外侧多轴锁定钢板与后外侧多轴锁定钢板应用于腓骨远端的生物力学比较。

Biomechanical comparison of a lateral polyaxial locking plate with a posterolateral polyaxial locking plate applied to the distal fibula.

作者信息

Hallbauer Jakob, Klos Kajetan, Rausch Sascha, Gräfenstein Andreas, Wipf Felix, Beimel Claudia, Hofmann Gunther, Mückley Thomas

机构信息

Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Jena, Germany.

Department of Foot and Ankle Surgery, St. Vincenz and Elisabeth Hospital Mainz, Germany.

出版信息

Foot Ankle Surg. 2014 Sep;20(3):180-5. doi: 10.1016/j.fas.2014.03.005. Epub 2014 Apr 13.

DOI:10.1016/j.fas.2014.03.005

PMID:25103705

Abstract

BACKGROUND

Polyaxial locking plates are becoming popular for the fixation of distal fibula fractures. This study establishes how construct stiffness and plate loosening, measured as range of motion, differs between lateral and posterolateral plate location.

METHODS

Seven matched pairs of cadaver fibulae were osteotomized in standardized fashion to produce a Weber type B distal fibula fracture. The fragments were fixated with an interfragmentary lag screw and polyaxial locking plates, with one fibula in each pair receiving a posterolateral anti-glide-plate, and the other a lateral neutralization-plate. In a biomechanical test, the bending and torsional stiffnesses of the constructs and the ranges of motion (ROM) were measured and subjected to a paired comparison.

RESULTS

The laterally plated group had a higher median (interquartile range) bending stiffness (29.2 (19.7) N/mm) and a smaller range of motion (2.06 (1.99) mm) than the posterolaterally plated group (14.6 (20.6) N/mm, and 4.11 (3.28) mm, respectively); however, the results were not statistically significant (pbending=0.314; pROM=0.325). Similarly, the torsional stiffness did not differ significantly between the two groups (laterally plated: 426 (259) Nmm/°; posterolaterally plated: 248 (399) Nmm/°; ptorsion=0.900). The range of motion measurements between the two groups under torsional loading were also statistically insignificant (laterally plated: 8.88 (6.30) mm; posterolaterally plated: 15.34 (12.64) mm; pROM=0.900).

CONCLUSION

In biomechanical cadaver-model tests of Weber type B fracture fixation with polyaxial locking plates, laterally plated constructs and posterolaterally plated constructs performed without significantly difference. Therefore, other considerations, such as access morbidity, associated injuries, patient anatomy, or surgeon's preference, may guide the choice of plating pattern. Further clinical studies will be needed for the establishment of definitive recommendations.

CLINICAL RELEVANCE

Information on the behavior of polyaxial locking plates is relevant to surgeons performing internal fixation of distal fibula fractures.

摘要

背景

多轴锁定钢板在腓骨远端骨折固定中越来越常用。本研究旨在确定以活动范围衡量的结构刚度和钢板松动情况在外侧钢板与后外侧钢板放置位置之间有何不同。

方法

七对匹配的尸体腓骨以标准化方式截骨，造成韦伯B型腓骨远端骨折。骨折块用一枚骨折块间拉力螺钉和多轴锁定钢板固定，每对中的一根腓骨接受一块后外侧抗滑移钢板，另一根接受一块外侧中和钢板。在生物力学测试中，测量结构的弯曲和扭转刚度以及活动范围（ROM），并进行配对比较。

结果

与后外侧钢板固定组相比，外侧钢板固定组的中位（四分位间距）弯曲刚度更高（29.2（19.7）N/mm），活动范围更小（分别为2.06（1.99）mm和4.11（3.28）mm）；然而，结果无统计学意义（pbending = 0.314；pROM = 0.325）。同样，两组之间的扭转刚度也无显著差异（外侧钢板固定组：426（259）Nmm/°；后外侧钢板固定组：248（399）Nmm/°；ptorsion = 0.900）。两组在扭转负荷下的活动范围测量结果也无统计学意义（外侧钢板固定组：8.88（6.30）mm；后外侧钢板固定组：15.34（12.64）mm；pROM = 0.900）。