AO Research-Institut, AO Foundation Davos, Jena, Germany.
Foot Ankle Int. 2011 Nov;32(11):1081-5. doi: 10.3113/FAI.2011.1081.
Lapidus arthrodesis with a plate and a compression screw is an established procedure in hallux valgus surgery. The present study was performed to investigate the potential benefit of a compression screw combined with a plantarly applied angle-stable, anatomically precontoured plate or a dorsomedially applied angle-stable plate.
In six pairs of human cadaver specimens, one specimen each was randomized to receive a dorsomedial H-shaped plate, while the other received a plantar plate. Bone mineral density was measured with peripheral quantitative computed tomography. The specimens were loaded quasi-statically, followed by cyclic loading. Finally, they were loaded to failure. In the static tests, stiffness and range of motion (ROM) data were obtained. In the cyclic tests, the constructs' displacement was studied. In the load-to-failure test, stiffness and maximum load to failure were measured.
The two groups did not differ significantly with regard to BMD (p = 0.25). Any significant differences observed were in favor of the plantar constructs, which had greater initial stiffness (p = 0.028) and final stiffness (p = 0.042), a smaller ROM (p = 0.028), and a greater load to failure (p = 0.043). There was no significant difference regarding displacement (p = 0.14).
In the static tests, the plantar angle-stable plate construct was superior to the dorsomedial angle-stable plate construct.
Plantar plating appears to offer biomechanical benefit. Clinical studies will be required to show whether this translates into earlier resumption of weightbearing and into lower rates of nonunion.
跟骨截骨楔形骨切开术联合使用钢板和加压螺钉是治疗拇外翻的成熟手术方法。本研究旨在探讨联合应用跖侧应用的角度稳定、解剖预弯钢板或背侧应用的角度稳定钢板的加压螺钉的潜在益处。
在 6 对人体尸体标本中，每对标本随机分为接受背侧 H 形钢板或跖侧钢板。采用外周定量 CT 测量骨密度。标本进行准静态加载，随后进行循环加载，最后进行失效加载。在静态测试中，获得了刚度和活动范围（ROM）数据。在循环测试中，研究了结构的位移。在失效负载测试中，测量了刚度和失效负载的最大值。
两组间骨密度无显著差异（p = 0.25）。观察到的任何显著差异都有利于跖侧结构，其初始刚度更大（p = 0.028）和最终刚度更大（p = 0.042）、ROM 更小（p = 0.028）和失效负载更大（p = 0.043）。位移无显著差异（p = 0.14）。
在静态测试中，跖侧角度稳定钢板结构优于背侧角度稳定钢板结构。
跖侧钢板固定似乎具有生物力学优势。需要进行临床研究，以确定这是否转化为更早地恢复负重和更低的不愈合率。
