Franssen Bas B G M, Schuurman Arnold H, Brouha Pascal C R, Kon Moshe
Department of Plastic Reconstructive and Hand Surgery, University Medical Center Utrecht, Room number G.04.122, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
Hand (N Y). 2009 Jun;4(2):108-12. doi: 10.1007/s11552-008-9153-8. Epub 2008 Dec 10.
Cooling during drilling Kirschner wires is not always effective in preventing thermal related damage. In this study, we used a human in vitro model and compared temperature elevation, insertion time, and extraction force between three Kirschner wire insertion methods-drilling with and without irrigation and pneumatic hammering. Forty five Kirschner wires were inserted into 15 fresh human cadaver metacarpals. All three insertion methods were applied in each metacarpal. Drilling without irrigation resulted in a temperature elevation of 67.25 +/- 5.4 degrees C with significantly lower values for drilling with irrigation (4.15 +/- 0.6 degrees C) and pneumatic hammering (31.52 +/- 3.4 degrees C). The insertion time for pneumatic hammering (47.63 +/- 8.8 s) was significantly lower compared to drilling without irrigation (263.16 +/- 36.5 s) and drilling with irrigation (196.10 +/- 28.5 s). Extraction forces after drilling without irrigation, drilling with irrigation, and pneumatic hammering were 39.85 +/- 4.1 N, 57.81 +/- 6.5 N, and 62.23 +/- 6.7 N, respectively. Pneumatic hammering is superior to drilling without irrigation, especially when irrigation is not possible.
在克氏针钻孔过程中进行冷却并非总能有效防止热相关损伤。在本研究中，我们使用了人体体外模型，并比较了三种克氏针插入方法（带冲洗和不带冲洗的钻孔以及气动锤击）之间的温度升高、插入时间和拔出力。将45根克氏针插入15根新鲜的人体尸体掌骨中。每种掌骨都应用了所有三种插入方法。不带冲洗的钻孔导致温度升高至67.25±5.4摄氏度，而带冲洗的钻孔（4.15±0.6摄氏度）和气动锤击（31.52±3.4摄氏度）的值明显更低。气动锤击的插入时间（47.63±8.8秒）与不带冲洗的钻孔（263.16±36.5秒）和带冲洗的钻孔（196.10±28.5秒）相比明显更短。不带冲洗的钻孔、带冲洗的钻孔和气动锤击后的拔出力分别为39.85±4.1牛、57.81±6.5牛和62.23±6.7牛。气动锤击优于不带冲洗的钻孔，尤其是在无法进行冲洗时。
