钛缆环扎增加了股骨远端骨折钢板内固定的失效负荷。

Titanium Cable Cerclage Increases the Load to Failure in Plate Osteosynthesis for Distal Femoral Fractures.

机构信息

Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Baldingerstrasse, 35043 Marburg, Germany.

Philipps-University Marburg, 35037 Marburg, Germany.

出版信息

Medicina (Kaunas). 2024 Sep 19;60(9):1524. doi: 10.3390/medicina60091524.

Abstract

The reduction of two-part oblique or spiral fractures of the distal femur using steel wire cerclage prior to plate osteosynthesis is a proven procedure. In addition to being useful in fracture reduction, wire cerclage was also shown to increase the stability of osteosynthesis. Nevertheless, metal corrosion and the allergenic potency of steel remain problematic disadvantages of this method. A biomechanical study was carried out to evaluate titanium cable cerclage as an alternative supplement for plate osteosynthesis of a distal femoral two-part fracture. An unstable AO/OTA 32-A2.3 fracture was created in eleven pairs of nonosteoporotic human cadaver femora. All the samples were treated with polyaxial angular stable plate osteosynthesis. One femur from each pair was randomly selected for an additional fracture fixation with multifilament titanium cable cerclage. Stepwise cyclic axial loading was applied in a load-to-failure mode using a servohydraulic testing machine. All specimens (mean age: 80 years; range: 57-91 years) withstood a cycling force of at least 1800 N. With a mean load of 2982 N (95% CI: 2629-3335 N), the pressure forces resulting in osteosynthesis failure were significantly higher in specimens with an additional titanium cerclage (Group 1) than in samples that were solely treated with plate osteosynthesis (Group 2) at 2545 N (95% CI: 2257-2834 N) ( = 0.024). In both groups, cutting out the distal screws at the condyle region, resulting in shearing of the distal fragment proximal to the fracture line, was the most frequent cause of construct failure. Among the specimens assigned to Group 1, 36% exhibited a specific fracture pattern, namely, a fracture of the dorsal buttress above the cerclage. Analysis of axial stiffness ( = 0.286) and irreversible deformity of the specimens revealed no differences between the groups ( = 0.374). Titanium cable cerclage application, as a supplement to an angular stable plate, resulted in an increased load to failure. In terms of stability, the use of this adjunct for fracture fixation of supracondylar two-part oblique femoral fractures might, therefore, be an option, especially in patients who are sensitive to nickel.

摘要

在钢板内固定之前使用钢丝环扎术对股骨远端的双部分斜形或螺旋形骨折进行复位,这是一种经过验证的方法。钢丝环扎术除了有助于骨折复位外,还可以增加内固定的稳定性。然而,金属腐蚀和钢的致敏性仍然是这种方法的问题。进行了一项生物力学研究,以评估钛缆环扎术作为股骨远端双部分骨折钢板内固定的一种替代补充方法。在 11 对非骨质疏松性人尸体股骨中创建了不稳定的 AO/OTA 32-A2.3 骨折。所有样本均采用多轴角稳定钢板内固定治疗。每对股骨中的一条随机选择用多股钛缆环扎术进行额外的骨折固定。使用伺服液压试验机以负荷失效模式逐步进行轴向循环加载。所有标本(平均年龄:80 岁;范围:57-91 岁)均能承受至少 1800 N 的循环力。在平均负荷为 2982 N(95%置信区间:2629-3335 N)时,具有附加钛环扎术的标本(第 1 组)导致内固定失败的压力显著高于仅接受钢板内固定的标本(第 2 组)(2545 N;95%置信区间:2257-2834 N)(=0.024)。在两组中,最常见的内固定失败原因是在髁区域切除远端螺钉,导致骨折线近端的远端骨块发生剪切。在被分配到第 1 组的标本中,36%表现出特定的骨折模式,即环扎上方的背侧支柱骨折。对轴向刚度(=0.286)和标本的不可逆变形进行分析,发现两组之间无差异(=0.374)。钛缆环扎术作为角稳定钢板的补充应用可增加断裂负荷。在稳定性方面,因此,对于对镍敏感的患者,这种辅助物可作为治疗髁上双部分斜形股骨骨折的固定方法之一。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b3d2/11434472/f4b398628cdc/medicina-60-01524-g001.jpg

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