Edward Hines, Jr. VA Hospital, Hines, IL, USA.
Loyola University Chicago, Maywood, IL, USA.
Hand (N Y). 2023 Mar;18(2):314-319. doi: 10.1177/15589447211003172. Epub 2021 May 14.
We examined the effect of Kirschner wire (K-wire) reuse and use of oscillating mode on heat generation within cortical bone.
Two trocar-tipped K-wires were drilled through the diaphysis of each of 30 human metacarpals and phalanges: one K-wire was inserted in rotary mode and another in oscillating mode. Each wire was reused once. Thermocouples placed within the dorsal and volar bone adjacent to the K-wire drill path measured temperatures throughout each test.
Peak cortex temperatures were 25°C to 164°C. Rotary drilling achieves peak temperatures quicker (31 ± 78 seconds vs 44 ± 78 seconds, = .19) than oscillating drilling, but insertion time is also less, resulting in lower overall heat exposure. This effect is also seen when the K-wire is reused (34 ± 70 seconds vs 41 ± 85 seconds, = .4). The length of time that cortical bone was exposed to critical temperatures (47°C or more) was significantly higher when a wire was reused (36 ± 72 seconds vs 43 ± 82 seconds, = .008). Peak temperatures greater than 70°C (a temperature associated with instantaneous cell death) were observed on many occasions.
Overall heat exposure may be higher if a K-wire is reused or inserted in oscillating mode. In the absence of external cooling, K-wire insertion into cortical bone can easily expose bone to temperatures that exceed 70°C and may increase the risk of osteonecrosis.
我们研究了克氏针（K-wire）重复使用和摆动模式对皮质骨产热的影响。
在 30 个人类掌骨和指骨的骨干中分别用带套管的 K-wire 以旋转模式和摆动模式各钻一根 K-wire：一根 K-wire 重复使用一次。将热电偶放置在 K-wire 钻孔路径附近的背侧和掌侧骨内，以测量整个测试过程中的温度。
皮质骨的最高温度为 25°C 至 164°C。旋转钻孔达到最高温度的速度更快（31 ± 78 秒比 44 ± 78 秒， =.19），但插入时间也更短，因此总体热暴露较低。当 K-wire 重复使用时，也会出现这种效果（34 ± 70 秒比 41 ± 85 秒， =.4）。皮质骨暴露于临界温度（47°C 或更高）的时间明显更长（36 ± 72 秒比 43 ± 82 秒， =.008）。在许多情况下，观察到超过 70°C 的峰值温度（与瞬时细胞死亡相关的温度）。
如果 K-wire 重复使用或插入摆动模式，整体热暴露可能会更高。在没有外部冷却的情况下，K-wire 插入皮质骨很容易使骨暴露于超过 70°C 的温度，并可能增加骨坏死的风险。
