应用微动平衡接骨术治疗粉碎性干骺端股骨远端骨折：一项动物研究。

Treatment of comminuted metaphyseal distal femoral fractures with a micromotion-balancing osteosynthesis: an animal study.

机构信息

Department of Orthopaedics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.

Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine Chongming Branch, Shanghai, 202150, China.

出版信息

BMC Surg. 2023 May 11;23(1):118. doi: 10.1186/s12893-023-01939-2.

DOI:10.1186/s12893-023-01939-2

PMID:37170233

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10176858/

Abstract

BACKGROUND

Locking plates are commonly used in the treatment of comminuted metaphyseal distal femoral fractures. However, locking plates form a strong structure and promote asymmetrical callus formation, which is not conducive for rapid fracture healing and may increase fracture risk. To overcome this, we designed a micromotion-balancing fixation system based on locking plates.

METHODS

Six healthy pigs (Bama miniature pigs) were used to establish a model of bilateral comminuted distal femoral fracture (AO/ASIF: 33-C2). Standard drilling was performed on one of each pig's hind limbs (control group), whereas eccentric drilling was performed on the other hind limb (experimental group). Both femurs were fixed with a 3-hole locking compression plate using 5-mm-diameter screws. At 12 postoperative weeks, all pigs were euthanized and the femurs with compression plates were radiographically examined. The level of fracture healing and loosening/internal fixation failure were recorded. Bone mineral density, number of trabeculae, trabecular morphology, and calcification precipitations were assessed.

RESULTS

All pigs survived, and the fractures healed. No complications related to fracture healing, such as infection and internal fixation failure, were noted. The bone mineral density of the near and far cortical calli, number of the near and far cortical callus trabeculae, and difference in bone mineral density between the near and far cortical calli in the experimental group were significantly higher than those in the control group (p < 0.01). However, the difference in the number of trabeculae between the near and far cortical calli was significantly lower in the experimental group than in the control group (p < 0.01).

CONCLUSION

This newly designed system provides stable fixation for comminuted distal femoral fracture, increases the overall strain at the fracture site, and balances the strains at the near and far cortices to achieve uniform callus growth and fracture healing.

摘要

背景

锁定钢板常用于治疗粉碎性干骺端股骨远端骨折。然而，锁定钢板形成了一个坚固的结构，促进了不对称性的骨痂形成，这不利于快速骨折愈合，并可能增加骨折的风险。为了克服这一问题，我们设计了一种基于锁定钢板的微动平衡固定系统。

方法

使用 6 只健康猪（巴马小型猪）建立双侧粉碎性股骨远端骨折模型（AO/ASIF：33-C2）。每只猪的一侧后腿进行标准钻孔（对照组），另一侧后腿进行偏心钻孔（实验组）。使用 5mm 直径的螺钉，通过 3 孔锁定加压钢板固定双侧股骨。术后 12 周，所有猪被安乐死，并对带有加压钢板的股骨进行影像学检查。记录骨折愈合和松动/内固定失败的程度。评估骨密度、骨小梁数量、骨小梁形态和钙化沉淀。