Bras Jose J, Lillich James D, Beard Warren L, Anderson David E, Armbrust Laura J, Frink Elizabeth, Lease Kevin
Department of Clinical Sciences, Kansas State University, Manhattan, KS, USA.
Vet Surg. 2011 Jan;40(1):73-81. doi: 10.1111/j.1532-950X.2010.00741.x. Epub 2010 Nov 15.
To (1) compare the effect of a collateral ligament sparing surgical approach with an open surgical approach on mechanical properties of proximal interphalangeal joint (PIPJ) arthrodesis, and (2) to determine the percentage of articular cartilage surface removed by transarticular (TA) drilling with different diameter drill bits.
Randomized paired limb design.
Cadaveric equine limbs (n=76).
Cadaveric PIPJ were drilled using a 3.5, 4.5, or 5.5 mm drill bit at 80-84° to the dorsal plane to remove articular cartilage and subchondral bone from the distal articular surface of the proximal phalanx (P1) and the proximal articular surface of the middle phalanx (P2). Bone ends were photographed and the percentage of the projected surface area that was denuded of cartilage was measured. PIPJ arthrodesis constructs (3-hole dynamic compression plate [DCP], two 5.5 mm TA screws inserted in lag fashion, medial and lateral to the DCP; DCP-TA) were created using 2 surgical approaches in paired limbs. A conventional open approach was used in 1 limb and a collateral ligament sparing approach used in the other limb. Constructs were tested to failure in single-cycle 3-point dorsopalmar/plantar or lateromedial bending. Maximum load, yield load, and composite stiffness were compared between techniques.
The 3.5, 4.5, and 5.5 mm drill bits removed 24±4%, 35±5%, and 45±7% of total PIPJ articular cartilage surface, respectively. Constructs with the collateral ligament sparing approach had significantly greater mean yield load (11.3±2.8 versus 7.68±1.1 kN, P=.008) and mean maximum load (13.5±3.1 versus 10.1±1.94 kN, P=.02) under lateromedial bending. Under dorsopalmar/plantar bending there was no significant difference between surgical approaches. The collateral ligament sparing arthrodesis technique had a shorter surgical time (19±3 minutes) compared with the open technique (31±3 minutes).
A collateral ligament sparing surgical approach to the PIPJ with removal of articular cartilage by TA drilling and arthrodesis by DCP-TA was faster and stronger in mediolateral bending than arthrodesis constructs created with an open surgical approach.
Preservation of the collateral ligaments and TA drilling for cartilage removal during PIPJ arthrodesis may be a superior approach to the conventional open approach and warrants clinical evaluation.
（1）比较保留侧副韧带手术入路与开放手术入路对近节指间关节（PIPJ）融合力学性能的影响；（2）确定使用不同直径钻头经关节（TA）钻孔去除的关节软骨表面百分比。
随机配对肢体设计。
马尸体肢体（n = 76）。
使用3.5、4.5或5.5毫米钻头，以与背侧平面呈80 - 84°的角度对尸体PIPJ进行钻孔，以去除近节指骨（P1）远端关节面和中节指骨（P2）近端关节面的关节软骨和软骨下骨。拍摄骨端照片并测量软骨剥脱的预计表面积百分比。在配对肢体中使用两种手术入路创建PIPJ融合结构（3孔动力加压钢板[DCP]，以拉力方式在DCP内侧和外侧插入两枚5.5毫米TA螺钉；DCP - TA）。一条肢体采用传统开放入路，另一条肢体采用保留侧副韧带入路。对结构进行单周期三点背掌/跖侧或内外侧弯曲直至破坏测试。比较不同技术之间的最大载荷、屈服载荷和复合刚度。
3.5、4.5和5.5毫米钻头分别去除了PIPJ总关节软骨表面的24±4%、35±5%和45±7%。采用保留侧副韧带入路的结构在内外侧弯曲时平均屈服载荷（11.3±2.8对7.68±1.1 kN，P = 0.008）和平均最大载荷（13.5±3.1对10.1±1.94 kN，P = 0.02）明显更大。在背掌/跖侧弯曲时，手术入路之间无显著差异。与开放技术（31±3分钟）相比，保留侧副韧带融合技术的手术时间更短（19±3分钟）。
PIPJ保留侧副韧带的手术入路，通过TA钻孔去除关节软骨并采用DCP - TA进行融合，在内外侧弯曲时比开放手术入路创建的融合结构更快且更强。
在PIPJ融合过程中保留侧副韧带并采用TA钻孔去除软骨可能是一种优于传统开放入路的方法，值得临床评估。
