长骨干钻孔深度对接骨螺钉固定强度的影响
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摘要
目的研究钢板螺钉固定中的钻孔类型对钉道微观结构和螺钉固定强度的影响。方法取8根防腐尸体股骨,每根股骨均布10个钻孔标记并随机分通孔、半通孔两组,钻取通孔、半通孔两种孔型并置入螺钉测试拔出力。两组螺钉置入深度一致,截取骨段量取两组孔型孔位的骨皮质厚度,最后用体视显微镜观察比较孔道骨组织微观结构。结果通孔、半通孔组的骨皮质厚度分别为(0.687±0.046)cm、(0.706±0.014)cm,两组间骨皮质厚度无统计学差异;通孔、半通孔组的螺钉拔出力分别为(3.495±0.345)kN、(4.008±0.548)kN,两组间的螺钉拔出力存在统计学差异;通孔、半通孔组钻孔出口侧外环骨板表面撕裂区的平均高度分别为(0.256±0.045)cm、(0.078±0.035)cm,两组间有统计学差异。结论钢板螺钉固定钻取孔道时采用半通孔,螺钉置入深度不变,在满足与通孔同样的骨-螺钉接触面积的同时,因出口侧外环骨板破坏较轻,可提供更强的螺钉固定强度。
Objective To study the effects of borehole patterns on bone microstructure and screw fixation strength in orthopedic plate and screw fixation. Methods Eight anti-corrosive femoral specimens were taken. Each specimen was marked with 10 boreholes and randomly divided into two groups: throughhole and semi-through-hole. Two types of boreholes were drilled and screws were inserted to test pullout force. The depth of screw placement was the same in both groups. The cortical thickness of the two groups of boreholes was taken from the amount of the cut-off bone segment. Finally, the microstructure of the porous bone tissue was observed and compared by stereomicroscope. Results The thickness of bone cortex in through-hole and semi-through-hole groups were(0.687±0.046) cm and(0.706±0.014) cm, respectively. There was no significant difference in the thickness of bone cortex between the two groups. The pull-out force of screw in through-hole and semi-through-hole groups was(3.495 ± 0.345) kN and(4.008 ± 0.548) kN,respectively. There was significant difference in the pull-out force between the two groups. The average height of tear zone on the outer annular bone plate at the exit of through-hole and semi-through-hole groups was(0.256±0.045) cm and(0.078±0.035) cm, respectively, and there was significant difference between the two groups. Conclusion The semi-through holes can be used when steel plate screws were used to fix drilling holes. The depth of screw placement remains unchanged. While meeting the same bone-screw contact area as through holes, it can provide stronger screw fixation strength due to lighter damage of the outer ring bone plate at the outlet side.
Objective To study the effects of borehole patterns on bone microstructure and screw fixation strength in orthopedic plate and screw fixation. Methods Eight anti-corrosive femoral specimens were taken. Each specimen was marked with 10 boreholes and randomly divided into two groups: throughhole and semi-through-hole. Two types of boreholes were drilled and screws were inserted to test pullout force. The depth of screw placement was the same in both groups. The cortical thickness of the two groups of boreholes was taken from the amount of the cut-off bone segment. Finally, the microstructure of the porous bone tissue was observed and compared by stereomicroscope. Results The thickness of bone cortex in through-hole and semi-through-hole groups were(0.687±0.046) cm and(0.706±0.014) cm, respectively. There was no significant difference in the thickness of bone cortex between the two groups. The pull-out force of screw in through-hole and semi-through-hole groups was(3.495 ± 0.345) kN and(4.008 ± 0.548) kN,respectively. There was significant difference in the pull-out force between the two groups. The average height of tear zone on the outer annular bone plate at the exit of through-hole and semi-through-hole groups was(0.256±0.045) cm and(0.078±0.035) cm, respectively, and there was significant difference between the two groups. Conclusion The semi-through holes can be used when steel plate screws were used to fix drilling holes. The depth of screw placement remains unchanged. While meeting the same bone-screw contact area as through holes, it can provide stronger screw fixation strength due to lighter damage of the outer ring bone plate at the outlet side.
引文
[1]冯卫,刘建国,徐莘香.四肢长骨骨折的治疗进展[J].中华创伤杂志,2010,26(2):102-105.
[2]冯鹏,董文明,杨王宽,等.四肢长管状骨骨折的临床治疗方法及效果观察[J].世界最新医学信息文摘(电子版),2013(1):229.
[3]柏冰,马松涛,侯志勇.生物学内固定技术在四肢长骨骨折治疗中的应用进展[J].临床合理用药杂志,2015(21):162-164.
[4]石勇,洪泽亚,陈子建,等.不同内固定方式对股骨干骨折术后行动能力的影响[J].中国骨与关节损伤杂志,2017,32(8):847-849.
