CN111870407A

CN111870407A - Structure of bone-patellar tendon-bone graft and preparation method thereof

Info

Publication number: CN111870407A
Application number: CN202010797135.0A
Authority: CN
Inventors: 余家阔; 原福贞; 沈飞; 谢兴
Original assignee: Peking University Third Hospital Peking University Third Clinical Medical College
Current assignee: Peking University Third Hospital Peking University Third Clinical Medical College
Priority date: 2020-08-10
Filing date: 2020-08-10
Publication date: 2020-11-03

Abstract

The invention relates to a structure of a bone-patellar tendon-bone graft and a preparation method thereof, wherein the structure comprises a patellar cylinder, a patellar ligament, a tibia cylinder and a conical body, wherein the patellar cylinder and the tibia cylinder are connected at two ends of the patellar ligament by natural biological tissues, the conical body is formed by polishing one ends of the patellar cylinder and the tibia cylinder, and the tips of the two conical bodies face towards the same direction; the knee joint cylindrical body and the tibia cylindrical body are respectively provided with round holes with the diameter of 2mm at one third of the dividing positions, the round holes penetrate through the knee joint cylindrical body and the tibia cylindrical body, and the round holes are internally penetrated with a second polymer non-absorbable braided wire.

Description

Structure of bone-patellar tendon-bone graft and preparation method thereof

Technical Field

The invention relates to the technical field of transplantation operations, in particular to a structure of a bone-patellar tendon-bone graft and a preparation method thereof.

Background

The knee joint cruciate ligament is an important stable structure of the knee joint and is hinged between the intercondylar notch of the femur and the intercondylar eminence of the tibia, so that the tibia can be prevented from shifting forwards and backwards along the femur. The knee cruciate ligament can be divided into a front cruciate ligament and a rear cruciate ligament, wherein the front cruciate ligament is started from the inner side surface of the lateral condyle of the femur, is inclined to the front lower part and is stopped at the front part of the tibial intercondylar eminence and the anterior horn of the inner meniscus and the lateral meniscus; the posterior cruciate ligament originates from the lateral surface of the medial condyle of the femur, slopes posteriorly and inferiorly, and ends at the posterior of the tibial intercondylar eminence and the posterior horn of the lateral meniscus. When the knee joint moves, part of the fiber of each of the two ligaments is in a tense state. Therefore, in addition to the anterior cruciate ligament preventing anterior tibial migration and the posterior cruciate ligament preventing posterior femoral migration, hyperextension, hyperflexion and rotation of the knee joint are also limited, with cruciate ligament injury often occurring simultaneously with tibial collateral ligament or meniscus injury.

There are few blood vessels in the ligaments of the knee joint, and nutrients are supplied by synovial fluid in the joint capsule and capillary vascular networks attached to the surfaces of the ligaments, so that the ligaments are difficult to heal by themselves after being broken, and old injuries are caused when the ligaments are broken for more than 6 weeks, most of the ligaments are usually dissolved and absorbed in joint fluid, so that ligament reconstruction surgery is usually required to treat the cruciate ligament injury of the knee joint to restore the functions of the cruciate ligament injury. The repairing materials are mainly autologous tendons, allogeneic tendons, artificial ligaments and the like. The pain of tendon-taking part is often left after operation for autologous tendon, meanwhile, the strength of lower limb is also lost to a certain extent, and the artificial ligament is caused by rejection reaction, high price and other factors.

Therefore, in view of the above disadvantages, it is desirable to provide a structure of a bone-patellar tendon-bone graft and a method for preparing the same.

Disclosure of Invention

Technical problem to be solved

The invention aims to solve the technical problems that anterior and posterior cruciate ligaments transplanted by own tendons have rejection reaction and are expensive.

(II) technical scheme

In order to solve the technical problems, the invention provides a structure of a bone-patellar tendon-bone graft, which comprises a patellar cylinder, a patellar ligament, a tibia cylinder and a conical body, wherein the patellar cylinder and the tibia cylinder are connected at two ends of the patellar ligament by natural biological tissues, the conical body is formed by grinding one ends of the patellar cylinder and the tibia cylinder, and the tips of the two conical bodies face towards the same direction; the diameter is 2mm round hole has respectively been seted up to the respective third demarcation punishment of patella cylinder and shin bone cylinder, and the round hole runs through patella cylinder and shin bone cylinder, has worn No. two polymer non-absorbable braided wires in the round hole.

