Lenz Mark, Perren Stephan M, Gueorguiev Boyko, Richards Robert G, Hofmann Gunther O, Fernandez dell'Oca Alberto, Höntzsch Dankward, Windolf Markus
AO Research Institute Davos, Clavadelerstrasse 8, CH-7270 Davos-Platz, Switzerland; Department of Trauma, Hand and Reconstructive Surgery, Friedrich-Schiller-University Jena, Erlanger Allee 101, D-07747 Jena, Germany.
AO Research Institute Davos, Clavadelerstrasse 8, CH-7270 Davos-Platz, Switzerland.
Injury. 2014 Jan;45 Suppl 1:S71-5. doi: 10.1016/j.injury.2013.10.027. Epub 2013 Oct 29.
Proximal plate fixation is a crucial factor in osteosynthesis of periprosthetic femur fractures. Stability and strength of different fixation concepts for proximal plate fixation were compared.
Twelve fresh frozen, bone mineral density matched human femora, instrumented with cemented hip endoprosthesis were osteotomized simulating a Vancouver B1 fracture. Specimens were instrumented with locking compression plates, fixed proximally with either locking attachment plate (LAP), monocortical screws, cerclage plus monocortical screws (1cerclage) or cerclages only (4cerclages). Cyclic testing was performed with monotonically increasing load until failure. Relative movements at the proximal plate-femur interface were registered by motion tracking.
The LAP construct exhibited a significantly longer cumulative survival (failure criterion 1mm separation at the proximal plate fixation) compared to the monocortical (p=0.048) and 4cerclages constructs (p=0.012) but not to 1cerclage constructs.
Bicortical screw anchorage improves proximal plate fixation in periprosthetic fractures. The cerclage-screw combination is a valuable alternative especially in osteoporotic bone.
近端钢板固定是人工关节周围股骨骨折接骨术中的关键因素。比较了近端钢板固定的不同固定方式的稳定性和强度。
选取12具新鲜冷冻、骨密度匹配的人体股骨，安装骨水泥型髋关节假体后模拟温哥华B1型骨折进行截骨。标本安装锁定加压钢板，近端分别用锁定附接钢板（LAP）、单皮质螺钉、环扎加单皮质螺钉（1环扎）或仅用环扎（4环扎）固定。进行循环测试，载荷单调增加直至失效。通过运动跟踪记录近端钢板-股骨界面的相对运动。
与单皮质固定（p = 0.048）和4环扎固定（p = 0.012）相比，LAP固定结构的累积生存期显著更长，但与1环扎固定结构相比无显著差异。
双皮质螺钉锚固可改善人工关节周围骨折的近端钢板固定。环扎-螺钉组合是一种有价值的替代方法，尤其适用于骨质疏松性骨。