[5]陈路.钢板螺钉内固定技术应用于四肢长管骨创伤骨折的效果及生物力学分析[J].中国组织工程研究,2012,16(30):5639-5643.
[6]李振立.分析钢板螺钉内固定技术应用于四肢长管骨创伤骨折的效果及生物力学[J].中国伤残医学,2015(16):2-3.
[7]马显志,张伯松,王满宜,等.辅助钢板治疗股骨干骨折髓内钉固定术后骨折不愈合的生物力学研究[J].中华创伤骨科杂志,2016,18(2):158-162.
[8]Koistinen AP,Korhonen H,Kr?ger H,et al.Interfacial sliding properties of bone screw materials and their effect on screw fixation strength[J].J Appl Biomater Funct Mater,2014,12(2):90-96.
[9]Pohlemann T,Gueorguiev B,Agarwal Y,et al.Dynamic locking screw improves fixation strength in osteoporotic bone:an in vitro study on an artificial bone model[J].Int Orthop,2015,39(4):761-768.
[10]Juvonen T,Nuutinen JP,Koistinen AP,et al.Biomechanical evaluation of bone screw fixation with a novel bone cement[J].Biomed Eng Online,2015,14:74.
[11]Lenz M,Lehmann W,W?hnert D.Periprosthetic fracture fixation in osteoporotic bone[J].Injury,2016,47 Suppl 2:S44-S50.
[12]Kim MB,Lee YH,Kim JH,et al.Biomechanical comparison of three2.7-mm screws and two 3.5-mm screws for fixation of simple oblique fractures in human distal fibulae[J].Clin Biomech(Bristol,Avon),2013,28(2):225-231.
[13]Nieto H,Baroan C.Limits of internal fixation in long-bone fracture[J].Orthop Traumatol Surg Res,2017,103(1S):S61-S66.
[14]谈庆明.机械工程师手册第4版[J].国外科技新书评介,2016,10:256.
[15]Shah MD,Kapoor CS,Soni RJ,et al.Evaluation of outcome of proximal femur locking compression plate(PFLCP)in unstable proximal femur fractures[J].J Clin Orthop Trauma,2017,8(4):308-312.
[16]Arirachakaran A,Amphansap T,Thanindratarn P,et al.Comparative outcome of PFNA,Gamma nails,PCCP,Medoff plate,LISS and dynamic hip screws for fixation in elderly trochanteric fractures:a systematic review and network meta-analysis of randomized controlled trials[J].Eur J Orthop Surg Traumatol,2017,27(7):937-952.
[17]Ehlinger M,Scheibling B,Rahme M,et al.Minimally invasive surgery with locking plate for periprosthetic femoral fractures:technical note[J].Int Orthop,2015,39(10):1921-1926.
[18]Krishnan V,Varghese V,Kumar G S.Comparative analysis of effect of density,insertion angle and reinsertion on pull-out strength of single and two pedicle screw constructs using synthetic bone model[J].Asian Spine J,2016,10(3):414-421.
[19]Patel PS,Shepherd DE,Hukins DW.The effect of screw insertion angle and thread type on the pullout strength of bone screws in normal and osteoporotic cancellous bone models[J].Med Eng Phys,2010,32(8):822-828.
[20]Wu C,Chen C,Wu W,et al.Biomechanical analysis of differential pullout strengths of bone screws using cervical anterior transpedicular technique in normal and osteoporotic cervical cadaveric spines[J].Spine(Phila Pa 1976),2015,40(1):E1-E8.
[21]李长树.面向虚拟手术系统离体股骨干钻削力学参数的测试与研究[D].广州:南方医科大学,2014.
[22]李长树,卢启贵,黄东红,等.新鲜尸体股骨干钻削进给力与扭矩的测试研究[J].中国数字医学,2015(6):57-61.
[23]Imbert L,Auregan JC,Pernelle K,et al.Microstructure and compressive mechanical properties of cortical bone in children with osteogenesis imperfecta treated with bisphosphonates compared with healthy children[J].J Mech Behav Biomed Mater,2015,46:261-270.
[24]O'Neill KR,Stutz CM,Mignemi NA,et al.Micro-computed tomography assessment of the progression of fracture healing in mice[J].Bone,2012,50(6):1357-1367.
[25]王法琪,严亚波,温鑫鑫,等.显微CT分辨率对松质骨微观结构及生物力学测量的影响[J].现代生物医学进展,2015,15(10):1877-1880,1835.
[26]Matsukawa K,Yato Y,Hynes RA,et al.Comparison of pedicle screw fixation strength among different transpedicular trajectories:a finite element study[J].Clin Spine Surg,2017,30(7):301-307.
[27]倪鹏辉,张鹰,杨晶,等.临床骨科中应用的有限元分析法:新理论与新进展[J].中国组织工程研究,2016,20(31):4693-4699.
