Chen Lei, Li Annie D R, Symonds Christopher, Holmes James R, Weick Jack W
Department of Mechanical Engineering, University of Massachusetts Lowell, Lowell, Massachusetts, USA.
Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan, USA.
J Orthop Res. 2022 Jun;40(6):1301-1311. doi: 10.1002/jor.25163. Epub 2021 Aug 21.
Heat generation during the Kirschner wire (K-wire) insertion process, under either unidirectional or oscillatory drilling mode, places bone at risk of thermal osteonecrosis which can lead to infection. There is a lack of quantitative understanding of the heat generation difference between the two drilling modes and knowledge of optimal thrust force level under each mode is missing. The goal of this study is to investigate the effects of drilling modes and thrust force levels on the bone drilling outcomes. Controlled machine-based constant thrust force K-wire insertion experiments were conducted with key process parameters monitored and compared quantitatively. Statistical analysis showed that the oscillatory mode consumed 2.6 times more electricity than the unidirectional mode but generated 53% less thermal energy and 23% lower peak temperature. However, the oscillation also led to 18% higher peak torque in the transient drilling stage and 23% shallower drilling depth. The optimal choice of the drilling mode depends on specific surgical needs to minimize bone damage (control of peak temperature vs. exposure time and torque control). Heat generation was dominated by the torque and corresponding rotational power under both modes. To minimize the bone temperature while keeping high drilling speed efficiency, a moderate thrust force is preferred under the unidirectional mode to balance between feed force and compressed debris resistance. For oscillatory mode, a small thrust force to keep the K-wire engaged with the bone is optimal.
在克氏针（K 线）插入过程中，无论是单向钻孔模式还是振荡钻孔模式，都会产生热量，使骨骼面临热坏死的风险，进而可能导致感染。目前对于两种钻孔模式之间的产热差异缺乏定量认识，并且每种模式下的最佳推力水平也尚不明确。本研究的目的是探究钻孔模式和推力水平对骨骼钻孔结果的影响。进行了基于机器的可控恒定推力 K 线插入实验，对关键过程参数进行监测并定量比较。统计分析表明，振荡模式的耗电量比单向模式多 2.6 倍，但产生的热能少 53%，峰值温度低 23%。然而，振荡在瞬态钻孔阶段还导致峰值扭矩提高 18%，钻孔深度浅 23%。钻孔模式的最佳选择取决于特定的手术需求，以尽量减少对骨骼的损伤（控制峰值温度与暴露时间以及扭矩控制）。两种模式下产热均由扭矩和相应的旋转功率主导。为了在保持高钻孔速度效率的同时将骨骼温度降至最低，单向模式下优选中等推力以平衡进给力和碎屑阻力。对于振荡模式，保持克氏针与骨骼接触的小推力是最佳选择。