As a further explanation of the present invention, preferably, bone tunnels are opened in both tibia and femur of the patient, and the cylindrical patella cylinder and its conical body are inserted into the tibia bone tunnel or femur bone tunnel of the patient by being pulled by the No. two polymer non-absorbable braided wires; the tibia cylinder and the conical body thereof are pulled and inserted into a femur bone tunnel or a tibia bone tunnel of a patient by a second polymer non-absorbable braided wire.

As a further illustration of the invention, the bone tunnel is preferably a circular anterior-posterior pair of perforations of 2mm diameter.

As a further explanation of the invention, it is preferred that the patellar cylinder and its taper and the tibial cylinder and its taper for transplantation have a length of 10mm to 70mm, a diameter of 8mm to 20mm, a patellar ligament length of 30mm to 75mm, a width of 5mm to 25mm and a thickness of 1mm to 5 mm.

The invention also provides a preparation method of the bone-patellar tendon-bone graft, which comprises the following steps,

completely taking off the patella, the patellar ligament and a part of the tibia from a donor, connecting the patellar ligament with the patella and the part of the tibia at two ends through a natural structure, and dividing the patellar ligament and the part of the tibia into two parts from the midline of the patellar, the patellar ligament and the part of the tibia;

polishing each half patellar bone block divided into two parts into a patellar cylinder and a conical body thereof, and polishing each half tibial bone block divided into two parts into a tibial cylinder and a conical body thereof to realize the function of manufacturing two pieces of bone-patellar tendon-bone graft;

drilling a round hole with the diameter of 2mm on the one-third boundary line of each patella cylinder and each tibia cylinder, wherein the round holes are vertical to the surface of the cylinders and penetrate through the cylinders in the front and back directions;

and IV, penetrating a second polymer non-absorbable braided wire into each round hole for pulling the patella cylinder and the conical body thereof and the tibia cylinder and the conical body thereof to required positions.

As a further illustration of the invention, the patellar cylinder, patellar ligament and tibial cylinder for transplantation are preferably obtained from healthy donors aged 18-45 years within 12 hours of death.

As a further illustration of the present invention, it is preferred that the patellar and tibial cylinders for implantation be white or yellowish with red health, the patellar ligament be white or yellowish, the cancellous bone trabecular structure be clear, and the cortical bone surface be smooth.

As a further illustration of the invention, it is preferred that the maximum load of the patellar cylinder, patellar ligament and tibial cylinder for implantation is greater than 1500N.

As a further illustration of the present invention, the patellar cylinder, patellar ligament and tibial cylinder for transplantation are preferably tested for cytotoxicity, genotoxicity, sensitization, pyrogen, hemolysis prior to transplantation.

(III) advantageous effects

The technical scheme of the invention has the following advantages:

the invention depends on reliable graft source, the bone structure of the graft is trimmed, the fixation convenience, the fixation stability and the anatomical fixation are greatly increased, the invention has reasonable structure and anatomical structure and convenient operation, is suitable for knee joints with fractured cruciate ligaments, and is suitable for clinical popularization and application in orthopedics department.

Drawings

FIG. 1 is a diagram of the bones of the knee joint of the present invention;

FIG. 2 is a view of the patellar cylinder, patellar ligament and tibial cylinder for implantation of the present invention;

FIG. 3 is a threading path diagram of a second non-absorbable braided wire for transplantation according to the present invention;

FIG. 4 is a migration state diagram of the present invention.

In the figure: 1. a cylindrical patella; 2. the patellar ligament; 21. the bone marrow tract; 3. a tibial cylinder; 4. a conical body; 5. a circular hole; 6. a second non-absorbable braided wire; 7. the femur; 8. a patella; 9. the tibia.

Detailed Description

In order to make the objects, technical solutions and advantages of the embodiments of the present invention clearer, the technical solutions in the embodiments of the present invention will be clearly and completely described below with reference to the drawings in the embodiments of the present invention, and it is obvious that the described embodiments are some, but not all, embodiments of the present invention. All other embodiments, which can be obtained by a person skilled in the art without any inventive step based on the embodiments of the present invention, are within the scope of the present invention.

