Boháč Petr, Apostolopoulos Vasileios, Marcián Petr, Tomáš Tomáš, Mahdal Michal, Návrat Tomáš
Faculty of Mechanical Engineering, Institute of Solid Mechanics, Mechatronics and Biomechanics, University of Technology, Brno, Czech Republic.
First Department of Orthopaedic Surgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
PLoS One. 2025 Feb 6;20(2):e0316719. doi: 10.1371/journal.pone.0316719. eCollection 2025.
The use of bone allograft reconstructions after tumor resection can introduce significant complications. Stable fixation is required to decrease the incidence of mechanical complications of segmental bone allografts. The purpose of the present study is to compare plating fixation methods of diaphyseal allografts after intercalary resection of the femur.
We created four defined fixation models using plates and/or intramedullary polymethylmethacrylate (PMMA) to simulate typical bone tumor resection with intercalary allograft reconstruction. One angularly stable plate (DFP) with 13 locking screws and fresh frozen allografts (labeled "I") were used for bone reconstruction. Three modified reconstructions were created: "II" included a supplementary plate (SP) with four locking screws, "III" was augmented with intramedullary PMMA in the allograft, and "IV" combined intramedullary PMMA and both plates. We applied a load model that simulates partial weight bearing on the lower limb to simulate the load during postoperative rehabilitation.
The highest stress in the DFP occurred at the allograft-bone transition, with variant IV reaching 297 MPa. PMMA augmentation reduced median interfragmentary motion (IFM) and sliding distances, with variant III achieving the lowest distal sliding distance (0.9 μm) in the distal area. Supplementary plate fixation reduced maximal and median proximal IFM distances (86.9 μm in variant II vs. 116.0 μm in variant I) but increased sliding distances (23.7 μm in variant II vs. 0.6 μm in variant I).
PMMA augmentation reduces IFM and sliding distances, enhancing rigidity, particularly in the distal area. Supplementary plate fixation decreases IFM distances in the proximal area but increases sliding distances in the same region. Variants III and IV demonstrate lower IFM and sliding distances in the distal area overall. Variant III shows very low sliding distances in both distal and proximal areas. Variant IV combines improved firmness with slightly higher stress levels.
肿瘤切除术后使用同种异体骨重建可能会引发严重并发症。需要稳定固定以降低节段性同种异体骨机械并发症的发生率。本研究的目的是比较股骨节段间切除术后骨干同种异体骨的钢板固定方法。
我们使用钢板和/或髓内聚甲基丙烯酸甲酯（PMMA）创建了四种明确的固定模型，以模拟典型的骨肿瘤切除及节段间同种异体骨重建。使用一块带有13枚锁定螺钉的角度稳定钢板（DFP）和新鲜冷冻同种异体骨（标记为“I”）进行骨重建。创建了三种改良重建方式：“II”包括一块带有4枚锁定螺钉的辅助钢板（SP），“III”在同种异体骨内增加髓内PMMA，“IV”则结合了髓内PMMA和两块钢板。我们应用一种模拟下肢部分负重的负荷模型来模拟术后康复期间的负荷。
DFP中最高应力出现在同种异体骨与宿主骨的交界处，IV型达到297MPa。PMMA增强降低了平均骨块间运动（IFM）和滑动距离，III型在远端区域实现了最低的远端滑动距离（0.9μm）。辅助钢板固定降低了近端的最大和平均IFM距离（II型为86.9μm，I型为116.0μm），但增加了滑动距离（II型为23.7μm，I型为0.6μm）。
PMMA增强可降低IFM和滑动距离，提高刚性，尤其是在远端区域。辅助钢板固定可降低近端区域的IFM距离，但增加了同一区域的滑动距离。III型和IV型总体上在远端区域显示出较低的IFM和滑动距离。III型在远端和近端区域均显示出非常低的滑动距离。IV型结合了更好的稳固性和略高的应力水平。
