使用推拉技术预防先天性腓骨骨折:单皮质后螺钉与双皮质后螺钉的生物力学比较。

IF 1.1 4区 医学 Q3 ORTHOPEDICS Orthopedics Pub Date : 2024-09-01 Epub Date: 2024-07-08 DOI:10.3928/01477447-20240702-02
Sheldon A McCown, Paul J Weatherby, Randal P Morris, Vinod K Panchbhavi, John C Hagedorn, William M Weiss, Jie Chen
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引用次数: 0

摘要

背景:移位的骺端骨折可采用推拉技术进行复位,即在骨折远端碎片上固定钢板,在钢板近端放置后螺钉,并使用薄板扩张器进行牵引。本研究评估了双皮质和单皮质后螺钉在复位过程中的失效载荷和失效机制:对四对匹配的尸体腿部进行 2 厘米斜截骨,模拟移位的斜骺骨折。用 2 颗单皮质锁定螺钉将 6 孔加压钢板固定在远端碎片上,并在钢板近端插入 12 毫米单皮质或 20 毫米双皮质螺钉作为后置螺钉。使用薄层骨扩张器在钢板和后螺钉之间施加牵引力。机械致动器模拟牵引过程,直至失效。记录最大施加载荷、位移和吸收能量,并通过配对 t 检验比较单皮质组和双皮质组:在最大负荷下,我们发现两组之间的位移(P=.003)和能量吸收(P=.022)有显著的统计学差异。所有单皮质螺钉均因螺钉拨动和骨切断而失效。双皮质螺钉通过弯曲失效,螺钉部位的骨骼没有明显损伤:结论:当骺端骨折明显缩短,需要更大的牵引力来实现骨折复位时,双皮质螺钉会表现出更高的失效机械负荷,螺钉移除部位的骨质流失也会增加。如果只需要很小的牵引力,可以使用单皮质后螺钉。[骨科。202x;4x(x):xx-xx]。
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Preventing Iatrogenic Fibula Fractures Using the Push-Pull Technique: A Biomechanical Comparison of Unicortical Versus Bicortical Post Screws.

Background: Displaced diaphyseal fractures can be reduced using the push-pull technique, wherein a plate is affixed to the distal fragment of the fracture, a post screw is placed proximal to the plate, and a lamina spreader creates distraction. This study evaluated the load to failure and mechanism of failure of bicortical and unicortical post screws during reduction.

Materials and methods: Four matched pairs of cadaver legs were subjected to a 2-cm oblique osteotomy simulating a displaced, oblique diaphyseal fracture. A 6-hole compression plate was affixed to the distal fragment with 2 unicortical locking screws, and a 12-mm unicortical or 20-mm bicortical screw was inserted as a post screw proximal to the plate. A lamina bone spreader was used to exert a distraction force between the plate and the post screw. A mechanical actuator simulated the distraction procedure until failure. Maximum applied load, displacement, and absorbed energy were recorded and compared across unicortical and bicortical groups by paired t tests.

Results: At maximum load, we found statistically significant differences in displacement (P=.003) and energy absorbed (P=.022) between the two groups. All unicortical screws failed through screw toggle and bone cut-out. Bicortical screws failed through bending, with no visible damage to the bone at the screw site.

Conclusion: When diaphyseal fractures are significantly shortened and require a greater distraction force to achieve reduction, bicortical screws demonstrate a higher mechanical load to failure and increased bone loss from the screw-removal site. A unicortical post screw may be used if minimal distraction is needed. [Orthopedics. 2024;47(5):308-312.].

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来源期刊
Orthopedics
Orthopedics 医学-整形外科
CiteScore
2.20
自引率
0.00%
发文量
160
审稿时长
3 months
期刊介绍: For over 40 years, Orthopedics, a bimonthly peer-reviewed journal, has been the preferred choice of orthopedic surgeons for clinically relevant information on all aspects of adult and pediatric orthopedic surgery and treatment. Edited by Robert D''Ambrosia, MD, Chairman of the Department of Orthopedics at the University of Colorado, Denver, and former President of the American Academy of Orthopaedic Surgeons, as well as an Editorial Board of over 100 international orthopedists, Orthopedics is the source to turn to for guidance in your practice. The journal offers access to current articles, as well as several years of archived content. Highlights also include Blue Ribbon articles published full text in print and online, as well as Tips & Techniques posted with every issue.
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