A structure of a bone-patellar tendon-bone graft is combined with figures 2 and 3 and comprises a patellar cylinder 1, a patellar ligament 2, a tibial cylinder 3 and a cone 4, wherein the patellar cylinder 1 and the tibial cylinder 3 are connected to two ends of the patellar ligament 2 by natural biological tissues, the patellar cylinder 1 and the tibial cylinder 3 used for the graft are preferably cylinders milled by irregular cutting blocks (dotted parts) taken from a patella 8 and a tibia 9 of the graft, and the cone 4 is milled by one end of the patellar cylinder 1 and one end of the tibial cylinder 3, wherein the tips of the two cones 4 are in the same direction; referring to fig. 4, bone tunnels 21 are formed on the curved surfaces of the patient's femur 7 and tibia 9 in the joint cavity, and the bone tunnels 21 are circular front and back pairs of perforations with a diameter of 2 mm; cylindric patella cylinder 1 and shin bone cylinder 3 all peg graft in bone tunnel 21, and cylindric patella cylinder 1 and shin bone cylinder 3 insert in patient's shin bone 9 or thighbone 7 to the physiological state of cruciate ligament around the simulation makes patella ligament 2 after the transplantation can be close to the perfect replacement and has been damaged the cruciate ligament around, guarantees to transplant the back and enable patient's knee joint and can normally carry out physiological work.

With reference to fig. 3 and 4, round holes 5 with a diameter of 2mm are respectively formed in the three-third boundaries of the patella cylinder 1 and the tibia cylinder 3, the round holes 5 penetrate through the patella cylinder 1 and the tibia cylinder 3, and a second polymer non-absorbable braided wire 6 penetrates through the round holes 5; the cylindrical patella cylinder 1 and the conical body 4 thereof are pulled and inserted into a tibia bone tunnel 21 or a femur bone tunnel 22 of a patient by a second polymer non-absorbable braided wire 6; the tibia cylinder 3 and the conical body 4 thereof are drawn and inserted into the femoral bone tunnel 21 or the tibia bone tunnel 21 of the patient by the polymer non-absorbable braided wire 6 with the conical body 4 facing the medullary canal 21, so as to reduce the resistance of the patellar cylinder 1 and the tibia cylinder 3 with the femur 7 and the tibia 9 when drawn.

The bone tunnel 21 is arranged to facilitate transplanting the cylindrical patella cylinder 1 and the cylindrical tibial cylinder 3 to an affected part, so that a simple and convenient transplanting process is realized.

With reference to fig. 2 and 3, the patellar cylinder 1, the patellar ligament 2 and the tibial cylinder 3 for transplantation need to be taken from a healthy donor aged 18-45 years within 12 hours of death, so as to ensure that the patellar cylinder 1, the patellar ligament 2 and the tibial cylinder 3 for transplantation have excellent physiological structures and can perform physiological work for a long time after transplantation; the patellar cylinder 1 and the tibia cylinder 3 for transplantation are white or yellowish and have red health states, the patellar ligament 2 is white or yellowish, the trabecular structure of cancellous bone is clear, and the surface of cortical bone is smooth, so that the patellar cylinder 1, the patellar ligament 2 and the tibia cylinder 3 to be transplanted are ensured to be healthy and have no damage or disease, and secondary damage to a patient is avoided; the maximum load of the patella cylinder 1, the patella ligament 2 and the tibia cylinder 3 for transplantation is more than 1500N, so that the patella ligament 2 after transplantation can excellently replace the original anterior and posterior cruciate ligaments, and the normal physiological work of the knee joint of a patient can be further ensured; before the patella cylinder 1, the patella ligament 2 and the tibia cylinder 3 for transplantation are transplanted, the detection of cytotoxicity, genetic toxicity, allergenicity, heat source and hemolysis is needed, so that the patella cylinder 1, the patella ligament 2 and the tibia cylinder 3 for transplantation have extremely high safety, and the rejection phenomenon of a patient is avoided. Patella cylinder 1 and shin bone cylinder 3 length of transplanting usefulness are 15mm ~ 70mm, and the diameter is 8mm ~ 12mm, and patellar ligament 2 length is 30mm ~ 75mm, and the width is 5mm ~ 25mm, and thickness is 1mm ~ 5mm, can directly select when the operation, reduces the fixed unstable risk, improves the suitability of graft.

