Herzberg W, Overbeck E, Herzberg R, Deckelmann G
Chirurgische Abteilung, Kreiskrankenhauses Wedel.
Unfallchirurg. 1990 Jun;93(6):257-62.
In the treatment of comminuted Colles' fractures different types of external fixation devices are used. Three main types are compared: (1) Fixation with two pins in each plane: Ace-Colles' type; (2) fixation with four or more parallel pins in one plane: Wagner/Hoffmann type; (3) fixation with four pins in one plane, two pins on each side of the fracture forming an angle of 60 degrees: ASIF-type fixator. These three types are compared with reference to the different forces that have to be neutralized by the seating of the pin in the bone. To minimize these forces with the aim of preventing pin-loosening, the theoretical results are used as the basis of practical surgical advice: (1) The distance between skin and fixator should be as short as possible. (2) The fixator should be fixed as close as possible to the fracture. (3) The diameter of the pins should be as great as possible. (4) If more than two pins per plane are used (Hoffmann/Wagner type), the pins should be wide apart. (5) If only two pins per plane are used (Ace-Colles Type) the bending stress on each pin is high (6) If more than two parallel pins per plane are used (Hoffmann/Wagner type), the axial forces on each pin are high. (7) The pins should be fixed at right angles to the fractured bone. Pins at other angles do more harm than good.
在治疗粉碎性科雷氏骨折时，会使用不同类型的外固定装置。本文比较了三种主要类型：（1）在每个平面用两根钢针固定：Ace-Colles型；（2）在一个平面用四根或更多平行钢针固定：Wagner/Hoffmann型；（3）在一个平面用四根钢针固定，骨折两侧各两根钢针，形成60度角：ASIF型固定器。根据钢针植入骨中时必须抵消的不同力，对这三种类型进行了比较。为了将这些力降至最低以防止钢针松动，理论结果被用作实际手术建议的基础：（1）皮肤与固定器之间的距离应尽可能短。（2）固定器应尽可能靠近骨折处固定。（3）钢针的直径应尽可能大。（4）如果每个平面使用超过两根钢针（Hoffmann/Wagner型），钢针应相距较远。（5）如果每个平面仅使用两根钢针（Ace-Colles型），则每根钢针上的弯曲应力较高。（6）如果每个平面使用超过两根平行钢针（Hoffmann/Wagner型），则每根钢针上的轴向力较高。（7）钢针应与骨折骨垂直固定。以其他角度固定钢针弊大于利。
