Rosa Natacha, Marta Miguel, Vaz Mário, Tavares Sergio M O, Simoes Ricardo, Magalhães Fernão D, Marques Antonio Torres
1 Department of Mechanical Engineering, Faculty of Engineering, University of Porto, Porto, Portugal.
2 Department of Orthopaedics, Centro Hospitalar de São João, Porto, Portugal.
Proc Inst Mech Eng H. 2019 Mar;233(3):295-308. doi: 10.1177/0954411919827044.
This article aims to review the biomechanical evolution of intramedullary nailing and describe the breakthrough concepts which allowed for nail improvement and its current success. The understanding of this field establishes an adequate background for forthcoming research and allows to infer on the path for future developments on intramedullary nailing. It was not until the 1940s, with the revolutionary Küntscher intramedullary nailing design, that this method was recognized as a widespread medical procedure. Such achievement was established based on the foundations created from intuition-based experiments and the first biomechanical ideologies. The nail evolved from allowing alignment and stability through press-fit fixation with nail-cortical wall friction to the nowadays nail stability achieved through interlocking screws mechanical linkage between nail and bone. Important landmarks during nail evolution comprise the introduction of flexible reaming, the progress from slotted to non-slotted nails design, the introduction of nail 'dynamization' and the use of titanium alloys as a new nail material. Current biomechanical improvement efforts aim to enhance the bone-intramedullary nail system stability. We suggested that benefit would be attained from a better understanding of the ideal mechano-biological environment at the fracture site, and future improvements will emerge from combining mechanics and biological tools.
本文旨在回顾髓内钉的生物力学演变，并描述促成髓内钉改进及其当前成功的突破性概念。对该领域的理解为即将开展的研究奠定了充分的基础，并有助于推断髓内钉未来的发展方向。直到20世纪40年代，随着具有革命性的克氏髓内钉设计的出现，这种方法才被公认为一种广泛应用的医疗程序。这一成就建立在基于直觉的实验和最初的生物力学理念所奠定的基础之上。髓内钉从通过钉与皮质骨壁摩擦的压配固定来实现对线和稳定性，发展到如今通过锁定螺钉在钉与骨之间建立机械连接来实现钉的稳定性。髓内钉演变过程中的重要里程碑包括引入弹性扩髓、从开槽钉设计发展到非开槽钉设计、引入髓内钉“动力化”以及使用钛合金作为新型钉材料。当前生物力学改进工作旨在增强骨 - 髓内钉系统的稳定性。我们认为，更好地理解骨折部位的理想机械生物学环境将带来益处，未来的改进将来自力学和生物学工具的结合。
