Wyrsch B, Dawson J, Aufranc S, Weikert D, Milek M
Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA.
J Hand Surg Am. 1996 May;21(3):438-43. doi: 10.1016/S0363-5023(96)80360-1.
Thirty cadaveric distal interphalangeal joints (15 male and 15 female joints) were prepared with either a Herbert screw or a tension-band wire technique to simulate an arthrodesis. To elucidate mechanical differences between these constructs, the strength of the specimens was determined for three-point anteroposterior and lateral bending and for axial torsion. The Herbert screw demonstrated significantly greater anteroposterior bending strength and greater torsional rigidity when compared to the tension-band wire technique. For dimensional analysis, the height and width of each distal phalanx was measured prior to fixation, 4 mm from the distal tip of the bone (the region that must accommodate the large-diameter threads of the Herbert screw). Results indicated that the mean height of the distal phalanx (3.55 mm) is smaller than the diameter of the screw (3.90 mm). Fracture or thread penetration at the tip of the distal phalanx during screw placement occurred in 25 of the specimens overall and in all the female phalanges, often resulting in stretching or violation of the nail bed. Despite fracture or screw penetration, the Herbert screw appears to offer additional strength that may be clinically important for joint arthrodesis.
使用Herbert螺钉或张力带钢丝技术制备了30个尸体远侧指间关节（15个男性关节和15个女性关节）以模拟关节融合术。为了阐明这些固定方法之间的力学差异，对标本进行了三点前后向和侧向弯曲以及轴向扭转试验以测定其强度。与张力带钢丝技术相比，Herbert螺钉在前后向弯曲强度和扭转刚度方面表现出明显更大的优势。为了进行尺寸分析，在固定前，从骨远端尖端4毫米处（必须容纳Herbert螺钉大直径螺纹的区域）测量每个远节指骨的高度和宽度。结果表明，远节指骨的平均高度（3.55毫米）小于螺钉直径（3.90毫米）。在所有标本中，有25个在放置螺钉时远节指骨尖端发生骨折或螺纹穿透，并且所有女性指骨均出现这种情况，这常常导致甲床拉伸或受损。尽管发生了骨折或螺钉穿透，但Herbert螺钉似乎提供了额外的强度，这在临床上对关节融合术可能很重要。