In some embodiments of the present invention, the patellar cylinder 1, the patellar ligament 2, and the tibial cylinder 3 for knee joint transplantation may also be made of tissue engineering materials, including natural biomaterials and synthetic biomaterials, such as polyvinyl alcohol-hydrogel (PVA-H), gelatin sponge, collagen, alginate, polyglycolic acid (PGA), polylactic acid (PLA), fibrin gel, etc. For example, in one embodiment of the present invention, the patellar cylinder 1, patellar ligament 2, and tibial cylinder 3 may employ a 3D printed polylactic acid-polycaprolactone copolymer P (LLA-CL) scaffolding material. The implantation materials of the patella cylinder 1, the patellar ligament 2 and the tibia cylinder 3 for knee joint transplantation can further perform in vitro cell culture on the tissue engineering bracket material to obtain corresponding bionic tissues; the adoption of artificially produced substitutes can avoid rejection reaction of patients.

The invention also provides a preparation and transplantation method of the bone-patellar tendon-bone graft, which comprises the following steps:

completely taking off the patella 8, the patellar ligament 2 and a part of the tibia 9 from a donor, connecting the patellar ligament 2 with the patella 8 and the part of the tibia 9 at two ends through a natural structure, and dividing the patella 8, the patellar ligament 2 and the part of the tibia 9 into two parts at the midline;

II, polishing each half patella 8 bone block divided into two parts into a patella cylinder 1 and a conical body 4 thereof, and polishing each half tibia 9 bone block divided into two parts into a tibia cylinder 3 and a conical body 4 thereof, so as to realize the effect of manufacturing two pieces of bone-patellar tendon-bone graft;

drilling a round hole 5 with the diameter of 2mm on the one-third dividing line of each patella cylinder 1 and each tibia cylinder 3, wherein the round hole 5 is vertical to the surface of the cylinder and penetrates through the cylinder in the front and back directions;

IV, a second polymer non-absorbable braided wire 6 is penetrated into each round hole 5 and used for pulling the patella cylinder 1 and the conical body 4 thereof, the tibia cylinder 3 and the conical body 4 thereof to a required position;

and VI, drilling a bone tunnel 21 on the femur 7 and the tibia 9 of the knee joint of the patient by using a hollow drill, respectively inserting the polished patella cylinder 1 and the conical body 4 thereof, the tibia cylinder 3 and the conical body 4 thereof into the bone tunnel 21 of the tibia 7 and the femur 9 of the patient for fixation, wherein a through hole needs to be formed in the femur 7, and the second-macromolecule non-absorbable braided wire 6 on the patella cylinder 1 penetrates out of the femur 7 through the through hole so as to pull the patella cylinder 1 and the conical body 4 thereof into the bone marrow channel 21 of the femur 7.

The invention utilizes reasonable anatomical structure to reconstruct knee joint ligaments of the processed cylindrical bone graft with the conical body 4 and the round hole 5, ensures that the operation is quicker and simpler without reducing the fixation firmness, realizes the reliable and effective transplantation and repair of the fractured knee joint cruciate ligaments, is suitable for the fractured knee joints of the cruciate ligaments, and is suitable for clinical popularization and application in orthopedics department.

Finally, it should be noted that: the above examples are only intended to illustrate the technical solution of the present invention, but not to limit it; although the present invention has been described in detail with reference to the foregoing embodiments, it will be understood by those of ordinary skill in the art that: the technical solutions described in the foregoing embodiments may still be modified, or some technical features may be equivalently replaced; and such modifications or substitutions do not depart from the spirit and scope of the corresponding technical solutions of the embodiments of the present invention.

