脛骨固定釘

1、Intrafix 背景,誰發(fā)明了Intrafix?Joseph Sklar, MDSpringfield, MA, USAPublished research partner of Charlie Brown, MD.對(duì)T-Fix 半月板修復(fù) and EndoButton 股骨端固定技術(shù)有貢獻(xiàn),Intrafix 背景,為什么發(fā)明 Intrafix?因?yàn)闆]有針對(duì)軟組織移植物的堅(jiān)強(qiáng)的，牢固的隧道內(nèi)固定裝置。Intrafix 什么

2、時(shí)候問世的?1999年第四季度在美國有限量的推出。被Mitek并構(gòu)時(shí)中斷。1999年6月起有臨床報(bào)道。,BTB Segment:BiocrylAbsoluteST Segment:IntrafixRIGIDfixLinx HTBiocrylAbsolute,定位,定位,,“Hamstring 固定?！惫潭◤?qiáng)度 > than BTB, 金標(biāo)準(zhǔn)。,特征:30mm 4 根凹槽的鞘。統(tǒng)一標(biāo)準(zhǔn)30mm 錐形螺釘

3、6-8mm7-9mm8-10mm,Intrafix 脛骨固定,Intrafix 脛骨固定,其他工具:拉緊器 – separates sheath placement and compatible w/ any ST GraftsModular ACL 手柄 – 植入用30mm Hex 螺絲刀 – 和 Absolute 30mm螺絲刀一樣 9” x .045 合金導(dǎo)針 – 防止螺釘偏移，促進(jìn)鞘的膨脹,Intraf

4、ix 設(shè)計(jì)原理,軟組織脛骨固定:脛骨骨密度不均勻 經(jīng)典的干擾固定力量較小。不帶骨的肌腱較滑。不帶骨的肌腱質(zhì)量較小。關(guān)節(jié)線固定在軟的松質(zhì)骨上。遠(yuǎn)端皮質(zhì)骨的固定突出。懸吊費(fèi)用較高。,這些研究表明有關(guān) Intrafix?,這是一種新的為軟組織移植物設(shè)計(jì)的脛骨端固定標(biāo)準(zhǔn)，和最好的股骨端固定一樣。固定強(qiáng)度。移植物硬度高。分離移植物，促使四周愈合。臨床表明，膝關(guān)節(jié)有和BTB重建類似的強(qiáng)度。,Intrafix 技術(shù)as d

5、escribed by J. Sklar, M.D.,用#2 Ethibond縫線編織移植物的兩頭。,Intrafix 技術(shù),脛骨導(dǎo)向器用40-50o 通常 35-45mm 長。,Intrafix 技術(shù),鉆孔，擴(kuò)隧 隧道=移植物 簡單T=G 使隧道較緊，很多醫(yī)生喜歡用。醫(yī)生根據(jù)不同的螺釘尺寸調(diào)整。,Intrafix 技術(shù),把縫線編成2個(gè)圈 ， 把線圈套在拉緊器上，施加拉力。,Intrafix 技術(shù),插入 Shea

6、th Trial 對(duì)肌腱加壓，準(zhǔn)備植入鞘的路徑。重要!隧道 < 8mm – 植入移植物前先用trial。,Intrafix 技術(shù),插入鞘(tab 置于12點(diǎn)鐘的位置)。插入鞘，直到接觸皮質(zhì)骨，不要超過。,Intrafix 技術(shù),屈膝至 10-40o (醫(yī)生偏好）重要: 植入時(shí)保持拉力器和螺釘?shù)膲毫Α０崖葆斨萌肭蕛?nèi)。螺釘接觸皮質(zhì)。,Intrafix 技術(shù),修剪多余的鞘和移植物。完成!簡單固定牢“No profi

7、le”,Intrafix 尺寸選擇參考,Intrafix Pearls,Dilation is goodIf the tunnel is </= to 8mm, insert the Sheath Trial before passing graft to pre-notch the tunnel.Clear tissue away from tunnel edge to improve visibility. “How d

8、o I know when the screw is flush?”,Intrafix Pearls,Use a guide wire in the tunnel between the graft limbs as a hole finder to confirm tunnel angle.Use the Tie Tensioner: It separates the strands for the Sheath, creates

9、 uniform tension on all strands, minimizes Sheath rotation during insertion.Use a guide wire to guide the tapered screw to prevent divergence.,Intrafix Pearls,Don’t advance the Screw and Sheath up the tunnel. (Rare)Ca

10、ncellous bone will not fixate as strong as cortical. Remember the screw is tapered. 6-8 means it’s 6mm on distal end, 7mm in the middle, and 8mm proximal.,Intrafix,,Intrafix Features and Benefits,Clinical Experience,H

11、ow do surgeons define a successful ACL procedure?,Clinical Experience to Date,33 patients: >6 months post-opSuccessful ACL Surgery –KT 1000 5mmLachman82% negative,ACL Biomechanics Graft Strength,ACL Biomechanics

12、Graft Fixation Strength,Intrafix provides strength equal to femoral fixation,Intrafix Tibial Stiffness Compared to Femoral Fixation,Brown & Sklar, human cadaver knees,Sheep Histology, 12 Weeks, Sklar,Bone ingrowth,

13、Graft tissue,,,,,Intrafix Tissue to Bone Healing,Easy revision,Graft strands are compressed against bone Sheath comes out in one pieceVascularization can be seen,Intrafix Quote’s from Orthopedic Surgeons,Richmond “In

14、trafix has given me results at least equal if not better than prior bioabsorbable screw with secondary fixation around the post, while eliminating hardware problems”Simonian “I used to use a belt and suspenders system.

15、 Intrafix .. allows for secure intratunnel fixation on its own and therefore shortens the points of fixation at the same time does not require a back-up device”Friedman “I think the learning curve is easy, it is import

16、ant to aggressively debride the tibial tunnel for visualization,Intrafix Quote’sfrom Orthopedic Surgeons,Burks “Intrafix gives me 1mm better KT-1000 scores than my old fixation”Lintner “I switched to Intrafix because

17、of the superior strength, the ability to obtain equal tension on all four of the graft strands, and circumferential fill of the tunnel. The tensioner can look cumbersome but in fact, after a few cases it becomes quite