使用螺钉锁定元件可改善股骨截骨术的影像学和生物力学效果。

Use of screw locking elements improves radiological and biomechanical results of femoral osteotomies.

作者信息

Garcés Gerardo L, Rodríguez Oliver, Grau-Bassas Enrique Rodríguez, Roiz Syra, Yánez Alejandro, Cuadrado Alberto

机构信息

Hospital Perpetuo Socorro and Department of Medical and Surgical Sciences, Las Palmas de Gran Canaria University, c/ León y Castillo 407, 35007 Las Palmas de Gran Canaria, Spain.

出版信息

BMC Musculoskelet Disord. 2014 Nov 21;15:387. doi: 10.1186/1471-2474-15-387.

DOI:10.1186/1471-2474-15-387

PMID:25414116

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4258045/

Abstract

BACKGROUND

Dynamic compression plate (DCP) constructs provide inadequate fixation in cases of poor bone quality and early weight-bearing. Screw locking elements (SLE) are flat locking nuts placed at the end of the screw to prevent screw stripping from the bone, improving fixation stability. The purpose of this work was to compare biomechanical and radiological evaluations of femoral ovine osteotomies fixed using DCP constructs with and without SLE.

METHOD

A dyaphyseal femoral osteotomy was performed in sixteen adult sheep and fixed with a DCP and cortical screws. Half of the animals were operated on with a SLE on each side of the osteotomy and the rest without the addition of SLE. Four animals of each group were euthanized after 8 weeks, and the remaining after 16 weeks. Both femora of each animal were radiographed and mechanically tested in torsion.

RESULTS

Radiologically femoral malalignment or screw loosening was observed in six out of the eight animals operated on without SLE. In contrast, all animals subjected to the operation with SLE showed complete radiological consolidation of the osteotomy. Seven of these eight animals showed normal femoral alignment and no osteosynthesis failure. Stiffness of the bones fixed with SLE was among 145% and 177% the value of their contralateral non-operated femurs (all animals of this group showed greater stiffness on the operated bone than its contralateral non-operated femur). However, stiffness of the bones operated on without SLE was among 58% and 87% the value of the stiffness of their contralateral non-operated bone (all animals of this group showed greater stiffness on the non-operated bone than the osteotomized ones).

CONCLUSIONS

Use of SLE avoided loosening of the system and stimulated stronger osteotomy consolidation. Clinical application of this improved system may thus be a feasible and cost-effective alternative to other more rigid and expensive bone fixation techniques.

摘要

背景

动力加压钢板（DCP）结构在骨质量差和早期负重的情况下固定效果不佳。螺钉锁定元件（SLE）是置于螺钉末端的扁平锁定螺母，可防止螺钉从骨中脱出，提高固定稳定性。本研究的目的是比较使用有或无SLE的DCP结构固定绵羊股骨截骨术的生物力学和影像学评估结果。

方法

对16只成年绵羊进行股骨干截骨术，并用DCP和皮质骨螺钉固定。一半动物在截骨术两侧使用SLE进行手术，其余动物不添加SLE。每组4只动物在8周后安乐死，其余在16周后安乐死。对每只动物的双侧股骨进行X线摄影并进行扭转力学测试。

结果

在未使用SLE进行手术的8只动物中，有6只在影像学上出现股骨排列不齐或螺钉松动。相比之下，所有接受SLE手术的动物截骨处均显示完全的影像学愈合。这8只动物中有7只股骨排列正常，未发生骨不连。使用SLE固定的骨的刚度是其对侧未手术股骨刚度的145%至177%（该组所有动物手术侧骨的刚度均高于其对侧未手术股骨）。然而，未使用SLE进行手术的骨的刚度是其对侧未手术骨刚度的58%至87%（该组所有动物未手术骨的刚度均高于截骨处骨）。