Omar Noor Azzizah, McKinley John C
Department of Biomedical Sciences, School of Medicine and Veterinary Medicine, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh EH8 9AG, United Kingdom.
Department of Orthopaedics and Rheumatology, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, United Kingdom.
Foot (Edinb). 2018 Jun;35:63-69. doi: 10.1016/j.foot.2018.02.002. Epub 2018 Feb 19.
There has been growing interest in minimally invasive foot surgery due to the benefits it delivers in post-operative outcomes in comparison to conventional open methods of surgery. One of the major factors determining the protocol in minimally invasive surgery is to prevent iatrogenic thermal osteonecrosis. The aim of the study is to look at various drilling parameters in a minimally invasive surgery setting that would reduce the risk of iatrogenic thermal osteonecrosis.
Sixteen fresh-frozen tarsal bones and two metatarsal bones were retrieved from three individuals and drilled using various settings. The parameters considered were drilling speed, drill diameter, and inter-individual cortical variability. Temperature measurements of heat generated at the drilling site were collected using two methods; thermocouple probe and infrared thermography. The data obtained were quantitatively analysed.
There was a significant difference in the temperatures generated with different drilling speeds (p<0.05). However, there was no significant difference in temperatures recorded between the bones of different individuals and in bones drilled using different drill diameters. Thermocouple showed significantly more sensitive tool in measuring temperature compared to infrared thermography.
Drilling at an optimal speed significantly reduced the risk of iatrogenic thermal osteonecrosis by maintaining temperature below the threshold level. Although different drilling diameters did not produce significant differences in temperature generation, there is a need for further study on the mechanical impact of using different drill diameters.
与传统的开放手术方法相比，微创足部手术因其在术后效果方面的优势而受到越来越多的关注。决定微创手术方案的主要因素之一是预防医源性热骨坏死。本研究的目的是研究在微创手术环境中各种钻孔参数，以降低医源性热骨坏死的风险。
从三名个体中获取16块新鲜冷冻的跗骨和两块跖骨，并使用各种设置进行钻孔。考虑的参数包括钻孔速度、钻头直径和个体间皮质变化。使用两种方法收集钻孔部位产生的热量的温度测量数据；热电偶探头和红外热成像。对获得的数据进行定量分析。
不同钻孔速度产生的温度存在显著差异（p<0.05）。然而，不同个体的骨骼之间以及使用不同钻头直径钻孔的骨骼之间记录的温度没有显著差异。与红外热成像相比，热电偶在测量温度方面显示出明显更灵敏的工具。
以最佳速度钻孔通过将温度保持在阈值水平以下，显著降低了医源性热骨坏死的风险。尽管不同的钻头直径在产生温度方面没有产生显著差异，但需要进一步研究使用不同钻头直径的机械影响。
