组织变形控制骨折愈合。
Tissue deformation controlling fracture healing.
机构信息
AO Research Institute Davos CH 7260, Switzerland; University of Regensburg, Regensburg D 93042, Germany; Kliniken Südostbayern AG, Bad Reichenhall D 83435, Germany.
AO Research Institute Davos CH 7260, Switzerland; IHBI Queensland University of Technology, Brisbane, Australia.
出版信息
J Biomech. 2021 Aug 26;125:110576. doi: 10.1016/j.jbiomech.2021.110576. Epub 2021 Jun 12.
To achieve optimal flexibility in biological internal fracture fixation two questions require clarification: which biomechanical parameter controls healing and what are the boundary conditions thereof? Fracture movement interacts with callus and local stress and strain are influencing the reaction of the tissue cells. A linear gradient of strain was created inside a sheep tibia osteotomy using an active external fixator. The effect of different amounts of strain applied at 10 stimulation cycles/day on the occurrence of callus and on enabling osseous connection of the fragments was evaluated using micro-radiology to determine the amount of calcified new bone formation and its quality of gap bridging. A strong relation between level of strain and amount of callus was observed. Depending on the strain level different pattern of connections were seen. At the lowest investigated gap strain level of about 7% direct connection of the fragments within the gap occurred. Beyond 13% the callus only connected indirectly outside the gap. At over 36% callus did not connect the fragments anymore comparable to a situation in hypertrophic non-unions. The observed strong relation between interfragmentary strain and reduced osseous bridging may support the hypothesis that the elongation at rupture of connecting tissue plays an important role defining the upper limit for solid bridging. In planning fracture treatment, the amount of fracture mobility resulting in interfragmentary strain may play a crucial role to achieve solid healing.
为了在生物内部骨折固定中实现最佳的灵活性,有两个问题需要澄清:哪个生物力学参数控制愈合,其边界条件是什么?骨折运动与骨痂相互作用,局部应力和应变影响组织细胞的反应。使用主动外固定器在绵羊胫骨截骨处产生线性应变梯度。通过微射线照相术评估每天 10 个刺激循环施加不同量的应变对骨痂形成和使碎片骨连接的影响,以确定新骨形成的钙化量及其间隙桥接的质量。观察到应变水平与骨痂量之间存在很强的关系。根据应变水平,观察到不同的连接模式。在最低研究的间隙应变水平约 7%时,直接在间隙内发生碎片连接。超过 13%时,骨痂仅在间隙外间接连接。超过 36%时,骨痂不再连接碎片,类似于肥大性骨不连的情况。观察到的片段间应变与骨桥接减少之间的强关系可能支持这样的假设,即连接组织的断裂伸长在确定坚固桥接的上限方面起着重要作用。在规划骨折治疗时,导致片段间应变的骨折活动性的量可能在实现坚固愈合方面起着至关重要的作用。