Harbrecht Andreas, Rausch Valentin, Wegmann Kilian, Hackl Michael, Uschok Stephan, Leschinger Tim, Müller Lars P
Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
Department of Anatomy I, Medical Faculty, University of Cologne, Cologne, Germany.
Arch Orthop Trauma Surg. 2021 Oct;141(10):1683-1690. doi: 10.1007/s00402-020-03628-8. Epub 2020 Oct 19.
In this study we investigated if realistic fracture patterns around the hip can be produced on human cadaveric specimens with intact soft tissue envelope. Possible applications of such fractured specimens would be in surgical training.
7 cadaveric specimens (2 male, 5 female, 2 formalin-fixed, 5 fresh-frozen) were fractured. 2 specimens were fractured on both femurs, 5 only on one side, resulting in 9 fractures total. 5 fractures were set in our custom-made drop-test bench, 2 fractures by inducing axial force using a hammer, and the remaining 2 fractures by a direct dorsal approach and a chisel. AO/OTA and Pauwels classification were used to classify the fractures on the specimens by two independent trauma surgeons.
In our drop-test bench, axial load with the femur adducted by 10° resulted in an intertrochanteric fracture (AO type A1.3), adducted by 20° resulted in a femoral neck fracture (Pauwels type III). Fracture induction using a hammer resulted in two intertrochanteric fractures (AO type A2.2 right, A3.3 left). The use of a chisel resulted in both cases in a femoral neck fracture. The acetabulum could be fractured multifragmentarily through use of a hemiprosthesis as a stamp.
A high energetic impulse induced by a custom-made drop-test bench can successfully simulate realistic proximal femur and acetabular fractures in cadaveric specimens with intact soft tissue. Furthermore, axial load using a hammer as well as using a chisel through a direct dorsal approach represent additional methods for fracture induction. These pre-fractured specimens can be utilized in surgical education to provide a realistic teaching experience for specialized trauma education courses.
在本研究中，我们调查了在具有完整软组织包膜的人体尸体标本上是否能产生逼真的髋部周围骨折模式。此类骨折标本的可能应用在于外科手术训练。
对7具尸体标本（2例男性，5例女性，2例经福尔马林固定，5例新鲜冷冻）进行骨折处理。2具标本双侧股骨均发生骨折，5具仅一侧发生骨折，共产生9处骨折。5处骨折在我们定制的落锤试验台上造成，2处骨折通过用锤子施加轴向力造成，其余2处骨折通过直接后方入路并用凿子造成。两名独立的创伤外科医生使用AO/OTA和 Pauwels分类法对标本上的骨折进行分类。
在我们的落锤试验台上，股骨内收10°时施加轴向载荷导致转子间骨折（AO A1.3型），内收20°时导致股骨颈骨折（Pauwels III型）。用锤子诱导骨折产生了两处转子间骨折（右侧AO A2.2型，左侧A3.3型）。使用凿子在两例中均导致股骨颈骨折。通过使用半髋关节假体作为压模可使髋臼发生多块骨折。
定制的落锤试验台产生的高能量脉冲能够成功模拟具有完整软组织的尸体标本中逼真的股骨近端和髋臼骨折。此外，用锤子施加轴向载荷以及通过直接后方入路使用凿子是造成骨折的额外方法。这些预先骨折的标本可用于外科教育，为专业创伤教育课程提供逼真的教学体验。
