Dalton Sandra K, Bauer Gary R, Lamm Bradley M, Hillstrom Howard J, Spadone Samuel J
Temple University School of Podiatric Medicine, 8th at Race Street, Philadelphia, PA 19107, USA.
J Foot Ankle Surg. 2003 Mar-Apr;42(2):53-62. doi: 10.1016/s1067-2516(03)70002-7.
Polyurethane foam models and cadaver specimens were used to examine the stability of the offset V first metatarsal osteotomy. Uniform osteotomies were performed in all specimens by using a specially designed jig. Specimens in the polyurethane foam model series (n = 10) varied with respect to fixation type, fixation orientation, and degree of lateral translocation of the osteotomy. All specimens were loaded to failure in an Instron testing machine (Instron, Canton, MA). The plantar wing-pin (Kirschner wire) osteotomy group showed statistically significantly greater stiffness (P =.0119) and load at failure (P =.0027) than the dorsal wing-pin group. Cadaveric offset V specimens received the same amount of capital fragment lateral translocation but had different fixation types and orientations. Using the identical protocol as the models, the cadaveric dorsal wing-screw group showed statistically significantly less displacement at failure than the plantar wing-screw, plantar wing-pin, and dorsal wing-pin groups (P =.0262). The dorsal wing-pin group with a synthetic tension band showed a statistically significant greater stiffness (P =.0054) and peak load at failure (P =.0004) compared with the dorsal wing-pin group without the tension band. The most stable offset V construct in the polyurethane foam model was the plantar wing-pin group. The preserved cadaveric specimens yielded different results. The cadaveric dorsal wing-pin group with the synthetic tension band showed superior stability compared with all other non-tension-band groups. These results indicate the importance of tension band effects provided by capsular and ligamentous structures, which are typically ignored in surgical optimization research.
采用聚氨酯泡沫模型和尸体标本研究偏置V形第一跖骨截骨术的稳定性。使用专门设计的夹具在所有标本上进行均匀截骨。聚氨酯泡沫模型系列中的标本（n = 10）在固定类型、固定方向和截骨的侧向移位程度方面存在差异。所有标本均在英斯特朗试验机（英斯特朗，坎顿，马萨诸塞州）上加载至失效。与背侧翼针组相比，足底翼针（克氏针）截骨组在统计学上具有显著更高的刚度（P = 0.0119）和失效载荷（P = 0.0027）。尸体偏置V形标本的股骨头碎片侧向移位量相同，但固定类型和方向不同。采用与模型相同的方案，尸体背侧翼螺钉组在失效时的位移在统计学上显著小于足底翼螺钉组、足底翼针组和背侧翼针组（P = 0.0262）。与没有张力带的背侧翼针组相比，带有合成张力带的背侧翼针组在统计学上具有显著更高的刚度（P = 0.0054）和失效时的峰值载荷（P = 0.0004）。聚氨酯泡沫模型中最稳定的偏置V形结构是足底翼针组。保存的尸体标本得出了不同的结果。与所有其他无张力带组相比，带有合成张力带的尸体背侧翼针组显示出更好的稳定性。这些结果表明了关节囊和韧带结构提供的张力带效应的重要性，而这在手术优化研究中通常被忽略。
