical hollow boring bit, tibial bone road is made.
(6) wire of transplanting tendon one end in step (1) is penetrated into band uropore guide pin, the other end is fixed on step (3) In guide pin, will be extracted with uropore guide pin and take wire one end out of, make transplanting tendon enter femoral bone tunnel and tibial tunnel;
(7) tail end for being close to transplant tendon push-in expansion sleeve to expansion sleeve along femur bone road with instrument enters femur bone road, Expansion sleeve is inserted screws into, makes one end of the fixed transplanting tendon of expansion sleeve expansion.
(8) tail end for being close to transplant tendon push-in expansion sleeve to expansion sleeve along tibial bone road with instrument enters tibial bone road, Insert screws into expansion sleeve to consolidate, make the other end of the fixed transplanting tendon of expansion sleeve expansion.
Absorbable expansion screw in step (1) is combined simultaneously by BMP-2 by absorption process with nanometer hydroxyapatite carrier The sustained-release micro-spheres being prepared into using multi-emulsion method composite polyethylene levorotatory lactide are combined and are made.
Polyethylene levorotatory lactide (Poly-L-lactide, PLLA) is a kind of new biodegradation material, Ke Yicong It is made in the starch of plant resources (such as corn), is finally degraded into carbon dioxide and water in vivo, it is this kind of material non-toxic, nonantigenic Property, with good degradability, absorbability, mechanical strength and biological safety, it can be adjusted by controlling component content The degradation speed of material is saved, the repeatability and mechanical property of product property is reached higher level.Nanometer hydroxyapatite (nano-Hydroxyapatite, abbreviation nHA) is a kind of most common bioactive materials, and it has and body bone tissue phase As inorganic constituents, be generally acknowledged at present there is preferable biocompatibility and the bioactive materials of osteoconductive.Nano-hydroxy Apatite is the chief component of bone, because it implants with good biocompatibility, non-toxic, no inflammation reaction Property, first in pharmaceutical carrier field by numerous studies, there are many researchs to show that nanometer hydroxyapatite is combined PLLA microballoons and delayed Release system and the encapsulating effect for increasing substantially medicine and protein, extend the release time of medicine, it was reported that wherein nanometer hydroxyl Suction-operated of the base apatite to medicine serves the effect of key.Nano-HA and PLLA are combined, on the one hand can be made big Width improves the encapsulating effect of sustained-release micro-spheres, extends the slow-release time of medicine, and the shakiness of explosive release and protein is reduced as far as possible It is fixed, greatly improve the utilization rate of microglobulin matter, it is to avoid a large amount of prominent local acid concentrations for releasing generation of protein are too high Phenomenon so that avoid influence bone tissue generation.On the one hand the acid degradation products of PLA can be made to be buffered by HA, simultaneously HA osteoconductive can provide good osteocyte adhesion growing environment, and the loose structure of compound is then cell growth, organized Regeneration and adhesion offer condition, meet the biological requirement of bone tissue engineer.BMP-2 is that the unique one kind having now been found that can be made For the protein factor for the adequate condition for inducing bon e formation, i.e., it can induce cartilage and bone under the condition that only independent BMP-2 is present The formation of tissue, and all played an important role in each stage of skeletonization.Divide in addition, BMP-2 can be induced substantially from marrow From obtained pluripotent stem cell to cartilage cell, bone cell differentiation, the protein such as BGP are synthesized, occur entochondrostosis, Osteocyte is formed, and bone mineralization forms new bone.But simple BMP-2 spreads too soon in vivo, is also easily decomposed by protein acid, Yi Fa It is raw to be lost in, degrade and absorb, thus can not be acted within effective time in more target cells, therefore basis and clinical research It is mainly used in other carrier material Application of composite in the reparation of tissue.Microballoon (microsphere) refer to medicine dissolving or The microscopic, spherical entity formed in the matrix for being dispersed in high polymer material, belongs to matrix type skeleton particulate.Because it is to certain organs With the slow release of insoluble drug release in the targeting and particulate of tissue, the focus of controlled release agent type research in recent years is had become.Structure The absorbable expansion bolted fastening system of BMP-2 sustained releases is built, not only with osteoconductive but also with osteoinductive, while can gradually inhale Incorporate solution.
BMP-2 is combined by absorption process with nanometer hydroxyapatite carrier and is prepared into using the compound PLLA of multi-emulsion method slow Release microballoon (BMP-2:HA:PLLA=15mg:15mg:200mg), sustained-release micro-spheres are be combined with each other by technique and bolt are made, PLLA is nontoxic, inorganization reaction, and BMP-2/ nanometer hydroxyapatite microballoons are sustained during slow degraded, sustained release BMP-2 can promote tendon bone intersection Derived from Mesenchymal Stem Cells, and can promote newborn cartilaginous tissue to bone tissue knot Structure is remolded, so as to reappear original tendon-bone interface biological function.
BMP-2 is combined with nanometer hydroxyapatite carrier by absorption process and is combined PLLA and is prepared into sustained-release microparticle, so After be fabricated in absorbable expansion bolted fastening system, bolt degradation process it is slow, continue, stable release BMP-2/ hydroxy-apatites Stone particulate, maintains certain BMP-2 concentration in tendon-bone interface, to promote tendon-bone healing, ultimately forms natural fabric.
In expanding screw pessulus road it is fixed after slow degrade and be sustained BMP-2/ nanometer hydroxyapatite microballoons.Prepare in vitro The environment similar to articular cavity determines BMP-2 sustained concentrations by Shu Jiafa, and it is left that BMP-2 local concentrations maintain 0.01mg/mL Fluctuated in right scope.
Above-mentioned simply presently preferred embodiments of the present invention, not makees any formal limitation to the present invention.Although of the invention It is disclosed above with preferred embodiment, but it is not limited to the present invention.Therefore, it is every without departing from technical solution of the present invention Content, according to the technology of the present invention essence to any simple modifications, equivalents, and modifications made for any of the above embodiments, all should fall In the range of technical solution of the present invention protection.

