NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York, USA.
J Orthop Res. 2024 Oct;42(10):2210-2215. doi: 10.1002/jor.25908. Epub 2024 May 28.
The purpose of this study was to assess the biomechanical contributions of the nail and the plate individually to a complete nail-plate construct in the setting of comminuted distal femur fractures. For this biomechanical study, comminuted extra-articular distal femur fractures were created in 24 synthetic osteoporotic femur models. These were then split into three groups: the nail-only group, the plate-only group, and the nail-plate group. After fixation, each specimen underwent sequential axial and torsional loading, and axial and torsional stiffness were calculated and compared. The addition of a nail to a plate-only construct increased axial stiffness by 19.7% and torsional stiffness by 59.4%. The plate-only group and nail-plate group both demonstrated significantly greater axial and torsional stiffness than the nail-only group at all levels of axial and torsional load. (p < 0.001) At 1000 and 2000 N of cyclic loading, the nail-plate group demonstrated significantly greater axial stiffness than the plate-only group (p ≤ 0.018). The nail-plate group demonstrated greater torsional stiffness than the plate-only groups at all levels of torsional loading (p < 0.001). In osteoporotic comminuted distal femur fracture models, most of the axial stiffness in a nail-plate construct comes from the plate. While the combination of the two constructs is not fully additive, the plate contributes the majority of the axial and torsional stiffness in a nail-plate construct. The supplementation of the plate with a nail primarily helps to increase resistance to rotational forces. Level of Evidence: III.
本研究的目的是评估在粉碎性股骨远端骨折的情况下，单独的钉子和钢板对完整的钉板结构的生物力学贡献。在这项生物力学研究中，在 24 个合成骨质疏松股骨模型中创建粉碎性关节外股骨远端骨折。然后将它们分为三组：仅钉组、仅板组和钉板组。固定后，每个标本都进行了顺序轴向和扭转加载，计算并比较了轴向和扭转刚度。将钉子添加到仅板结构中可使轴向刚度增加 19.7%，扭转刚度增加 59.4%。在所有轴向和扭转加载水平下，仅板组和钉板组的轴向和扭转刚度均明显大于仅钉组（p<0.001）。在 1000 和 2000 N 的循环加载下，钉板组的轴向刚度明显大于仅板组（p≤0.018）。在所有扭转加载水平下，钉板组的扭转刚度均大于仅板组（p<0.001）。在骨质疏松性粉碎性股骨远端骨折模型中，钉板结构的大部分轴向刚度来自于钢板。虽然两种结构的组合不是完全相加的，但钢板在钉板结构中贡献了大部分的轴向和扭转刚度。钢板加上钉子的补充主要有助于增加抗旋转力。证据水平：III。
