Lin K Y, Bartlett S P, Yaremchuk M J, Fallon M, Grossman R F, Whitaker L A
Department of Pathology, University of Pennsylvania School of Medicine, Philadelphia.
Plast Reconstr Surg. 1990 Sep;86(3):449-56. doi: 10.1097/00006534-199009000-00010.
Much attention has recently been focused on rigid fixation as a method of improving fracture healing. Whether such fixation, when applied to onlay grafting, improves graft take and volume is unknown. To examine this question, we compared survival of both endochondral and membranous grafts fixed rigidly and nonrigidly in areas of low motion (snout) and high motion (femur) in a rabbit model. Gross morphology, histologic analysis, and graft volume kinetics were evaluated. Findings demonstrate that in areas of high motion, the application of rigid fixation improves graft survival, whereas in a low-motion region, no differences in graft volume retention as a function of fixation were observed. Histologically, no differences with the method of fixation employed were seen, and similar revascularization patterns were noted. By kinetic analysis, rigid fixation appears to exert its most profound effect early in the postgraft period. Membranous bone grafts remain superior to endochondral grafts under all circumstances. From these studies, we conclude that rigid fixation is the method of choice in all circumstances where onlay bone grafts may be exposed to motion, shear, and torsional forces.
最近，刚性固定作为一种促进骨折愈合的方法受到了广泛关注。当这种固定方法应用于贴附植骨时，是否能提高植骨的成活率和体积尚不清楚。为了研究这个问题，我们在兔模型中比较了在低活动区域（口鼻部）和高活动区域（股骨）进行刚性固定和非刚性固定的软骨内植骨和膜性植骨的成活率。评估了大体形态、组织学分析和植骨体积动力学。研究结果表明，在高活动区域，应用刚性固定可提高植骨成活率，而在低活动区域，未观察到固定方式对植骨体积保留的影响存在差异。组织学上，未发现所采用的固定方法存在差异，且观察到相似的血管化模式。通过动力学分析，刚性固定似乎在植骨后的早期发挥其最显著的作用。在所有情况下，膜性骨移植均优于软骨内骨移植。从这些研究中，我们得出结论，在所有可能使贴附骨移植受到运动、剪切力和扭力作用的情况下，刚性固定是首选方法。
