Fletcher James W A, Wenzel Lisa, Neumann Verena, Richards R Geoff, Gueorguiev Boyko, Gill Harinderjit S, Preatoni Ezio, Whitehouse Michael R
Department for Health, University of Bath, UK.
AO Research Institute Davos, Switzerland.
EFORT Open Rev. 2020 Jan 29;5(1):26-36. doi: 10.1302/2058-5241.5.180066. eCollection 2020 Jan.
Billions of screws are inserted by surgeons each year, making them the most commonly inserted implant. When using non-locking screws, insertion technique is decided by the surgeon, including how much to tighten each screw. The aims of this study were to assess, through a systematic review, the screw tightness and rate of material stripping produced by surgeons and the effect of different variables related to screw insertion.Twelve studies were included, with 260 surgeons inserting a total of 2793 screws; an average of 11 screws each, although only 1510 screws have been inserted by 145 surgeons where tightness was measured - average tightness was 78±10% for cortical ( = 1079) and 80±6% for cancellous screw insertions ( = 431).An average of 26% of all inserted screws irreparably damaged and stripped screw holes, reducing the construct pullout strength. Furthermore, awareness of bone stripping is very poor, meaning that screws must be considerably overtightened before a surgeon will typically detect it.Variation between individual surgeons' ability to optimally insert screws was seen, with some surgeons stripping more than 90% of samples and others hardly any. Contradictory findings were seen for the relationship between the tightness achieved and bone density.The optimum tightness for screws remains unknown, thus subjectively chosen screw tightness, which varies greatly, remains without an established target to generate the best possible construct for any given situation. Work is needed to establish these targets, and to develop methods to accurately and repeatably achieve them. Cite this article: 2020;5:26-36. DOI: 10.1302/2058-5241.5.180066.
每年外科医生要植入数十亿颗螺钉，使其成为最常植入的植入物。使用非锁定螺钉时，植入技术由外科医生决定，包括每颗螺钉拧紧的程度。本研究的目的是通过系统评价，评估外科医生植入螺钉时的拧紧程度和材料剥离率，以及与螺钉植入相关的不同变量的影响。纳入了12项研究，260名外科医生共植入2793颗螺钉；平均每人植入11颗，不过只有145名外科医生植入的1510颗螺钉测量了拧紧程度——皮质骨螺钉植入时平均拧紧程度为78±10%（ = 1079），松质骨螺钉植入时为80±6%（ = 431）。所有植入螺钉中平均有26%造成了无法修复的损坏并使螺孔剥离，降低了结构的拔出强度。此外，对骨剥离的认知非常不足，这意味着在外科医生通常能检测到之前，螺钉必须过度拧紧。观察到不同外科医生最佳植入螺钉的能力存在差异，一些外科医生的样本剥离率超过90%，而另一些几乎没有。对于所达到的拧紧程度与骨密度之间的关系，存在相互矛盾的研究结果。螺钉的最佳拧紧程度仍然未知，因此主观选择的拧紧程度差异很大，在任何给定情况下，都没有既定目标来生成最佳结构。需要开展工作来确定这些目标，并开发准确且可重复实现这些目标的方法。引用本文：2020；5：26 - 36。DOI：10.1302/2058 - 5241.5.180066。
