Tarabichi Majd, Mungalpara Nirav, Lichtig Asher, Kim Sunjung, Karam Joseph, Koh Jason, Amirouche Farid
Department of Orthopaedic Surgery University of California, San Francisco San Francisco California USA.
Department of Orthopaedic Surgery University of Illinois Chicago Chicago Illinois USA.
J Exp Orthop. 2024 Jul 5;11(3):e12088. doi: 10.1002/jeo2.12088. eCollection 2024 Jul.
This paper investigates the biomechanical benefits of using hybrid constructs that combine cannulated screws with tension band wiring (TBW) cerclage compared to cannulated screws with anterior Variable Angle locking neutralisation plates (VA LNP). These enhancements can bear heavier loads and maintain the repaired patella's integrity, in contrast to traditional methods.
Eighteen fresh-frozen human cadaver patellae were carefully fractured transversely at their midpoints using a saw. They were then divided into two groups of nine for subsequent utilisation. Fixation methods included Cannulated Screw Fixation added with either TBW or VA LNP Fixation Technique. Cyclic loading simulations (500 cycles) were conducted to mimic knee motion, tracking fracture displacement with Optotrak. After that, the constructs were secured over a servo-hydraulic testing machine to determine the load-to-failure on axial mode.
The average fracture displacement for the anterior neutralisation plate group was 0.09 ± 0.12 mm, compared to 0.77 ± 0.54 mm for the tension band wiring with cannulated screw group after 500 cyclic loading. This result is statistically significant ( = 0.004). The anterior neutralisation plate group exhibited a mean load-to-failure of 1359 21.53 N, whereas the tension band wiring group showed 780.1 ± 22.62 N, resulting in a significant difference between the groups ( = 0.007).
This research highlights the superior biomechanical advantage of VA LNP over TBW for treating simple transverse patella fractures with two cannulated screws. It also highlights how the TBW is still a valuable option considering the load-to-failure limit.
Not Applicable.
本文研究了与使用空心螺钉加前路可变角度锁定中和钢板（VA LNP）相比，采用空心螺钉与张力带钢丝（TBW）环扎相结合的混合结构的生物力学优势。与传统方法相比，这些改进能够承受更重的负荷并维持修复髌骨的完整性。
使用锯子小心地将18个新鲜冷冻的人体髌骨在中点处横向骨折。然后将它们分成两组，每组9个用于后续使用。固定方法包括空心螺钉固定加上TBW或VA LNP固定技术。进行循环加载模拟（500次循环）以模拟膝关节运动，使用Optotrak跟踪骨折位移。之后，将构建体固定在伺服液压试验机上，以确定轴向模式下的失效载荷。
在500次循环加载后，前路中和钢板组的平均骨折位移为0.09±0.12毫米，而空心螺钉加张力带钢丝组为0.77±0.54毫米。该结果具有统计学意义（P = 0.004）。前路中和钢板组的平均失效载荷为1359±21.53牛，而张力带钢丝组为780.1±22.62牛，两组之间存在显著差异（P = 0.007）。
本研究强调了VA LNP在使用两枚空心螺钉治疗简单横行髌骨骨折方面比TBW具有更好的生物力学优势。它还强调了考虑到失效载荷极限，TBW仍然是一个有价值的选择。
不适用。
