Kojima K, Gueorguiev B, Seva G, Stoffel K, de Oliveira R Garcia, Eberli U, Nicolino T, Lenz M
From the Department of Orthopaedics and Traumatology, Faculty of Medicine, University of Sao Paulo, Brazil (KK, GS, GdO); AO Research Institute, Davos, Switzerland (BG, GS, UE, TN, ML); University of Basel, Cantonal Hospital Baselland, Liestal, Switzerland (KS); Department of Orthopaedics and Traumatology, Italian Hospital of Buenos Aires, Argentina (TN); and Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Germany (ML).
Medicine (Baltimore). 2015 Jan;94(1):e282. doi: 10.1097/MD.0000000000000282.
Reliable osteosynthesis of intraarticular fractures depends on lasting interfragmentary compression. Its amount differs in the applied fixation method. The interfragmentary compression of cancellous and cortical lag screws and angle stable locking plates was quantified in an osteoporotic and non-osteoporotic synthetic human bone model.A split fracture of the lateral tibia plateau (AO/OTA type 41-B1.1) was mimicked by an osteotomy in right adult synthetic human tibiae with hard or soft cancellous bone. Specimens were fixed with either two 6.5 mm cancellous, four 3.5 mm cortical lag screws, or 3.5 mm LCP proximal lateral tibia plate preliminary compresed by a reduction clamp (n = 5 per group). A pressure sensor film was used to register the interfragmentary compression. One-way analysis of variance (ANOVA) with Bonferroni post hoc correction was performed for statistical analysis (p < 0.05).Interfragmentary compression under reduction clamp was 0.59 ± 0.12 MPa in the non-osteoporotic and 0.55 ± 0.14 MPa in the osteoporotic group. The locking plate itself maintained the compression in non-osteoporotic (0.53 ± 0.11 MPa) and osteoporotic bone (0.50 ± 0.14 MPa). Four 3.5 mm cortical lag screws provided a compression of 1.69 ± 0.65 MPa in non-osteoporotic bone, being not significantly different to the osteoporotic bone group (1.43 ± 0.47 MPa, P = 1.0). Two 6.5 mm cancellous lag screws showed a significantly higher compression in non-osteoporotic (2.1 ± 0.59 MPa) compared to osteoporotic (0.77 ± 0.21 MPa, P < 0.01) bone.Angle stable locking plates maintained the compression preliminarily applied by a reduction clamp. Two 6.5 mm cancellous lag screws are especially suited for non-osteoporotic bone, whereas four 3.5 mm cortical screws exhibited comparable compression in both bone qualities.
关节内骨折的可靠骨合成取决于持久的骨折块间加压。其加压量因所应用的固定方法而异。在骨质疏松和非骨质疏松的人工合成人体骨模型中，对松质骨和皮质骨拉力螺钉以及角度稳定锁定钢板的骨折块间加压情况进行了量化。
通过在具有硬松质骨或软松质骨的成年人工合成人体右胫骨上进行截骨术，模拟外侧胫骨平台的劈裂骨折（AO/OTA 41 - B1.1型）。标本分别用两枚6.5毫米松质骨螺钉、四枚3.5毫米皮质骨拉力螺钉或一枚经复位钳初步加压的3.5毫米LCP胫骨近端外侧钢板固定（每组n = 5）。使用压力传感膜记录骨折块间加压情况。采用单因素方差分析（ANOVA）并进行Bonferroni事后检验进行统计学分析（p < 0.05）。
在非骨质疏松组，复位钳下的骨折块间加压为0.59±0.12兆帕，在骨质疏松组为0.55±0.14兆帕。锁定钢板本身在非骨质疏松骨（0.53±0.11兆帕）和骨质疏松骨（0.50±0.14兆帕）中均能维持加压。四枚3.5毫米皮质骨拉力螺钉在非骨质疏松骨中提供的加压为1.69±0.65兆帕，与骨质疏松骨组（1.43±0.47兆帕，P = 1.0）无显著差异。两枚6.5毫米松质骨拉力螺钉在非骨质疏松骨中的加压（2.1±0.59兆帕）明显高于骨质疏松骨（0.77±0.21兆帕，P < 0.01）。
角度稳定锁定钢板能维持复位钳初步施加的加压。两枚6.5毫米松质骨拉力螺钉特别适用于非骨质疏松骨，而四枚3.5毫米皮质骨螺钉在两种骨质中均表现出相当的加压效果。
