Andreassen Geir Stray, Høiness Per Reidar, Skraamm Inge, Granlund Odd, Engebretsen Lars
Orthopaedic Centre, Ullevaal University Hospital, 0408, Oslo, Norway.
Arch Orthop Trauma Surg. 2004 Apr;124(3):161-5. doi: 10.1007/s00402-004-0642-0. Epub 2004 Feb 6.
Sufficiently stable constructs may be difficult to obtain with ankle fractures in patients with severe osteopenic bone. Augmentation of the osteosynthesis with a new synthetic bone void filler may help to solve this problem, and it can improve the clinical outcome.
A prospective, open-label study was performed in two surgical clinics in Norway. In 37 of 42 selected patients with Weber type B ankle fractures showing clinical and radiologic signs of osteopenic bone, at least one screw was found to be stripping during open reduction and internal fixation (ORIF). All the stripped screws were augmented with the bone void filler, and tightness was assessed clinically afterwards. All patients were followed up for 2 years. Successful healing of the fracture after 3 months and absence of radiographic movement of the augmented screws were assessed relative to the plate and the bone. Safety was assessed by recording adverse events and abnormal haematology findings.
All 86 augmented screws were clinically tight after augmentation. After 3 months, all fractures healed, and 1 augmented and 1 non-augmented screw appeared to be radiographically loose. After 2 and 6 months, respectively, deep wound infections occurred in 2 patients (5%), necessitating antibiotic treatment, revision surgery and implant removal. After 2 years, all patients had resumed their normal daily activities, and none of the augmented screws showed signs of loosening.
Augmentation of bone screws with this new synthetic bone void filler was an effective means of gaining screw anchorage. Screw stabilisation with the new synthetic bone void filler proved to be safe and effective in the ORIF of ankle fractures in patients with osteopenic bone.
对于骨质疏松严重的患者，踝关节骨折可能难以获得足够稳定的固定结构。使用新型合成骨缺损填充剂增强骨固定术可能有助于解决这一问题，并能改善临床疗效。
在挪威的两家外科诊所进行了一项前瞻性、开放标签研究。在42例入选的Weber B型踝关节骨折患者中，有37例表现出骨质疏松的临床和影像学征象，在切开复位内固定（ORIF）过程中至少有一枚螺钉出现松动。所有松动的螺钉均用骨缺损填充剂进行增强，术后临床评估其紧固程度。所有患者均随访2年。相对于钢板和骨骼，评估3个月后骨折的成功愈合情况以及增强螺钉在影像学上有无移位。通过记录不良事件和血液学异常结果评估安全性。
所有86枚增强后的螺钉在临床上均固定牢固。3个月后，所有骨折均愈合，1枚增强螺钉和1枚未增强螺钉在影像学上似乎出现松动。分别在2个月和6个月时，2例患者（5%）发生深部伤口感染，需要进行抗生素治疗、翻修手术并取出植入物。2年后，所有患者均恢复了正常日常活动，且所有增强螺钉均未出现松动迹象。
使用这种新型合成骨缺损填充剂增强骨螺钉是获得螺钉锚固的有效方法。在骨质疏松患者的踝关节骨折切开复位内固定术中，使用新型合成骨缺损填充剂稳定螺钉被证明是安全有效的。
