Arjmand Hanieh, Fialkov Jeffrey A, Whyne Cari M
Orthopaedic Biomechanics Lab, Sunnybrook Research Institute, Canada; Institute of Biomedical Engineering, University of Toronto, Canada.
Institute of Biomedical Engineering, University of Toronto, Canada; Department of Surgery, University of Toronto, Canada; Division of Plastic Surgery, Sunnybrook Health Sciences Centre, Canada.
J Plast Reconstr Aesthet Surg. 2024 Apr;91:241-248. doi: 10.1016/j.bjps.2024.02.002. Epub 2024 Feb 6.
Zygomaticomaxillary complex (ZMC) fracture repair is one of the most common surgical procedures performed in craniomaxillofacial trauma management. Miniplates and screws are used to stabilize the fractured bone using small local incisions, however, these procedures are not infrequently associated with hardware-related post-operative complications. The amount of fixation hardware utilized varies depending on the fracture pattern and surgical judgment, with three-point fixation being the conventionally accepted treatment. However, limited experimental testing and clinical studies have suggested that ZMC stabilization may be achieved with less than three-point fixation. In this study, we utilized a previously developed finite element modeling approach that allows for detailed bone and muscle representation to study the mechanical behavior of the fractured craniomaxillofacial skeleton (CMFS) under one, two, or three-point fixation of the ZMC. Results suggest that using a miniplate along the infraorbital rim in three-point fixation increases the amount of strain and load transfer to this region, rather than offloading the bone. Two-point (zygomaticomaxillary and zygomaticofrontal) fixation yielded strain patterns most similar to the intact CMFS. One-point (zygomaticofrontal) fixation resulted in higher tensile and compressive strains in the zygomaticofrontal region and the zygomatic arch, along with a higher tensile strain on the zygomatic body. These modeling results provide biomechanical evidence for the concept of over-engineering in the stabilization of facial fractures. Furthermore, they support previous suggestions that less than three-point fixation of ZMC fractures may be adequate to achieve uneventful healing.
颧上颌复合体（ZMC）骨折修复是颅颌面创伤治疗中最常见的外科手术之一。微型钢板和螺钉用于通过小的局部切口稳定骨折的骨头，然而，这些手术并不罕见地与硬件相关的术后并发症有关。所使用的固定硬件的数量因骨折类型和手术判断而异，三点固定是传统上公认的治疗方法。然而，有限的实验测试和临床研究表明，ZMC稳定可以通过少于三点的固定来实现。在本研究中，我们利用先前开发的有限元建模方法，该方法允许详细的骨骼和肌肉表示，以研究在ZMC的一点、两点或三点固定下骨折的颅颌面骨骼（CMFS）的力学行为。结果表明，在三点固定中沿眶下缘使用微型钢板会增加该区域的应变和载荷传递量，而不是减轻骨骼的负荷。两点（颧上颌和颧额）固定产生的应变模式与完整的CMFS最相似。一点（颧额）固定导致颧额区域和颧弓的拉伸和压缩应变较高，以及颧体上的拉伸应变较高。这些建模结果为面部骨折固定中的过度设计概念提供了生物力学证据。此外，它们支持先前的建议，即ZMC骨折少于三点固定可能足以实现顺利愈合。
