Weiner Marsha, Damron Timothy A, Patterson Francis R, Werner Frederick W, Mann Kenneth A
Department of Orthopedics, Upstate Medical University, State University of New York at Syracuse, Syracuse, New York, USA.
Clin Orthop Relat Res. 2004 Feb(419):232-7. doi: 10.1097/00003086-200402000-00038.
Defects from curettage for giant cell tumors of bone frequently have been reconstructed with bone cement with or without reinforcement pins. The biomechanical basis for the addition of reinforcement pins was examined using a model of a contained defect in the proximal tibia. Fifty-four cadaveric proximal tibia in matched pairs were divided into five test groups: intact tibia, medial metaphyseal contained defect, defect reconstructed with cement alone, defect reconstructed with cement and pins inserted within the medullary canal, and defect reconstructed with cement and pins inserted through the cortex. Specimens were tested to failure during one cycle of compressive loading. Defect specimens were significantly weaker and less stiff than intact specimens, establishing the validity of the model-contained defects. For the reconstructions, there was no statistically significant difference in load to failure, stiffness, energy to failure, or displacement for the polymethylmethacrylate treatment alone when compared with matched specimen receiving polymethylmethacrylate and pins treatment. Similarly, there was no statistical difference in biomechanical properties in comparing matched specimens treated with polymethylmethacrylate alone or polymethylmethacrylate/pins (cortex). For contained defects of the proximal tibia that are typical after curettage for giant cell tumor, there appears to be no biomechanical advantage to use of reinforcement pins in the cement.
骨巨细胞瘤刮除术后的骨缺损常常采用骨水泥进行重建，骨水泥中可加或不加加强针。使用胫骨近端包容型骨缺损模型研究了添加加强针的生物力学基础。将54对配对的尸体胫骨近端分为五个试验组：完整胫骨组、内侧干骺端包容型骨缺损组、单纯用骨水泥重建的缺损组、用骨水泥及髓腔内插入加强针重建的缺损组、用骨水泥及穿过皮质插入加强针重建的缺损组。在一个压缩载荷循环过程中对标本进行破坏试验。缺损标本比完整标本明显更脆弱且刚度更低，从而证实了包容型骨缺损模型的有效性。对于重建手术，与接受聚甲基丙烯酸甲酯和加强针治疗的配对标本相比，单纯聚甲基丙烯酸甲酯治疗在破坏载荷、刚度、破坏能量或位移方面没有统计学上的显著差异。同样，在比较单纯用聚甲基丙烯酸甲酯或聚甲基丙烯酸甲酯/加强针（皮质）治疗的配对标本时，生物力学性能也没有统计学差异。对于骨巨细胞瘤刮除术后典型的胫骨近端包容型骨缺损，在骨水泥中使用加强针似乎没有生物力学优势。
