Augustin Goran, Zigman Tomislav, Davila Slavko, Udilljak Toma, Staroveski Tomislav, Brezak Danko, Babic Slaven
University Hospital Center Zagreb and School of Medicine, University of Zagreb, Zagreb, Croatia.
Clin Biomech (Bristol). 2012 May;27(4):313-25. doi: 10.1016/j.clinbiomech.2011.10.010. Epub 2011 Nov 8.
Bone drilling is a common step in operative fracture treatment and reconstructive surgery. During drilling elevated bone temperature is generated. Temperatures above 47°C cause thermal osteonecrosis which contributes to screw loosening and subsequently implant failures and refractures.
The current literature on bone drilling and thermal osteonecrosis is reviewed. The methodologies involved in the experimental and clinical studies are described and compared.
Areas which require further investigation are highlighted and the potential use of more precise experimental setup and future technologies are addressed.
Important drill and drilling parameters that could cause increase in bone temperature and hence thermal osteonecrosis are reviewed and discussed: drilling speed, drill feed rate, cooling, drill diameter, drill point angle, drill material and wearing, drilling depth, pre-drilling, drill geometry and bone cortical thickness. Experimental methods of temperature measurement during bone drilling are defined and thermal osteonecrosis is discussed with its pathophysiology, significance in bone surgery and methods for its minimization.
骨钻孔是骨折手术治疗和重建手术中的常见步骤。钻孔过程中会产生骨温升高。47°C以上的温度会导致热骨坏死，这会导致螺钉松动，进而导致植入物失效和骨折不愈合。
回顾了当前关于骨钻孔和热骨坏死的文献。描述并比较了实验研究和临床研究中涉及的方法。
强调了需要进一步研究的领域，并探讨了更精确的实验装置和未来技术的潜在用途。
对可能导致骨温升高进而引起热骨坏死的重要钻头和钻孔参数进行了回顾和讨论：钻孔速度、钻头进给速度、冷却、钻头直径、钻尖角度、钻头材料和磨损、钻孔深度、预钻孔、钻头几何形状和骨皮质厚度。定义了骨钻孔过程中温度测量的实验方法，并讨论了热骨坏死及其病理生理学、在骨外科手术中的意义以及将其降至最低的方法。
