舟骨骨折不愈合模型中的固定：比较三种固定方式的生物力学研究
Scaphoid Fracture Fixation in a Nonunion Model: A Biomechanical Study Comparing 3 Types of Fixation.
作者信息
Mandaleson Avanthi, Tham Stephen K, Lewis Craig, Ackland David C, Ek Eugene T
机构信息
Division of Hand Surgery, Department of Orthopaedics, Monash University, Dandenong Hospital, Dandenong, Australia; Department of Mechanical Engineering, University of Melbourne, Parkville, Australia.
Division of Hand Surgery, Department of Orthopaedics, Monash University, Dandenong Hospital, Dandenong, Australia; Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute, St Vincent's Institute, Melbourne, Victoria, Australia; Victorian Hand Surgery Associates, Fitzroy, Australia; Department of Surgery, Monash Medical Centre, Monash University, Clayton, Australia.
出版信息
J Hand Surg Am. 2018 Mar;43(3):221-228. doi: 10.1016/j.jhsa.2017.10.005. Epub 2017 Nov 11.
PURPOSE
Union of a scaphoid fracture after fixation is influenced by various factors, one of which is fracture stability. This study aims to compare the biomechanical stability of 3 different types of scaphoid fracture fixation in a scaphoid nonunion model.
METHODS
Thirty cadaveric scaphoid specimens were assigned to one of 3 different fixation groups: (1) single 3.0-mm compression screw, (2) two 2.2-mm screws, and (3) scaphoid plate. A 3-mm volar wedge osteotomy was created at the scaphoid waist to simulate a nonunion model. The primary outcome measure was load to failure, whereas secondary outcome measures were load to 2-mm displacement, energy absorbed, stiffness, and mode of failure, recorded by video and retrieval analysis.
RESULTS
There was a significantly lower load to failure in the single screw construct compared with that in the double screw (mean difference 187.2 N) and plate fixation constructs (mean difference 150.7 N). The mean load to 2-mm displacement in the single screw construct (91.5 N) was also significantly lower than that in the double screw (181.8 N) and plate fixation constructs (197.2 N). There was a significantly lower stiffness with the single screw fixation compared with that of the double screws (mean difference 85.4 N/mm), and lower energy absorbed with single screws when compared with that of double screws (mean difference 386.5 mJ) and when compared with plate fixation (mean difference 270.8 mJ).
CONCLUSIONS
In this biomechanical study comparing fixation methods using a model of scaphoid nonunion with bone loss, we found that double screws or plate fixation demonstrated significantly greater stability, stiffness, and energy absorption when compared with a single compression screw. We found no discernible differences between double screw fixation and the plate groups.
CLINICAL RELEVANCE
The use of double screws or plate fixation in a nonunion setting may allow accelerated rehabilitation without compromise to fracture stability.
目的
舟骨骨折固定后的愈合受多种因素影响，其中之一是骨折稳定性。本研究旨在比较舟骨骨不连模型中3种不同类型舟骨骨折固定方式的生物力学稳定性。
方法
30个尸体舟骨标本被分配到3个不同的固定组之一：（1）单枚3.0毫米加压螺钉，（2）两枚2.2毫米螺钉，（3）舟骨钢板。在舟骨腰部做一个3毫米的掌侧楔形截骨以模拟骨不连模型。主要观察指标是破坏载荷，次要观察指标是2毫米位移时的载荷、吸收能量、刚度和破坏模式，通过视频和检索分析记录。
结果
与双螺钉固定组（平均差异187.2牛）和钢板固定组（平均差异150.7牛）相比，单螺钉固定结构的破坏载荷显著更低。单螺钉固定结构在2毫米位移时的平均载荷（91.5牛）也显著低于双螺钉固定组（181.8牛）和钢板固定组（197.2牛）。与双螺钉固定相比，单螺钉固定的刚度显著更低（平均差异85.4牛/毫米），与双螺钉固定相比以及与钢板固定相比，单螺钉吸收的能量更低（平均差异分别为386.5毫焦和270.8毫焦）。
结论
在这项使用伴有骨质缺损的舟骨骨不连模型比较固定方法的生物力学研究中，我们发现与单枚加压螺钉相比，双螺钉或钢板固定表现出显著更高的稳定性、刚度和能量吸收。我们发现双螺钉固定组和钢板组之间没有明显差异。
临床意义
在骨不连情况下使用双螺钉或钢板固定可能允许加速康复而不影响骨折稳定性。
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