University of Illinois at Chicago, USA.
Hand (N Y). 2020 May;15(3):393-398. doi: 10.1177/1558944718795510. Epub 2018 Sep 6.
Due to bone cutting loss from self-tapping screws (STS), progressive destruction of bone can occur with each reinsertion during surgery. When considering the use of jigs that utilize multiple insertions such as those seen in ulnar and radial shortening osteotomy systems, or scenarios where a screw needs to be removed and reinserted due to some technical issue, this can be concerning, as multiple studies examining the effects of multiple reinsertions and the relationship between insertional torque and pullout strength have had mixed results. Insertional torque and pullout strength were experimentally measured following multiple reinsertions of STS for up to 5 total insertions for various densities and locations along radial sawbone shafts. Torque and pullout strength were significantly greater in middle segments of the radial shaft. Our trials corroborate previous literature regarding a significant reduction in fixation between 1 and 2 insertions; beyond this, there was no significant difference between pullout strength across all segment locations as well as bone densities for 3 to 5 insertions. There was a moderate to high correlation of insertional torque to pullout strength noted across all bone densities and segments (Pearson = 0.663, < .001). While reinsertion of STS between 1 and 2 insertions has been shown to significantly differ in pullout strength, beyond this, there does not appear to be a significant difference in up to 5 insertions at any specific region of radial bone across a range of sawbone densities. Further insertions may be considered with caution.
由于自攻螺钉（STS）的骨切割损失，每次手术重新插入时都会发生骨的渐进性破坏。当考虑使用需要多次插入的夹具时，例如在尺骨和桡骨缩短截骨系统中看到的那些情况，或者由于某些技术问题需要移除和重新插入螺钉的情况，这可能会令人担忧，因为多项研究检查了多次重新插入的效果以及插入扭矩和拔出强度之间的关系，结果喜忧参半。实验测量了 STS 在各种密度和桡骨锯骨轴位置的多达 5 次总插入后的多次重新插入后的插入扭矩和拔出强度。在桡骨轴的中间段，扭矩和拔出强度明显更大。我们的试验与之前关于在 1 到 2 次插入之间固定力显著降低的文献一致；除此之外，在所有节段位置以及 3 到 5 次插入的骨密度之间，拔出强度没有显著差异。在所有骨密度和节段中，插入扭矩与拔出强度之间存在中度至高度相关性（Pearson = 0.663， <.001）。虽然已经表明在 1 到 2 次插入之间重新插入 STS 的拔出强度有显著差异，但除此之外，在任何特定的桡骨骨区域，在一系列锯骨密度范围内，多达 5 次插入似乎没有显著差异。进一步的插入可能需要谨慎考虑。
