Thome Andrew P, O'Donnell Ryan, DeFroda Steven F, Cohen Brian H, Cruz Aristides I, Fleming Braden C, Owens Brett D
Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA.
Department of Orthopaedic Surgery, Rush University School of Medicine, Chicago, Illinois, USA.
Orthop J Sports Med. 2021 Nov 12;9(11):23259671211049476. doi: 10.1177/23259671211049476. eCollection 2021 Nov.
Several fixation methods have been reported for the operative treatment of tibial eminence fractures. Previous biomechanical studies have demonstrated that suture fixation may be a stronger construct; however, the maturity status of these specimens was not scrutinized.
To examine if suture fixation remains a biomechanically superior fixation method to screw fixation in both skeletally mature and immature specimens.
Controlled laboratory study.
Sixteen total matched porcine (Yorkshire) knees (8 skeletally immature knees and 8 skeletally mature knees) were procured, and a standardized tibial eminence fracture was created. In each age-matched group of knees, 4 knees underwent randomization to fixation with 2 screws while 4 knees were randomized to fixation using a dual-suture technique. Once fixation was complete, the specimens underwent cyclic loading (200 cycles) in the anteroposterior plane of the tibia and load-to-failure testing, both with the knee positioned at 30° of flexion. Relevant measurements were recorded, and data were analyzed.
Among mature specimens, load to failure was 1.9 times higher in the suture fixation group compared with the screw fixation group (1318.84 ± 305.55 vs 711.66 ± 279.95 N, respectively; = .03). The load to failure was not significantly different between the groups in immature specimens (suture: 470.00 ± 161.91 N vs screw: 348.79 ± 102.46; = .08).
These findings suggest that suture fixation may represent a better construct choice for fixation of tibial eminence fractures in the skeletally mature population. However, in the skeletally immature population, fixation with screws or suture may be equivalent. Displacement after cyclic loading did not appear to differ by fixation method, nor did stiffness.
A stronger fixation construct may be beneficial and allow for earlier range of motion to help potentially decrease postoperative stiffness. Clinical studies are warranted to see if these results may be replicated in humans.
已有多种用于胫骨髁间隆起骨折手术治疗的固定方法被报道。既往生物力学研究表明，缝线固定可能是一种更强的固定方式；然而，这些标本的成熟状态未被仔细研究。
研究在骨骼成熟和未成熟标本中，缝线固定在生物力学上是否仍优于螺钉固定。
对照实验室研究。
获取16对匹配的猪（约克夏）膝关节（8个骨骼未成熟膝关节和8个骨骼成熟膝关节），制造标准化的胫骨髁间隆起骨折。在每个年龄匹配的膝关节组中，4个膝关节随机采用2枚螺钉固定，4个膝关节随机采用双缝线技术固定。固定完成后，标本在胫骨前后平面进行循环加载（200次循环）和破坏载荷测试，膝关节均处于30°屈曲位。记录相关测量数据并进行分析。
在成熟标本中，缝线固定组的破坏载荷比螺钉固定组高1.9倍（分别为1318.84±305.55 N和711.66±279.95 N；P = 0.03）。未成熟标本组间的破坏载荷无显著差异（缝线：470.00±161.91 N vs螺钉：348.79±102.46；P = 0.08）。
这些发现表明，缝线固定可能是骨骼成熟人群胫骨髁间隆起骨折固定的更好选择。然而，在骨骼未成熟人群中，螺钉固定或缝线固定可能等效。循环加载后的位移似乎不因固定方法而异，刚度也无差异。
更强的固定结构可能有益，并允许更早进行活动范围锻炼，以帮助潜在地降低术后僵硬程度。有必要进行临床研究，以确定这些结果是否能在人类中得到重复。