Claims

1. A structure of a bone-patellar tendon-bone graft, characterized in that: the patellar bone fixing device comprises a patellar cylinder (1), patellar ligaments (2), a tibia cylinder (3) and conical bodies (4), wherein the patellar cylinder (1) and the tibia cylinder (3) are connected to two ends of the patellar ligaments (2) by virtue of natural biological tissues, the conical bodies (4) are formed by grinding one ends of the patellar cylinder (1) and one end of the tibia cylinder (3), and the pointed ends of the two conical bodies (4) face in the same direction; the diameter is 2mm round hole (5) have been seted up respectively to the respective third demarcation punishment of patella cylinder (1) and shin bone cylinder (3), and patella cylinder (1) and shin bone cylinder (3) are run through in round hole (5), wear in round hole (5) No. two polymer can not absorb braided wire (6).

2. A structure of a bone-patellar tendon-bone graft as claimed in claim 1, wherein: bone tunnels (21) are respectively arranged in the tibia and the femur of a patient, and the cylindrical patella cylinder (1) and the conical body (4) thereof are pulled and inserted into the tibia bone tunnel (21) or the femur bone tunnel (21) of the patient by a second polymer non-absorbable braided wire (6); the tibia cylinder (3) and the conical body (4) thereof are pulled and inserted into a femur bone tunnel (21) or a tibia bone tunnel (21) of a patient by a second polymer non-absorbable braided wire (6).

3. A structure of a bone-patellar tendon-bone graft as claimed in claim 2, wherein: the bone tunnel (21) is a circular front and back pair of perforations with a diameter of 2 mm.

4. A structure of a bone-patellar tendon-bone graft as claimed in claim 1, wherein: the length of the patella cylinder (1) and the conical body (4) thereof, the tibia cylinder (3) and the conical body (4) thereof for transplantation is 10 mm-70 mm, the diameter is 8 mm-20 mm, the length of the patella ligament (2) is 30 mm-75 mm, the width is 5 mm-25 mm, and the thickness is 1 mm-5 mm.

5. A preparation method of a bone-patellar tendon-bone graft is characterized by comprising the following steps: comprises the following steps of (a) carrying out,

completely removing a patella (8), a patellar ligament (2) and a part of tibia (9) from a donor, connecting the patellar ligament (2) with the patella (8) and the part of tibia (9) at two ends through a natural structure, and dividing the patellar ligament (8), the patellar ligament (2) and the part of tibia (9) into two parts from the midline of the patellar ligament (8), the patellar ligament (2) and the part of tibia (9);

II, polishing each half patella (8) bone block divided into two parts into a patella cylinder (1) and a conical body (4) thereof, and polishing each half tibia (9) bone block divided into two parts into a tibia cylinder (3) and a conical body (4) thereof, so as to realize the effect of manufacturing two pieces of bone-patellar tendon-bone graft;

drilling a round hole (5) with the diameter of 2mm on the one-third boundary line of each patella cylinder (1) and each tibia cylinder (3), wherein the round hole (5) is vertical to the surface of the cylinder and penetrates through the cylinder in the front and back directions;

and IV, a second polymer non-absorbable braided wire (6) penetrates into each round hole (5) and is used for pulling the patellar cylinder (1) and the conical body (4) thereof and the tibia cylinder (1) and the conical body (4) thereof to a required position.

6. The transplantation method for patellar tendon replacement transplantation according to claim 5, wherein the transplantation method comprises: the patellar cylinder (1), the patellar ligament (2) and the tibia cylinder (3) for transplantation need to be taken from a healthy donor aged 18-45 years within 12 hours of death or made of artificial vinyl alcohol-hydrogel.

7. The transplantation method for patellar tendon replacement transplantation according to claim 5, wherein the transplantation method comprises: the patellar cylinder (1) and the tibia cylinder (3) for transplantation are white or yellowish and have red health conditions, the patellar ligament (2) is white or yellowish, the trabecular structure of cancellous bone is clear, and the surface of cortical bone is smooth.

8. The transplantation method for patellar tendon replacement transplantation according to claim 5, wherein the transplantation method comprises: the maximum load of the patellar cylinder (1), the patellar ligament (2) and the tibia cylinder (3) for transplantation is more than 1500N.

9. The transplantation method for patellar tendon replacement transplantation according to claim 5, wherein the transplantation method comprises: before the patella cylinder (1), the patellar ligament (2) and the tibia cylinder (3) for transplantation are transplanted, the detection of cytotoxicity, genetic toxicity, sensitization, heat source and hemolysis is needed.