Kimball H L, Aronow M S, Sullivan R J, Tarinelli D J, Nowak M D
The University of Connecticut Health Center, Department of Orthopaedic Surgery, Farmington 06034-4037, USA.
Foot Ankle Int. 2000 Oct;21(10):845-8. doi: 10.1177/107110070002101008.
Calcaneocuboid distraction arthrodesis can be used to treat stage 2 posterior tibial tendon dysfunction. Nonunion, graft resorption, and implant failure have been reported after this procedure. This study compared two of the most commonly used methods for fixation of calcaneocuboid distraction arthrodesis. Twelve pairs of cadaver feet underwent simulated calcaneocuboid distraction arthrodesis. One specimen in each pair was fixed with two crossed 3.5 mm cortical lag screws. The contralateral specimen was fixed with a cervical H-plate. The calcaneus was fixed and a load was applied to the plantar aspect of the cuboid at a rate of 5 mm/minute until joint separation of 3 mm or fracture occurred. The average applied load to failure at 1.0 mm of joint separation was 30.5 +/- 11.6 N for the crossed screws and 77.7 +/- 36.4 N for the cervical H-plate (p = 0.001). The average stiffness at 1.0 mm of joint separation was 27.5 +/- 10.9 N/mm for the crossed screws and 43 +/- 21.2 N/mm for the cervical H-plate (p = 0.036). The higher stiffness and load to failure may account for the decreased nonunion rate noted anecdotally by some surgeons with H-plate fixation over crossed screw fixation for calcaneocuboid distraction arthrodesis.
跟骰关节撑开融合术可用于治疗2期胫后肌腱功能障碍。据报道，此手术后会出现骨不连、移植物吸收和植入物失败等情况。本研究比较了跟骰关节撑开融合术中两种最常用的固定方法。对12对尸体足进行了模拟跟骰关节撑开融合术。每对中的一个标本用两根交叉的3.5毫米皮质拉力螺钉固定。对侧标本用颈椎H型钢板固定。固定跟骨，并以5毫米/分钟的速度向骰骨足底施加负荷，直至关节分离3毫米或发生骨折。关节分离1.0毫米时，交叉螺钉组至失败的平均施加负荷为30.5±11.6牛，颈椎H型钢板组为77.7±36.4牛（p = 0.001）。关节分离1.0毫米时，交叉螺钉组的平均刚度为27.5±10.9牛/毫米，颈椎H型钢板组为43±21.2牛/毫米（p = 0.036）。较高的刚度和至失败的负荷可能解释了一些外科医生在跟骰关节撑开融合术中采用H型钢板固定相对于交叉螺钉固定时骨不连发生率降低的现象。
