Wu X, Dai K, Qiu S
Department of Orthopaedics, Shanghai Second Meidcal University.
Zhonghua Wai Ke Za Zhi. 1995 Aug;33(8):481-4.
The authors made their own design of sawteeth-arm embracing internal fixator (SEIF) with NiTi shape memory alloy and used for fractured femoral shaft of dogs in comparison with 316L stainless steel plate-screw system. A transverse osteotomy on both sides of femoral diaphyses was performed in 15 adult dogs. One side was plated with bone plate and the other with SEIF. Five animals in each group were killed at 4, 8, 12 weeks after operation and observed under roentgen rays examination, light microscopy and transmission electron microscopy. The results showed that the fracture healing and the course of callus remodelling were similar in these two groups, but the cortical bone remodelling underneath the fixater near osteotomized area was significantly different. Eight-week post-implantation, osteocytes entered into degenerative phase were observed in cortical bone underneath SEIF, and 12-week after operation, the numbers of degenerative osteocytes increased remarkably. While in the case of bone plate, 4-week post-implantation, osteocytes entered into degenerative phase, and 8-week afterwards autolysis occurred in most of the degenerative osteocyles. In other words, the changes of osteocytes phase in bone plate side appeared earlier and more vigorous than that in the SEIF side. The authors are of the opinion that the elastic modulus of NiTi shape memory alloy is lower, the stress-shielding effect in the bone underneath SEIF is less, the axial compression stress of fracture line is kept larger and the contact of SEIF with the bone is not so close that is beneficial to the recovery of blood supply and bone remodelling.
作者采用镍钛形状记忆合金自行设计了锯齿臂环抱式内固定器(SEIF),并将其用于犬股骨干骨折,与316L不锈钢钢板螺钉系统进行比较。对15只成年犬的股骨干两侧进行横断截骨术。一侧用骨板固定,另一侧用SEIF固定。每组5只动物在术后4周、8周、12周处死,进行X线检查、光镜和透射电镜观察。结果显示,两组骨折愈合及骨痂重塑过程相似,但截骨区附近固定器下方的皮质骨重塑有显著差异。植入SEIF 8周后,观察到SEIF下方皮质骨中骨细胞进入退变期,术后12周,退变骨细胞数量显著增加。而在骨板固定侧,植入后4周骨细胞进入退变期,8周后大多数退变骨细胞发生自溶。也就是说,骨板侧骨细胞的变化比SEIF侧出现得更早且更明显。作者认为,镍钛形状记忆合金的弹性模量较低,SEIF下方骨的应力遮挡效应较小,骨折线的轴向压应力保持较大,且SEIF与骨的接触不那么紧密,这有利于血供恢复和骨重塑。