Klos Kajetan, Simons Paul, Schopp Pauline, Schenk Philipp, Kohler Felix C, Uddin Akram, Roth Edgar K, Biedermann Uta, Hofmann Gunther O, Lenz Mark
Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, 07747 Jena, Germany.
Foot and Ankle Division, Gelenkzentrum Rhein-Main, Frankfurter Str. 94, 65239 Hochheim am Main, Germany.
J Clin Med. 2023 Jun 7;12(12):3896. doi: 10.3390/jcm12123896.
Plantar plate positioning has been demonstrated as biomechanically superior. However, some operators remain resentful about the morbidity of the surgical approach. To provide improved plate fixation for first tarsometatarsal joint arthrodesis with respect to the tibialis anterior tendon, a medio-plantar plate was developed. The purpose of this biomechanical study was to compare its construct stability to that of a plantar plate construct. Twelve pairs of fresh frozen human specimens were used in a matched pair test. Each pair was fixed with a 4 mm compression screw and either a plantar locking plate or a medio-plantar locking plate. A cantilever beam test was performed in dorsiflexion. Before and after cyclic loading (5000 cycles; 40 N), bending stiffness and relative movements at the joint space were monitored in a quasi-static test including optical motion tracking. Maximum load and bending moment to failure were investigated in a load-to-failure ramp test. The bending stiffness of both groups did not significantly differ before (plantar 49.9 N/mm ± 19.2; medio-plantar 53.9 N/mm ± 25.4, = 0.43) or after (plantar 24.4 N/mm ± 9.7; medio-plantar 35.3 N/mm ± 22.0, = 0.08) cyclic loading but decreased significantly in both groups ( < 0.01) after cyclic loading. Relative movement increased significantly during cyclic testing in both groups ( < 0.01) but did not differ significantly between the groups before ( = 0.29) or after ( = 0.16) cyclic loading. Neither load nor bending moment to failure were significantly different (plantar 225 N ± 78, 10.8 Nm; medio-plantar 210 N ± 86, 10.1 Nm, = 0.61). Both plate constructs provided equivalent construct stability, both being well suited for Lapidus arthrodesis.
跖板定位已被证明在生物力学上更具优势。然而，一些手术医生仍然对该手术方法的发病率感到不满。为了在胫前肌腱方面为第一跖跗关节融合术提供更好的钢板固定，研发了一种中跖板。本生物力学研究的目的是将其结构稳定性与跖板结构的稳定性进行比较。在配对试验中使用了12对新鲜冷冻的人体标本。每对标本均用一枚4毫米加压螺钉以及一块跖侧锁定钢板或一块中跖侧锁定钢板进行固定。在背屈位进行悬臂梁试验。在包括光学运动跟踪的准静态试验中，监测循环加载（5000次循环；40牛）前后关节间隙处的弯曲刚度和相对运动。在破坏载荷斜坡试验中研究最大载荷和破坏弯矩。两组的弯曲刚度在循环加载前（跖侧49.9牛/毫米±19.2；中跖侧53.9牛/毫米±25.4，P = 0.43）或后（跖侧24.4牛/毫米±9.7；中跖侧35.3牛/毫米±22.0，P = 0.08）均无显著差异，但在循环加载后两组均显著降低（P < 0.01）。两组在循环测试期间相对运动均显著增加（P < 0.01），但在循环加载前（P = 0.29）或后（P = 0.16）两组之间无显著差异。破坏载荷和破坏弯矩均无显著差异（跖侧225牛±78，10.8牛·米；中跖侧210牛±86，10.1牛·米，P = 0.61）。两种钢板结构均提供了等效的结构稳定性，两者都非常适合拉皮德斯关节融合术。
