Reddy P J, Manning B T, Bezold W, Garlapaty A, Cook J L, Schweser K
Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA.
J Orthop. 2023 Feb 16;37:64-68. doi: 10.1016/j.jor.2023.02.010. eCollection 2023 Mar.
Talonavicular arthrodesis (TNA) is indicated for treatment of disorders that require immobilization of the hindfoot. Lag screw fixation is considered the reference standard technique for TNA. Despite consistently favorable clinical results using lag screw fixation, it is still associated with higher than desired complication and failure rates. Nitinol compression staples have been used for TNA based on potential advantages over lag screw fixation. However, functional biomechanical data comparing lag screw and nitinol compression staples for TNA are lacking. Therefore, the objective of this study was to compare nitinol compression staples to fully threaded lag screws for use in TNA with respect to their biomechanical properties during functional robotic testing.
TNA was performed on cadaveric feet (n = 12; 6 matched pairs) using either two nitinol compression staples (Arthrex, Naples, FL) or two fully threaded lag screws (Arthrex, Naples, FL) in random order, alternating between paired left and right feet. After instrumentation, specimens were mounting in a robotic testing system and loaded at 89 N/sec from 30 N to 445 N for 1 min. Then, continuous compressive load of 445 N was applied while cycling from 30° plantarflexion to 15° dorsiflexion for 10 cycles. Optical tracking markers attached to the talus and navicular bone tracked displacements. Translation data were recorded along the X, Y, Z planes. Rotation data were recorded for roll, pitch, and yaw. Significant (p < 0.05) differences between fixation methods were determined using paired t-Tests for each measured variable.
There were no statistically significant differences between staples and screws for translation in X, Y, or Z planes. When comparing rotation (roll, pitch, and yaw), there were no statistically significant differences with the exception of increased roll rotation for staple fixation versus lag screw fixation during static compression testing (p = 0.009).
Based on comparison to the reference standard lag screw fixation for clinically relevant biomechanical properties measured during functional robotic testing of the hindfoot, nitinol compression staples are a viable option for talonavicular arthrodesis.
距舟关节融合术（TNA）适用于治疗需要固定后足的疾病。拉力螺钉固定被认为是TNA的参考标准技术。尽管使用拉力螺钉固定一直能取得良好的临床效果，但它仍与高于预期的并发症和失败率相关。基于比拉力螺钉固定具有潜在优势，镍钛诺加压钉已被用于TNA。然而，缺乏比较拉力螺钉和镍钛诺加压钉用于TNA的功能生物力学数据。因此，本研究的目的是在功能机器人测试期间，比较镍钛诺加压钉和全螺纹拉力螺钉用于TNA时的生物力学特性。
在尸体足（n = 12；6对匹配足）上进行TNA，随机顺序使用两枚镍钛诺加压钉（Arthrex，那不勒斯，佛罗里达州）或两枚全螺纹拉力螺钉（Arthrex，那不勒斯，佛罗里达州），左右足对交替使用。器械置入后，将标本安装在机器人测试系统中，以89 N/秒的速度从30 N加载至445 N，持续1分钟。然后，在从30°跖屈到15°背屈循环10次的同时，施加445 N的持续压缩载荷。附着在距骨和舟骨上的光学跟踪标记跟踪位移。沿X、Y、Z平面记录平移数据。记录滚动、俯仰和偏航的旋转数据。使用配对t检验对每个测量变量确定固定方法之间的显著（p < 0.05）差异。
在X、Y或Z平面上，加压钉和螺钉之间的平移无统计学显著差异。比较旋转（滚动、俯仰和偏航）时，除了在静态压缩测试期间，加压钉固定与拉力螺钉固定相比滚动旋转增加外（p = 0.009），无统计学显著差异。
基于在功能机器人测试后足期间测量的与临床相关的生物力学特性与参考标准拉力螺钉固定进行比较，镍钛诺加压钉是距舟关节融合术的可行选择。
