Haddad Steven L, Hsu Andrew R, Templin Cary R, Ren Yupeng, Stewart Bruce, Kohli Navjot S, Zhang Li-Qun
Illinois Bone and Joint Institute, LLC, Glenview, IL, USA
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
Foot Ankle Int. 2014 Aug;35(8):796-801. doi: 10.1177/1071100714535767. Epub 2014 Jun 3.
High-speed burring used to prepare bony surfaces during arthrodesis procedures can increase heat generation that may impede healing and fusion. Irrigation during burring has the potential to improve early healing of burred bone surfaces and result in a stronger fusion mass. The purpose of this study was to determine the effects of continuous irrigation during burring on thermal necrosis and fusion strength in an in vivo arthrodesis animal model.
A small joint rabbit ulnohumeral arthrodesis model was developed and utilized in 16 New Zealand white rabbits. Joints were prepared and contoured using a high-speed cutting burr and fixed in compression with crossed screws to obtain fusion. Prepared bony surfaces were either irrigated (n = 8) with chilled 6°C (43°F) saline or not irrigated (n = 8). Specimens were harvested, radiographed, mechanically tested for torque to failure and stiffness, and evaluated for histology.
Fusion rate was 100% (8/8) when joints were irrigated during burring and 75% (6/8) when joints were not irrigated (P = .45). Mechanical testing showed a mean torque to failure of 0.85 Nm and 0.72 Nm in irrigated and nonirrigated specimens, respectively (P = .57). Histology showed evidence of less mature osseous formation in nonirrigated specimens compared to irrigated specimens.
There was an overall trend toward decreased fusion rate and lower fusion mass strength in nonirrigated fusion specimens compared with those treated with chilled irrigation during bone preparation.
Continuous chilled irrigation during bone preparation with burring may have a positive effect on fusion rate and fusion mass strength for arthrodesis procedures.
在关节融合手术中，用于准备骨表面的高速磨钻会增加产热，这可能会阻碍愈合和融合。磨钻过程中进行冲洗有可能改善磨钻后骨表面的早期愈合，并形成更强壮的融合块。本研究的目的是确定在体内关节融合动物模型中，磨钻过程中持续冲洗对热坏死和融合强度的影响。
建立了一个小型关节兔尺肱关节融合模型，并应用于16只新西兰白兔。使用高速切割磨钻对关节进行准备和塑形，并用交叉螺钉进行加压固定以实现融合。准备好的骨表面要么用6°C（43°F）的冷生理盐水冲洗（n = 8），要么不冲洗（n = 8）。采集标本，进行X线摄影，进行机械测试以测定破坏扭矩和刚度，并进行组织学评估。
磨钻过程中冲洗关节时融合率为100%（8/8），不冲洗关节时融合率为75%（6/8）（P = 0.45）。机械测试显示，冲洗组和未冲洗组标本的平均破坏扭矩分别为0.85 Nm和0.72 Nm（P = 0.57）。组织学显示，与冲洗组标本相比，未冲洗组标本中骨形成的成熟度较低。
与骨准备过程中用冷冲洗处理的融合标本相比，未冲洗的融合标本总体上有融合率降低和融合块强度较低的趋势。
在骨准备过程中使用磨钻时持续进行冷冲洗可能对关节融合手术的融合率和融合块强度有积极影响。
