用于肱骨近端骨折的带与不带内下螺钉的锁定钢板固定：一项生物力学研究
Locking plate fixation with and without inferomedial screws for proximal humeral fractures: a biomechanical study.
作者信息
Burke Neil G, Kennedy Jim, Cousins Grainne, Fitzpatrick David, Mullett Hannan
机构信息
Department of Orthopaedic Research, Royal College of Surgeons, Dublin, Ireland.
HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland.
出版信息
J Orthop Surg (Hong Kong). 2014 Aug;22(2):190-4. doi: 10.1177/230949901402200215.
PURPOSE. To compare the efficacy of locking plate fixation with and without inferomedial screws in maintaining the reduction of a proximal humeral fracture. METHODS. 22 synthetic humerus models were used. A standardised 3-part proximal humeral fracture with a 4-mm wedge segment was created and fixed with a locking plate and screws with (n=11) and without (n=11) inferomedial screws. The intrafragmentary motion of the construct at 250, 500, 750, and 1000 cycles of 532 N loading, and the load to failure of the 2 groups were compared. RESULTS. Locking plate fixation with inferomedial screws reduced the mean intrafragmentary motion in all cycles (p<0.01) and increased the load to failure (1452 N vs. 1159 N, p<0.001), compared to fixation without inferomedial screws. CONCLUSION. Additional inferomedial screws provide medial column support for fracture healing. This may reduce intrafragmentary motion and thus implant complications resulting from varus malalignment such as screw perforation or loss of reduction.
目的。比较使用和不使用内下螺钉的锁定钢板固定在维持肱骨近端骨折复位方面的疗效。方法。使用22个合成肱骨模型。制造一个带有4毫米楔形节段的标准化三部分肱骨近端骨折，并用锁定钢板和螺钉固定，其中11个模型使用内下螺钉，11个模型不使用内下螺钉。比较两组在532 N载荷下250、500、750和1000次循环时结构的骨折块内运动，以及两组的失效载荷。结果。与不使用内下螺钉的固定相比，使用内下螺钉的锁定钢板固定在所有循环中均降低了平均骨折块内运动（p<0.01），并增加了失效载荷（1452 N对1159 N，p<0.001）。结论。额外的内下螺钉为骨折愈合提供内侧柱支撑。这可能会减少骨折块内运动，从而减少因内翻畸形导致的植入物并发症，如螺钉穿孔或复位丢失。
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