Kloc Paul A, Kowaleski Michael P, Litsky Alan S, Brown Nancy O, Johnson Kenneth A
The Veterinary Orthopedic Research Laboratory, and the Orthopaedic BioMaterials Laboratory, TheOhio State University, Columbus, OH, USA.
Vet Surg. 2009 Jan;38(1):40-8. doi: 10.1111/j.1532-950X.2008.00464.x.
OBJECTIVE: To compare the axial compression stiffness of osteotomized canine tibiae stabilized with Slocum, Securos, or Synthes plates after a tibial plateau leveling osteotomy (TPLO) procedure. STUDY DESIGN: In vitro, paired comparison of cadaveric tibial constructs subjected to mechanical testing under an axial load. SAMPLE POPULATION: Canine tibiae (n=16 pairs) from skeletally mature male and female dogs of various breeds (18-55 kg). METHODS: Tibial pairs (n=16) were randomly assigned to 1 of 2 study cohorts (n=8 pairs/cohort): cohort 1, tibial osteotomy stabilization with a Slocum or a Securos plate, or cohort 2, tibial osteotomy stabilization with a Slocum or a Synthes plate. One tibia from each pair was stabilized with 1 of each plate design assigned to the cohort after TPLO. A 3.2 mm osteotomy gap was maintained during plate application in all constructs. Load and axial displacement were recorded while constructs were loaded to 2000 N in axial compression. Failure loads were not reported because no distinct yield point or failure point was evident within the load range for many specimens. Failure modes were recorded for each construct, and photographs of typical failures were obtained. Stiffness (N/mm) was calculated from load-displacement curves. Paired comparisons of mean stiffness were performed within study groups using a paired t-test. Significance was set at P<.05. RESULTS: The mean construct stiffnesses for the Slocum (383+/-183 N/mm) and Securos (258+/-64.1 N/mm) constructs were not significantly different (P=.164; power=0.566). The mean construct stiffness for the Synthes constructs (486+/-91.0 N/mm) was significantly greater than that of the Slocum constructs (400+/-117 N/mm); P=.0468. Modes of failure for the Slocum (16/16) and Securos (8/8) constructs included plastic deformation of the implant with valgus deformity combined with fibular luxation (2/16 Slocum; 1/8 Securos) or fibular fracture (2/16 Slocum; 4/8 Securos). Most Synthes constructs underwent elastic deformation (7/8). One Synthes construct fractured in the sagittal plane through the tibial plateau depression at the point of load application. CONCLUSIONS: The Slocum and Securos plate/tibia construct have similar stiffness, whereas the Synthes/tibia constructs are significantly stiffer than the Slocum/tibia constructs. Modes of fixation failure observed in this model were consistent with TPLO fixation failures observed clinically. CLINICAL RELEVANCE: Construct stiffness in axial load varies with implant type. Implants that confer higher stiffness to the construct may result in greater fixation stability in tibial metaphyseal osteotomies.
目的:比较在胫骨平台水平截骨术(TPLO)后,使用斯洛康(Slocum)、西库罗斯(Securos)或辛迪斯(Synthes)钢板固定的犬胫骨截骨后的轴向压缩刚度。 研究设计:体外对尸体胫骨构建体在轴向载荷下进行力学测试的配对比较。 样本群体:来自各种品种(体重18 - 55千克)骨骼成熟的雄性和雌性犬的胫骨(n = 16对)。 方法:将胫骨对(n = 16)随机分配到2个研究队列中的1个(每个队列n = 8对):队列1,用斯洛康或西库罗斯钢板进行胫骨截骨固定;队列2,用斯洛康或辛迪斯钢板进行胫骨截骨固定。在TPLO后,每对胫骨中的一根用分配给该队列的每种钢板设计中的一种进行固定。在所有构建体中,钢板应用过程中保持3.2毫米的截骨间隙。在构建体轴向压缩加载至2000牛时记录载荷和轴向位移。由于许多标本在载荷范围内没有明显的屈服点或失效点,因此未报告失效载荷。记录每个构建体的失效模式,并获取典型失效的照片。根据载荷 - 位移曲线计算刚度(牛/毫米)。使用配对t检验在研究组内进行平均刚度的配对比较。显著性设定为P <.05。 结果:斯洛康构建体(383±183牛/毫米)和西库罗斯构建体(258±64.1牛/毫米)的平均构建体刚度无显著差异(P = 0.164;检验效能 = 0.566)。辛迪斯构建体的平均构建体刚度(486±91.0牛/毫米)显著大于斯洛康构建体(400±117牛/毫米);P = 0.0468。斯洛康构建体(16/16)和西库罗斯构建体(8/8)的失效模式包括植入物的塑性变形伴外翻畸形并伴有腓骨脱位(2/16斯洛康;1/8西库罗斯)或腓骨骨折(2/16斯洛康;4/8西库罗斯)。大多数辛迪斯构建体发生弹性变形(7/8)。一个辛迪斯构建体在矢状面通过载荷施加部位的胫骨平台凹陷处发生骨折。 结论:斯洛康和西库罗斯钢板/胫骨构建体具有相似的刚度,而辛迪斯/胫骨构建体比斯洛康/胫骨构建体显著更硬。该模型中观察到的固定失效模式与临床观察到的TPLO固定失效一致。 临床意义:轴向载荷下的构建体刚度因植入物类型而异。赋予构建体更高刚度的植入物可能导致胫骨干骺端截骨术中更大的固定稳定性。
Vet Comp Orthop Traumatol. 2009