Hopf T, Mittelmeier W, Mittelmeier H
Orthopädische Universitätsklinik Homburg/Saar.
Aktuelle Traumatol. 1989 Apr;19(2):65-72.
Osteosynthesis with modern self-contracting plates has a few fundamental drawbacks apart from its undisputably good points. Among these drawbacks we have the pressure strain on the bone surface; the traction strain exercised by the screw thread in the bone; and, chiefly, spongiotisation and bone atrophy due to so-called stress protection. A new modification of this process, called Zespol, in which the plate is no longer fastened direct to the bone but is fastened floating over the bone surface to so-called platform screws, tries to solve these problems. In a comparative animal experiment tibial transverse osteotomies in the rabbit were treated by osteosynthesis using small fragmentary ACP and Zespol plates. In respect of healing of the fracture none of the two methods showed any advantage. Histological evaluation of the plated bone sections were characterised in both plate systems by increasing spongiotisation and bone atrophy that increased with the length of application. Degradation processes were about equal with both systems. A special feature with the Zespol animals was that the cleft originally existing between the plate and the bone was filled up with newly formed spongy and later cortical bone. Due to this process the original cortex layer lost its function and atrophied severely. After 12 to 18 weeks the bone surface had reached the lower side of the Zespol plate and there was contact by touch. This restored similar biomechanical conditions as those existing in conventional plates after this period.
除了具有无可争议的优点外,使用现代自固定接骨板进行骨接合术还有一些基本缺点。在这些缺点中,我们有骨表面的压力应变;螺纹在骨中施加的牵引应变;主要是由于所谓的应力保护导致的松质化和骨萎缩。这种方法的一种新改进,称为Zespol,其中接骨板不再直接固定在骨上,而是漂浮在骨表面固定在所谓的平台螺钉上,试图解决这些问题。在一项对比动物实验中,对兔胫骨横行截骨采用小碎片ACP接骨板和Zespol接骨板进行骨接合术治疗。在骨折愈合方面,两种方法均未显示出任何优势。两种接骨板系统的接骨板骨切片的组织学评估均表现为随着应用时间延长,松质化和骨萎缩增加。两种系统的降解过程大致相同。Zespol组动物的一个特殊特征是,接骨板与骨之间最初存在的裂隙被新形成的海绵骨和后来的皮质骨填充。由于这个过程,原来的皮质层失去了功能并严重萎缩。12至18周后,骨表面到达Zespol接骨板的下侧并通过触摸接触。在此之后,恢复了与传统接骨板相似的生物力学条件。