Claims (6)

  1. The fixing means of graft during 1. a kind of cruciate ligaments of knee joint is rebuild, it is characterised in that comprise the following steps:
    (1) two ends for transplanting tendon are woven with wire and sutured, select two swell fixtures;
    (2) femoral bone tunnel:120 ° of knee sprung, selects the direction of 2 points of 10 points of right knee or left knee, using femur locator, away from From femoral-posterior condyles cartilage wall 6mm;
    (3) guide pin is squeezed into the former femoral attachment centres of ACL, femur bone road is made of drill bit along guide pin direction;
    (4) tibial tunnel:Go down on one's knees 90 °, select in front of lateral meniscus anterior angle level, posterior cruciate ligament of knee, through inner side Xiyan otch Ligament tibia locator, is inserted in guide pin;
    (5) along guide pin direction use with step (3) identical drill bit, tibial bone road is made;
    (6) wire of transplanting tendon one end in step (1) is penetrated into band uropore guide pin, the other end is fixed in step (3) Guide pin, will extract with uropore guide pin and take wire one end out of, transplanting tendon is entered femoral bone tunnel and tibial tunnel;
    (7) tail end for being close to transplant tendon push-in expansion sleeve to expansion sleeve along femur bone road with instrument enters femur bone road, by spiral shell Nail is screwed into expansion sleeve and fixed;
    (8) tail end for being close to transplant tendon push-in expansion sleeve to expansion sleeve along tibial bone road with instrument enters tibial bone road, by spiral shell Nail is screwed into expansion sleeve and fixed.
  2. The fixing means of graft during 2. cruciate ligaments of knee joint according to claim 1 is rebuild, it is characterised in that described Swell fixture is absorbable expansion screw.
  3. The fixing means of graft during 3. cruciate ligaments of knee joint according to claim 2 is rebuild, it is characterised in that described Absorbable expansion screw is combined with nanometer hydroxyapatite carrier by absorption process by BMP-2 and uses multi-emulsion method composite polyethylene The sustained-release micro-spheres that levorotatory lactide is prepared into are combined and are made.
  4. The fixing means of graft during 4. cruciate ligaments of knee joint according to claim 1 is rebuild, it is characterised in that described Transplant tendon behaviour work tendon, goose tendon or from body Hams.
  5. The fixing means of graft during 5. cruciate ligaments of knee joint according to claim 1 is rebuild, it is characterised in that described Guide pin in step (3) is band nostril guide pin.
  6. The fixing means of graft during 6. cruciate ligaments of knee joint according to claim 1 is rebuild, it is characterised in that described The drill bit is hollow boring bit.
CN201710009323.0A 2017-01-06 2017-01-06 The fixing means of graft during cruciate ligaments of knee joint is rebuild Pending CN106963517A (en)

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Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN114028027A (en) * 2021-12-03 2022-02-11 长春圣博玛生物材料有限公司 Cruciate ligament rebuilds fixing device
CN114642771A (en) * 2020-12-21 2022-06-21 立心(深圳)医疗器械有限公司 Artificial ligament with traction unit and preparation method thereof

Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN114642771A (en) * 2020-12-21 2022-06-21 立心(深圳)医疗器械有限公司 Artificial ligament with traction unit and preparation method thereof
CN114028027A (en) * 2021-12-03 2022-02-11 长春圣博玛生物材料有限公司 Cruciate ligament rebuilds fixing device
CN114028027B (en) * 2021-12-03 2022-11-15 长春圣博玛生物材料有限公司 Cruciate ligament rebuilds fixing device

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