Jazrawi L M, Kummer F J, Simon J A, Bai B, Hunt S A, Egol K A, Koval K J
Department of Orthopaedic Surgery, New York University-Hospital for Joint Diseases, New York 10003, USA.
J Trauma. 2000 Jan;48(1):87-92. doi: 10.1097/00005373-200001000-00015.
A comminuted, intra-articular distal femur fracture was surgically treated by the authors with a locked, double-plating technique because fixation stability could not be initially achieved by using a standard double-plating technique. The purpose of this study was to determine biomechanically whether a locked double-plate construct would enhance fixation stability compared with a nonlocked double-plate construct.
Six matched pairs of mildly osteopenic femurs were selected and all had a reproducible intra-articular fracture pattern created. Each pair underwent fixation with either a double-plating construct or a locked, double-plating construct that was randomly assigned. The instrumented femurs were then mechanically tested in several loading modes to determine fixation stability. After initial testing, specimens were cyclically loaded and retested for stability.
The locked, double-plating construct provided significantly greater fixation stability than the standard double-plating construct in precycling and postcycling biomechanical testing.
The technique described is particularly applicable for severely comminuted fractures of the distal femur and fractures in osteopenic bone with poor screw purchase. It offers a simple alternative for enhancing fixation stability, which avoids the potential complications of methylmethacrylate-enhanced screw fixation.
作者采用锁定双钢板技术对一例股骨远端粉碎性关节内骨折进行了手术治疗，因为最初使用标准双钢板技术无法获得固定稳定性。本研究的目的是通过生物力学方法确定锁定双钢板结构与非锁定双钢板结构相比是否能提高固定稳定性。
选择六对匹配的轻度骨质疏松股骨，均制造出可重复的关节内骨折模式。每对股骨随机采用双钢板结构或锁定双钢板结构进行固定。然后对植入器械的股骨进行多种加载模式的力学测试以确定固定稳定性。初始测试后，对标本进行循环加载并重新测试稳定性。
在循环前和循环后的生物力学测试中，锁定双钢板结构比标准双钢板结构提供了显著更高的固定稳定性。
所描述的技术特别适用于股骨远端严重粉碎性骨折以及骨质疏松骨中螺钉把持力差的骨折。它为提高固定稳定性提供了一种简单的替代方法，避免了甲基丙烯酸甲酯增强螺钉固定的潜在并发症。
