Orthopedics. 2021 Jan 1;44(1):e36-e42. doi: 10.3928/01477447-20201202-07. Epub 2020 Dec 7.
Bicortical drilling of the clavicle is associated with risk of iatrogenic damage from plunging given the close proximity of neurovascular structures. This study determined plunge depth during superior-to-inferior clavicle drilling using a standard drill vs drill-sensing technology. Two orthopedic surgeons drilled 10 holes in a fresh cadaveric clavicle with drill-sensing technology in freehand mode (functions as standard orthopedic drill) and another 10 holes with drill-sensing technology in bicortical mode (drill motor stops when the second cortex is breached and depth is measured in real time). The drill-measured depths were compared with computed tomography-measured depths. Distances to the neurovascular structures were also measured. The surgeons' plunge depths were compared using an independent t test. With freehand (standard) drilling, the mean plunge depth was 8.8 mm. For surgeon 1, the range was 5.6 to 15.8 mm (mean, 10.9 mm). For surgeon 2, the range was 3.3 to 11.0 mm (mean, 6.4 mm). The surgeons' plunge depths were significantly different. In bicortical mode, the drill motor stopped when the second cortex was penetrated. Drill-measured depths were verified by computed tomography scan, with a mean difference of 0.8 mm. Mean distances from the clavicle to the neurovascular structures were 15.5 mm for the subclavian vein, 18.0 mm for the subclavian artery, and 8.0 mm for the brachial plexus. Plunge depths differed between surgeons. However, both surgeons' plunge depths were greater than distances to the neurovascular structures, indicating a risk of injury due to plunging. Although a nonspinning drill bit may still cause soft tissue damage, drill-sensing technology may decrease the risk of penetrating soft tissue structures due to plunging. [Orthopedics. 2021;44(1):e36-e42.].
锁骨的双皮质钻孔会因靠近神经血管结构而增加钻头切入的风险。本研究使用标准钻头和钻头感应技术确定了从上到下钻锁骨时的切入深度。两位骨科医生在新鲜的尸体锁骨上使用钻头感应技术以徒手模式（功能与标准骨科钻头相同）钻了 10 个孔，然后又在双皮质模式下钻了 10 个孔（当钻头切入第二层皮质时，钻头电机停止，并且实时测量深度）。将钻头测量的深度与计算机断层扫描测量的深度进行比较。还测量了到神经血管结构的距离。使用独立 t 检验比较了外科医生的切入深度。使用徒手（标准）钻孔，平均切入深度为 8.8 毫米。对于外科医生 1，范围为 5.6 至 15.8 毫米（平均值，10.9 毫米）。对于外科医生 2，范围为 3.3 至 11.0 毫米（平均值，6.4 毫米）。外科医生的切入深度有显著差异。在双皮质模式下，当钻头切入第二层皮质时，钻头电机停止。钻头测量的深度通过计算机断层扫描得到验证，平均差异为 0.8 毫米。锁骨到神经血管结构的平均距离为锁骨下静脉 15.5 毫米，锁骨下动脉 18.0 毫米，臂丛神经 8.0 毫米。切入深度在外科医生之间存在差异。然而，两位外科医生的切入深度都大于到神经血管结构的距离，这表明由于切入可能会造成损伤的风险。虽然非旋转钻头仍可能造成软组织损伤，但钻头感应技术可能会因切入而降低穿透软组织结构的风险。[骨科。2021;44(1):e36-e42.]。
