AO Research Institute Davos, AO Foundation, Clavadelerstrasse, 8, CH-7270, Davos Platz, Switzerland.
Eur Cell Mater. 2010 Feb 26;19:117-26. doi: 10.22203/ecm.v019a12.
Difficulties removing temporary fracture fixation devices due to excessive bony on-growth results in extended surgical time leading to excessive blood loss, debris contamination and potentially refracture. Commercially available locking plates and screws are manufactured for clinics with a micro-rough surface, which contributes to the excessive bony on-growth reported. We have applied polishing technology to commercially pure titanium locking compression plates (LCP) and titanium-6%aluminium-7%niobium (TAN) plates and screws to assess if it can alleviate problems with strong bony overgrowth. Samples were implanted for 6, 12 and 18 months in a bilateral sheep tibia non fracture model and assessed for screw removal torque, percentage of bone contact and tissue-material response. Both electropolishing (p=0.001) and paste polishing (p=0.010) of TAN screws significantly reduced the mean torque required for removal compared to their micro-rough counterparts. This was accompanied by a trend for a lower percentage of bone contact for polished screws. This difference in bone contact was significant for paste polished TAN screws (p<0.001 parallel but not electropolished TAN screws (p=0.066). Ex vivo, soft tissue removal was much easier (approximately five minutes) for polished constructs, which was difficult and at least four times longer for standard micro-rough constructs. We suggest that polishing of locked plate/screw systems will improve ease of removal and reduce implant related removal complications encountered due to excessive strong bony on-growth while maintaining biocompatibility and implant stability. Future studies aim to assess the potential of this technology in the next level of complication, a fracture model.
由于骨过度生长导致临时骨折固定装置难以去除，从而导致手术时间延长，失血过多、污染和潜在的再骨折。市售的锁定板和螺钉是为具有微粗糙表面的诊所制造的，这导致了报道的过度骨生长。我们已经将抛光技术应用于商用纯钛锁定加压板（LCP）和钛-6%铝-7%铌（TAN）板和螺钉，以评估其是否可以缓解严重骨过度生长的问题。在双侧绵羊胫骨非骨折模型中植入样品 6、12 和 18 个月，评估螺钉去除扭矩、骨接触百分比和组织-材料反应。与微粗糙的 TAN 螺钉相比，电抛光（p=0.001）和膏体抛光（p=0.010）均显著降低了 TAN 螺钉去除所需的平均扭矩。这伴随着抛光螺钉骨接触百分比降低的趋势。这种骨接触差异在膏体抛光的 TAN 螺钉中是显著的（p<0.001 平行但不是电抛光的 TAN 螺钉（p=0.066）。在体外，抛光结构的软组织去除更容易（大约五分钟），而标准微粗糙结构则困难得多，至少需要四倍的时间。我们建议，对锁定板/螺钉系统进行抛光将改善去除的便利性，并减少因过度强烈的骨生长而导致的与植入物相关的去除并发症，同时保持生物相容性和植入物稳定性。未来的研究旨在评估这项技术在骨折模型的下一级并发症中的潜力。
