Gotzen L, Hütter J, Haas N
Unfallchirurgie. 1980;6(1):14-23. doi: 10.1007/BF02589445.
By tensioning plates which are contoured exactly to the bone shaft a torque is produced leading to gapping of the cortex opposite to the plate. The gapping depends on the amount of tension force and plate stiffness. In osteosyntheses performed on transversely osteotomized tibial and femoral shafts with plates adapted to the bone surface the gapping angles of tibia osteotomies with narrow plates are twice as large as those of femur osteotomies with broad plates. In order to eliminate the torque the plates must be prebent before application. Three phases have been defined to describe the tension process of prebent plates. During phase I the fragments are in contact opposite the plates only. By further tensioning the plates are straightened and the fragments come in full contact, thus beginning phase II. When the center of compression is situated in the middle of the diaphysis cross-section a uniform compression distribution is achieved. Phase III begins when the force along the plates distracts the cortex opposite the implant. The boundaries of the phases and the prebending angles which guarantee uniform interfragmental compression distribution in dependence of the tension forces are of paramount importance. Therefore the relationship between the forces necessary to bend back the prebent plates and the prebending angles were investigated. With the obtained values diagrams were constructed for compression osteosynthesis either with narrow round hole and DC plates applied to radius/ulna and tibia, or with broad round hole and DC plates applied to humerus and femur.
通过张紧与骨干精确贴合的接骨板,会产生一个扭矩,导致接骨板对面的皮质骨出现间隙。间隙大小取决于张紧力的大小和接骨板的刚度。在用适配于骨表面的接骨板对横断的胫骨干和股骨干进行骨接合术时,使用窄接骨板的胫骨截骨术的间隙角度是使用宽接骨板的股骨截骨术间隙角度的两倍。为了消除扭矩,接骨板在应用前必须预弯。已定义了三个阶段来描述预弯接骨板的张紧过程。在第一阶段,骨折块仅在接骨板对面接触。通过进一步张紧,接骨板变直,骨折块完全接触,从而开始第二阶段。当压缩中心位于骨干横截面中部时,可实现均匀的压缩分布。当沿接骨板的力使植入物对面的皮质骨分离时,第三阶段开始。这些阶段的界限以及根据张紧力保证均匀骨折块间压缩分布的预弯角度至关重要。因此,研究了使预弯接骨板恢复原状所需的力与预弯角度之间的关系。利用所得值,构建了用于桡骨/尺骨和胫骨的窄圆孔及动力加压(DC)接骨板,或用于肱骨和股骨的宽圆孔及DC接骨板的加压骨接合术的图表。