1、ACL 股骨端固定 -可吸收横穿钉 BTB or ST 移植物,是什么?,手术技巧,工具,手术技巧 软组织,钻胫骨和股骨隧道直径，保证移植物与之相配。 30mm 推荐的股骨隧道深度。不能把横穿钉留在股骨里。,手术技巧 软组织,沿着胫骨隧道把RigidFix 导向器向上插入股骨。 杆的肩部应该接触到股骨隧道的底部。保证接近关节线固定。,钻入套管，从股骨外侧插入套针。钻的时候不要对框架过分加压。,手术技巧 软组织,手术技巧 软组织,取出交锁的套针, 把套管留在导向器中。 (敲打钻夹，使交锁钉从套管中心松解出来，然后可以取出套针）。,插入第二根套管/套针。,手术技巧 软组织,手术技巧 软组织,取下导
2、向器。在把移植物拉入关节前。.如果使用Intrafix, 用试验工具插入胫骨隧道深度到 30mm，为Intrafix器械开辟空间。,手术技巧 软组织,移除试验物。把移植物拉入隧道。 (移植物上 30mm的标记应该在股骨孔的边缘)。,手术技巧 软组织,用植入杆和锤子,插入横穿钉(插入植入杆直到碰到套针的肩部)。移植物被2根横穿钉固定。,手术技巧 软组织,用移除工具取出套管 (拉紧移植物，确保不移动)。用Intrafix固定胫骨端。,手术技巧 软组织,手术技巧BTB,钻胫骨和股骨隧道，使骨栓与之相配。股骨隧道的建议深度是25-30mm。（最深 45mm）钻的太深会导致框架 “bottom out”
3、 或 move out of the reach of the pins in the narrow shaft of the bone.You can insert the guide over a drill pin with BTB Rigidfix.,手术技巧BTB,沿着胫骨隧道把RigidFix 导向器向上插入股骨。 杆的肩部应该接触到股骨隧道的底部。You can insert the guide over a drill pin with BTB Rigidfix.,手术技巧BTB,手术技巧 BTB,从股骨外侧钻入套管和套针 (保证两者结合在一起）套管和套针停止，不和导针接触。,
4、Drill Pin w/eyelet,手术技巧BTB,取出交锁的套针，把套管留在导向器中。 敲打钻夹，使交锁钉从套管中心松解出来，然后可以取出套针）。,手术技巧BTB,插入第二根套管和套针。,手术技巧BTB,移除导向器。把移植物拉入隧道。 医生可以选择以下2种方法中的一种来定股骨隧道中移植物的方向皮质表面 前/后如果骨栓不是四边形的，钉子会固定不好，所有试验都已证明。皮质表面 内/外 钉子固定牢固胫骨端可以扭转重新定位。,手术技巧BTB,钻入套针，穿过骨栓，知道碰到套管中心停止。,手术技巧BTB,用植入杆和锤子，插入 Rigidfix横穿钉。植入杆有一个肩部,横穿钉不会插入过深。,手术技巧BT
5、B,移植物被2根平行的横穿钉固定（拉紧移植物，防止移动）。用移除工具取出套管。用Absolute螺钉作胫骨端固定。,手术技巧BTB,让医生理解为什么骨栓应该尽量作成圆形，而不是三角形。股骨端骨栓只用一根缝线。2根线会造成移植物的孔太多。在钻第二个横穿孔前，把远端的横穿钉穿过移植物。这样防止切割线。确保导向器放置恰当。不必测量。如果导向器框架松驰，事先测量的会不准。,手术技巧BTB,当把导向器框架置入胫骨和股骨隧道时，要用锤子。保证用锤子敲打框架的时候，敲股骨杆下面的框架，防止框架弯曲变形。对于一个左膝,如果 if the screw holding the femoral rod in pla
6、ce is digging into the tibia, it can be removed as long as special attention is given to making sure the rod stays completely seated while the sleeves/trocars are drilled.,特征和优点,特征 功能 优点,拉力,拉力,3-Week Results: Both the Mitek cross-pin and the Bio- Screw groups demonstrated a close apposition between
7、the bone plug and the drill hole. Both groups showed early signs of healing, and there was no apparent adverse local reaction to the Mitek BTB cross pins or the BioScrew. In three of the 3-week Linvatec BioScrew specimens, the bone plug appeared to be “wrapped around” the screw. This suggests that t
8、he plug may have split or fragmented, allowing the screw to “settle” deeper into the plug.6-Week Results: The bone plugs showed good integration into the surrounding bone in both groups. Evidence of endochondral bone repair was apparent throughout the interface of the bone plug and surrounding host
9、bone in all specimens. Clinical union (mineralized callus spanning the plug and the host bone) was observed in all specimens. Two of the 6-week BioScrew specimens wrapped around the screw. This suggests that the plug may have split or fragmented, allowing the screw to settle deeper in the plug. Ther
10、e was no evidence of tissue reaction to either implant.12-Week Results:Mature bone was seen bridging the interface between the bone plug and the surrounding host bone in all specimens. There was no evidence of tissue reaction to either implant. This study demonstrates that Mitek BTB cross pins do no
11、t affect the normal incorp- oration of a corticocancellous bone plug in comparison to an absorbable interference-fit screw (Linvatec BioScrew). The study also shows that Mitek BTB cross pins permit a significantly (p0.001) larger healing surface area for the bone plug compared to an absorbable inter
12、ference-fit screw (Linvatec BioScrew).,用预钻孔的假骨作 5-10 分钟的演示。你的目标是所有做BTB和ST的医生。在做演示前知道他们的手术方法，他们用什么？可吸收还是不可吸收，干预螺钉，横穿钉还是Endo Button.坚强，牢固，愈合好, 可重复, 使用方便。让相关人员参与。创造一种使用和需求的的紧急性。在测试阶段设定参数。,Rigidfix销售,Rigidfix 的反对意见,我担心横穿钉会损坏移植物。Mitek在Rigidfix推出前做过试验，用2.7mm的钉子做 9-12mm 的BTB骨栓固定，不会造成潜在的移植物损坏。获取四边形而不是三角形骨栓的
13、移植物，使之在股骨隧道中较紧的固定也很重要。,我担心如果移植物没有绕在横穿钉上，会影响固定效果。There are several factors that contribute to the great fixation that the ST Rigidfix offers;-Interference fixation-Fixation within the Tendon Fibers-Fixation within the whip stitch-Four bundles made into one tight bundle-Two points of fixation I do not
14、 like having the pins skewer the graft.The pins do not skewer the graft, they part the tendonfibers. As a result, the tendon fibers are compressed against the femoral tunnels walls.,Rigidfix的反对意见,股骨端固定 RIGIDfix versus Endobutton关节线固定比较,13mm from joint line (surgeon has the option to adjust), 50 + mmfrom joint Line,股骨端固定 RIGIDfix versus Endobutton关节线固定比较,
