胫骨平台塌陷骨折不同接骨术及联合骨替代物的生物力学分析

Biomechanical analysis of different osteosyntheses and the combination with bone substitute in tibial head depression fractures.

作者信息

Jordan Martin C, Zimmermann Christina, Gho Sheridan A, Frey Soenke P, Blunk Torsten, Meffert Rainer H, Hoelscher-Doht Stefanie

机构信息

Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Clinics of Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany.

Biomechanics Research Laboratory, School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia.

出版信息

BMC Musculoskelet Disord. 2016 Jul 15;17:287. doi: 10.1186/s12891-016-1118-4.

DOI:10.1186/s12891-016-1118-4

PMID:27422525

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4946189/

Abstract

BACKGROUND

Tibial head depression fractures demand a high level of fracture stabilization to prevent a secondary loss of reduction after surgery. Elderly individuals are at an increased risk of developing these fractures, and biomechanical investigations of the fractures are rare. Therefore, the aim of this study was to systematically analyze different types of osteosyntheses in combination with two commonly used bone substitutes.

METHODS

Lateral tibial head depression fractures were created in synthetic bones. After reduction, the fractures were stabilized with eight different treatment options of osteosynthesis alone or in combination with a bone substitute. Two screws, 4 screws and a lateral buttress plate were investigated. As a bone substitute, two common clinically used calcium phosphate cements, Norian® Drillable and ChronOS™ Inject, were applied. Displacement of the articular fracture fragment (mm) during cyclic loading, stiffness (N/mm) and maximum load (N) in Load-to-Failure tests were measured.

RESULTS

The three different osteosyntheses (Group 1: 2 screws, group 2: 4 screws, group 3: plate) alone revealed a significantly higher displacement compared to the control group (Group 7: ChronOS™ Inject only) (Group 1, 7 [p < 0.01]; group 2, 7 [p = 0.04]; group 3, 7 [p < 0.01]). However, the osteosyntheses in combination with bone substitute exhibited no differences in displacement compared to the control group. The buttress plate demonstrated a higher normalized maximum load than the 2 and 4 screw osteosynthesis. Comparing the two different bone substitutes to each other, ChronOS™ inject had a significantly higher stiffness and lower displacement than Norian® Drillable.

CONCLUSIONS

The highest biomechanical stability under maximal loading was provided by a buttress plate osteosynthesis. A bone substitute, such as the biomechanically favorable ChronOS™ Inject, is essential to reduce the displacement under lower loading.

摘要

背景

胫骨平台塌陷骨折需要高水平的骨折固定，以防止术后继发复位丢失。老年人发生这些骨折的风险增加，而对这些骨折的生物力学研究很少。因此，本研究的目的是系统分析不同类型的骨固定术与两种常用骨替代物的联合应用。

方法

在合成骨上制造外侧胫骨平台塌陷骨折。复位后，采用8种不同的骨固定术单独或联合骨替代物进行骨折固定。研究了2枚螺钉、4枚螺钉和外侧支撑钢板。作为骨替代物，应用了两种临床常用的磷酸钙骨水泥，即Norian® Drillable和ChronOS™ Inject。测量循环加载过程中关节骨折块的位移（mm）、刚度（N/mm）和破坏载荷试验中的最大载荷（N）。

结果

与对照组（第7组：仅使用ChronOS™ Inject）相比，单独使用三种不同的骨固定术（第1组：2枚螺钉，第2组：4枚螺钉，第3组：钢板）显示出明显更高的位移（第1组与第7组比较，P<0.01；第2组与第7组比较，P = 0.04；第3组与第7组比较，P<0.01）。然而，与对照组相比，联合骨替代物的骨固定术在位移方面没有差异。支撑钢板的归一化最大载荷高于2枚和4枚螺钉的骨固定术。将两种不同的骨替代物相互比较，ChronOS™ Inject的刚度明显更高，位移更低。