Jain R, Podworny N, Hearn T, Anderson G I, Schemitsch E H
Orthopaedic Research Laboratory, St. Michael's Hospital, Toronto, Ontario, Canada.
J Orthop Trauma. 1997 Oct;11(7):490-5. doi: 10.1097/00005131-199710000-00006.
Comparison of the effect of stainless steel and titanium low-contact dynamic compression plate application on the vascularity and mechanical properties of cortical bone after fracture.
Randomized, prospective.
Orthopaedic research laboratory.
Ten large (greater than twenty-five kilogram) adult dogs.
A short, midshaft spiral tibial fracture was created, followed by lag screw fixation and neutralization with an eight-hole, 3.5-millimeter, low-contact dynamic compression plate (LCDCP) made of either 316L stainless steel (n = five) or commercially pure titanium (n = five). After surgery, animals were kept with unrestricted weight-bearing in individual stalls for ten weeks.
Cortical bone blood flow was assessed by laser Doppler flowmetry using a standard metalshafted probe (Periflux Pf303, Perimed, Jarfalla, Sweden) applied through holes in the custom-made LCDCPs at five sites. Bone blood flow was determined at four times: (a) prefracture, (b) postfracture, (c) postplating, and (d) ten weeks postplating. After the dogs were killed, the implant was removed and both the treated tibia and contralateral tibia were tested for bending stiffness and load to failure.
Fracture creation decreased cortical perfusion in both groups at the fracture site (p = 0.02). The application of neither stainless steel nor titanium LCDCPs further decreased cortical bone blood flow after fracture creation. However, at ten weeks postplating, cortical perfusion significantly increased compared with acute postplating levels in the stainless steel (p = 0.003) and titanium (p = 0.001) groups. Cortical bone blood flow ten weeks postplating was not significantly different between the titanium group and the stainless steel group. Biomechanical tests performed on the tibiae with the plates removed did not reveal any differences in bending stiffness nor load required to cause failure between the two groups.
Both titanium and stainless steel LCDCPs were equally effective in allowing revascularization, and neither provided a significant advantage in biomechanical properties of fracture healing at ten weeks.
比较应用不锈钢和钛制低接触动力加压钢板对骨折后皮质骨血管分布和力学性能的影响。
随机、前瞻性研究。
骨科研究实验室。
10只成年大型犬（体重超过25千克）。
制造一个短的、胫骨中段螺旋形骨折，随后用拉力螺钉固定，并用一个由316L不锈钢制成的八孔、3.5毫米低接触动力加压钢板（LCDCP）（n = 5）或商业纯钛制成的相同钢板（n = 5）进行中和。手术后，动物在单独的畜栏中自由负重饲养10周。
使用标准金属杆探头（Periflux Pf303，Perimed，耶夫勒，瑞典）通过定制LCDCP上的孔，在五个部位用激光多普勒血流仪评估皮质骨血流。在四个时间点测定骨血流：（a）骨折前，（b）骨折后，（c）钢板固定后，（d）钢板固定后10周。在犬处死之后，取出植入物，对治疗的胫骨和对侧胫骨进行弯曲刚度和破坏载荷测试。
骨折形成使两组骨折部位的皮质灌注减少（p = 0.02）。应用不锈钢或钛制LCDCP均未在骨折形成后进一步降低皮质骨血流。然而，在钢板固定后10周，不锈钢组（p = 0.003）和钛组（p = 0.001）的皮质灌注与急性钢板固定后水平相比显著增加。钢板固定后10周，钛组和不锈钢组之间的皮质骨血流无显著差异。对去除钢板的胫骨进行的生物力学测试未显示两组之间在弯曲刚度或导致破坏所需载荷方面有任何差异。
钛制和不锈钢制LCDCP在促进血管再生方面同样有效，且在10周时两者在骨折愈合的生物力学性能方面均未显示出显著优势。
