Jain R, Podworny N, Hupel T M, Weinberg J, Schemitsch E H
Department of Surgery, St. Michael's Hospital, University of Toronto, Ontario, Canada.
J Orthop Trauma. 1999 Mar-Apr;13(3):178-86. doi: 10.1097/00005131-199903000-00005.
To investigate whether or not the limited contact design of the low-contact dynamic compression plate (LCDCP) provides advantages over the dynamic compression plate (DCP) in the context of cortical bone blood flow, biomechanical properties, and remodeling of bone in segmental tibial fractures.
Randomized trial using canines.
Animal research laboratory.
Eleven canines.
Segmental tibial fractures were surgically created in canine tibiae. The tibiae were reduced and stabilized with 316L stainless-steel, 3.5-millimeter, ten-hole plates: LCDCP (n = 5) or DCP (n = 6).
Laser Doppler flowmetry evaluated cortical bone perfusion in the proximal tibia, segmental piece, and distal tibia (a) before fracture, (b) after fracture, (c) immediately after plating, and (d) at ten weeks. After the dogs were killed at ten weeks, bending stiffness and load to failure of the tibiae were assessed. Tibial cortical bone porosity and new bone formation were measured.
Cortical bone blood flow was similar between the LCDCP and DCP groups throughout the study. Bending stiffness and load to failure of the tibiae were similar between the two groups. Whereas cortical bone porosity and new bone formation were higher in all plated tibiae at ten weeks compared with controls, no differences in cortical bone porosity were seen between the LCDCP and DCP groups. There was a trend toward significantly more new bone formation in the LCDCP group.
The LCDCP is not advantageous in fracture healing or restoration of cortical bone perfusion to devascularized cortex in segmental fractures when plate fixation has been chosen for fracture stabilization. The overall injury following segmental devascularization seems more important to outcome than the type of implant used for fracture fixation up to ten weeks.
探讨在胫骨节段性骨折中，低接触动力加压钢板（LCDCP）的有限接触设计在皮质骨血流、生物力学性能及骨重塑方面是否优于动力加压钢板（DCP）。
使用犬类的随机试验。
动物研究实验室。
11只犬。
通过手术在犬的胫骨上制造节段性骨折。使用316L不锈钢、3.5毫米、十孔钢板对胫骨进行复位和固定：LCDCP（n = 5）或DCP（n = 6）。
用激光多普勒血流仪评估胫骨近端、节段骨块及胫骨远端皮质骨灌注情况（a）骨折前，（b）骨折后，（c）钢板固定后即刻，（d）十周时。犬在十周时处死后，评估胫骨的弯曲刚度和破坏载荷。测量胫骨皮质骨孔隙率和新骨形成情况。
在整个研究过程中，LCDCP组和DCP组的皮质骨血流相似。两组胫骨的弯曲刚度和破坏载荷相似。与对照组相比，所有钢板固定的胫骨在十周时皮质骨孔隙率和新骨形成均更高，但LCDCP组和DCP组之间皮质骨孔隙率无差异。LCDCP组有新骨形成明显更多的趋势。
当选择钢板固定来稳定骨折时，在节段性骨折的骨折愈合或对缺血皮质骨的皮质骨灌注恢复方面，LCDCP并无优势。节段性缺血后的整体损伤对结果似乎比骨折固定所用植入物类型在长达十周的时间内更为重要。
