BioDesign Lab, School of Engineering, Computer and Mathematical Sciences, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand.
Department of Surgery, University of Auckland, Auckland, New Zealand.
J Orthop Surg Res. 2020 Jul 10;15(1):253. doi: 10.1186/s13018-020-01768-6.
Osteotomes are bone cutting tools commonly reused in orthopedic surgical procedures. Despite undergoing rigorous cleaning, visual inspection, and sterilization procedures between every use, the condition of the cutting blade edge is commonly not qualitatively assessed. Subjective feedback from surgeons suggests a large variation in osteotome cutting-edge sharpness is found during use. This study seeks to investigate the retention of osteotome cutting-edge sharpness by comparing the wear resistance of as-supplied, electroless nickel, and titanium nitride coated osteotomes following a series of bone cutting tests.
Changes in edge sharpness were assessed using visual inspection, depth penetration testing that quantified change in the blade sharpness index, and scanning electron microscopy visual analysis. Visual inspection of each osteotome blade edge was then compared to qualitative blade sharpness index measurement.
After use, no cutting-edge damage or change in blade sharpness was detected by visual examination of all three osteotomes; however, the as-supplied osteotome demonstrated 50% loss of blade sharpness index compared to 30% and 15% reduction for the electroless nickel and titanium nitride coated osteotomes, respectively. This finding was supported by scanning electron microscopy evaluation that found greater mechanical damage had occurred along the cutting edge of the as-supplied osteotome compared to the two coated with wear resistant materials.
The rapid loss of blade sharpness found in the as-supplied osteotome supports the degradation in cutting performance frequently reported by surgeons. The findings from this study demonstrate blade sharpness index better detects cutting-edge wear compared to visual inspection. Results from this pilot study also suggest the coating of osteotomes in hard-wearing biocompatible materials assists in retaining cutting-edge sharpness over multiple uses. Further study using a larger sample size is required to validate these findings.
骨凿是一种常用于矫形外科手术的骨切割工具。尽管在每次使用之间都经过了严格的清洁、目视检查和消毒程序，但通常不会对切割刃口的状态进行定性评估。外科医生的主观反馈表明，在使用过程中发现骨凿切割刃的锋利度有很大差异。本研究通过比较一系列骨切割试验后供应状态、化学镀镍和氮化钛涂层骨凿的耐磨损性，来研究骨凿切割刃锋利度的保持情况。
使用目视检查、定量测量刃口锋利度指数变化的深度穿透测试以及扫描电子显微镜视觉分析来评估边缘锋利度的变化。然后，将每个骨凿刃口的目视检查与定性刃口锋利度指数测量进行比较。
使用后，所有三种骨凿的刃口均未通过目视检查检测到任何刃口损坏或刃口变钝；然而，与化学镀镍和氮化钛涂层骨凿相比，供应状态的骨凿的刃口锋利度指数降低了 50%，而化学镀镍和氮化钛涂层骨凿分别降低了 30%和 15%。扫描电子显微镜评估结果支持了这一发现，该评估发现，与涂有耐磨材料的两种骨凿相比，供应状态的骨凿的刃口发生了更大的机械损伤。
供应状态的骨凿刃口迅速变钝，这支持了外科医生经常报告的切割性能下降。本研究的结果表明，刃口锋利度指数比目视检查更能检测到刃口磨损。这项初步研究的结果还表明，在骨凿上涂覆耐磨的生物相容性材料有助于在多次使用中保持刃口锋利。需要进一步使用更大的样本量进行研究，以验证这些发现。
