| Objective: With the increase in people’s outdoor sports and changes in traffic patterns,tibial intercondylar spine fracture had shown an increasing trend and usually occurred in spords and traffic accidents.Tibial intercondylar spine fracture,as a special form of anterior cruciate ligament injury,was divided into type 3 for Meyeers-Mckeever and at the same time type Ⅲ fractures need surgery.Treatments mainly include open reduction and internal fixation under arthroscopy,the clinical use of arthroscopic tibial dual tunnel suture fixation was common,but it easily lead to fracture uptake,poor fixation and obvious Cutting effect,so it needs to explore new fixation to achieve better clinical results.this study attempted to enrich the approach of minimally invasive arthroscopy for tibial intercondylar intertrochanteric fractures by designing a tibial intercondylar spine fracture under the tibial tunnel.In this study,through the production of tibial intercondylar spine Meyers-Mckeever typeⅢ fracture knee joint model,we established a new internal fixation model combined with self-designed idea.A comparative study of the biomechanical tests of animal fractures was conducted to compare the fixation strength of tibial intercondylar spine fractures between two different internal fixations,and the robustness of the fixation method was tested to understand the biomechanical properties and the fixation effect of two different tunneling paths under the same suture fixation technique between two different tunneling paths.it could guide the clinical treatment of arthroscopic intercondylar spine fracture and the therapeutic effect of long-term follow-up in the further,which also provided theoretical guidance for the study of clinical treatment of intercondylar spine fracture.Methods: A total of 45 male knee specimens were collected from 10 to 12 months old and weighing 60 to 65 kg,which were excluded from bone diseases,trauma and other metabolic diseases,osteoporosis and severe deformity by X-ray examination.The knee joints of the specimens were dissected at room temperature and the tibial intercondylar spine fracture model of Meyers-Mckeever type Ⅲ were established.Because tension band technology was used for minimally invasive treatment of tibial intercondylar spine fractures with arthroscopic techniques at this stage,the effect was clinically widely accepted.Therefore,the suture tension band technique is commonly used to fix the fracture mass and carryed out related biomechanics research.In this study,Arthrex’s Fiber Wire suture was selected.45 pig knee specimens were prepared and were randomly divided into 3 groups(n = 15).Group A was treated with tibial double tunnels with non-absorbable Fiber Wire line to fix tibial intercondylar fractures,while group B was treated with tibia three tunnels with Fiber Wire line and Group C was fixed with ordinary screws.The specimens were placed in the refrigerator cold standby after the production.For the establishment of the Meyers-Mckeever typeⅢ tibial intercondylar spine fracture model,bone chisel was used in the anterior cruciate ligament tibial puncture with a triangular fracture mass of 2.0 cm x 2.0 cm x 1.0 cm x1.0cm,and 1.5 cm deep.The Meyer-Mckeever typeⅢ fracture model of the tibial intercondylar spine of the pig knee joint was used to simulate front knee drawer test with a 90° flexion knee.First,the prepared fracture model was placed on a universal displacement mechanics machine in which the tibial ends were fixed to a specially tailored gripping tool and the femoral ends were secured with a special adhesive.Secondly,the front drawer test was simulated in the 90° state of the knee flexion,and the traction force of 60 N,90N,120 N was set in the continuous state.The displacement under different tension of the anterior cruciate ligament of each specimen was recorded by high performance computer.The change of displacement of anterior cruciate ligament in each group was analyzed and compared.The experimental data was used to analyze and compare the anterior displacement in each group.Finally,the collected data was analyzed by SPSS 22.0 and the final test results were obtained.The advantages and disadvantages of the two kinds of internal fixation methods were compared.Results: The displacement of the longitudinal anterior cruciate ligament was measured under the load of 60 N,90N and 120 N separately in the tibial three tunnels’ fixed group,the double tunnels’ fixed group and the screw fixation group: The average displacements of the two tunnel group unde the load of 60 N,90N and 120 N were 3.34?1.22 mm,6.23?2.32 mm,7.79?2.54 mm in turn;the average displacement of the tunnel group unde the load of 60 N,90N and 120 N were 1.60?0.53 mm,3.14?0.68 mm,4.24?0.81 mm in turn;The average displacement of the screw control group unde the load of 60 N,90N and 120 N were 1.48?0.36 mm,2.48?0.53 mm,3.34?0.75 mm in turn.The average displacement of the double-tunnel group,the three-tunnel group and the Screw control group were calculated by mechanical test and analyzed by SPSS22.0 software.There were statistically significant differences between the two groups in terms of(±S): There was no significant difference between the three-tunnel group and the screw control group(P>0.05),while the difference between the double-tunnel group and the screw control group and the difference between the double-tunnel group and the three-tunnel group were significant under the load of 60 N,90N and 120N(P<0.05).Conclusions: For the clinically treatment of intercondylar spine fracture by arthroscopic,tension band fixation technology was superior to other fixed way.The technique allowed the intercondylar spine to fix the entire fracture piece from the front to the back,the fracture mass could be very strong,and minimally invasive treatment could reduce Xpostoperative complications,postoperative knee function recovery was relatively good.In this study,The fixation of tibial intercondylar spine fractures with tibial three-tunnel fixation with Fiber Wire suture fixation is as reliable as that of screw control group.Compared with double-tunnel fixation,it has better stability,greater strength and better biomechanical performance. |
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