[2]冯鹏,董文明,杨王宽,等.四肢长管状骨骨折的临床治疗方法及效果观察[J].世界最新医学信息文摘(电子版),2013(1):229.
[3]柏冰,马松涛,侯志勇.生物学内固定技术在四肢长骨骨折治疗中的应用进展[J].临床合理用药杂志,2015(21):162-164.
[4]石勇,洪泽亚,陈子建,等.不同内固定方式对股骨干骨折术后行动能力的影响[J].中国骨与关节损伤杂志,2017,32(8):847-849.
[5]陈路.钢板螺钉内固定技术应用于四肢长管骨创伤骨折的效果及生物力学分析[J].中国组织工程研究,2012,16(30):5639-5643.
[6]李振立.分析钢板螺钉内固定技术应用于四肢长管骨创伤骨折的效果及生物力学[J].中国伤残医学,2015(16):2-3.
[7]马显志,张伯松,王满宜,等.辅助钢板治疗股骨干骨折髓内钉固定术后骨折不愈合的生物力学研究[J].中华创伤骨科杂志,2016,18(2):158-162.
[8]Koistinen AP,Korhonen H,Kr?ger H,et al.Interfacial sliding properties of bone screw materials and their effect on screw fixation strength[J].J Appl Biomater Funct Mater,2014,12(2):90-96.
[9]Pohlemann T,Gueorguiev B,Agarwal Y,et al.Dynamic locking screw improves fixation strength in osteoporotic bone:an in vitro study on an artificial bone model[J].Int Orthop,2015,39(4):761-768.
[10]Juvonen T,Nuutinen JP,Koistinen AP,et al.Biomechanical evaluation of bone screw fixation with a novel bone cement[J].Biomed Eng Online,2015,14:74.
[11]Lenz M,Lehmann W,W?hnert D.Periprosthetic fracture fixation in osteoporotic bone[J].Injury,2016,47 Suppl 2:S44-S50.
[12]Kim MB,Lee YH,Kim JH,et al.Biomechanical comparison of three2.7-mm screws and two 3.5-mm screws for fixation of simple oblique fractures in human distal fibulae[J].Clin Biomech(Bristol,Avon),2013,28(2):225-231.
[13]Nieto H,Baroan C.Limits of internal fixation in long-bone fracture[J].Orthop Traumatol Surg Res,2017,103(1S):S61-S66.
[14]谈庆明.机械工程师手册第4版[J].国外科技新书评介,2016,10:256.
[15]Shah MD,Kapoor CS,Soni RJ,et al.Evaluation of outcome of proximal femur locking compression plate(PFLCP)in unstable proximal femur fractures[J].J Clin Orthop Trauma,2017,8(4):308-312.
[16]Arirachakaran A,Amphansap T,Thanindratarn P,et al.Comparative outcome of PFNA,Gamma nails,PCCP,Medoff plate,LISS and dynamic hip screws for fixation in elderly trochanteric fractures:a systematic review and network meta-analysis of randomized controlled trials[J].Eur J Orthop Surg Traumatol,2017,27(7):937-952.
[17]Ehlinger M,Scheibling B,Rahme M,et al.Minimally invasive surgery with locking plate for periprosthetic femoral fractures:technical note[J].Int Orthop,2015,39(10):1921-1926.
[18]Krishnan V,Varghese V,Kumar G S.Comparative analysis of effect of density,insertion angle and reinsertion on pull-out strength of single and two pedicle screw constructs using synthetic bone model[J].Asian Spine J,2016,10(3):414-421.
[19]Patel PS,Shepherd DE,Hukins DW.The effect of screw insertion angle and thread type on the pullout strength of bone screws in normal and osteoporotic cancellous bone models[J].Med Eng Phys,2010,32(8):822-828.
[20]Wu C,Chen C,Wu W,et al.Biomechanical analysis of differential pullout strengths of bone screws using cervical anterior transpedicular technique in normal and osteoporotic cervical cadaveric spines[J].Spine(Phila Pa 1976),2015,40(1):E1-E8.
[21]李长树.面向虚拟手术系统离体股骨干钻削力学参数的测试与研究[D].广州:南方医科大学,2014.
[22]李长树,卢启贵,黄东红,等.新鲜尸体股骨干钻削进给力与扭矩的测试研究[J].中国数字医学,2015(6):57-61.
[23]Imbert L,Auregan JC,Pernelle K,et al.Microstructure and compressive mechanical properties of cortical bone in children with osteogenesis imperfecta treated with bisphosphonates compared with healthy children[J].J Mech Behav Biomed Mater,2015,46:261-270.
[24]O'Neill KR,Stutz CM,Mignemi NA,et al.Micro-computed tomography assessment of the progression of fracture healing in mice[J].Bone,2012,50(6):1357-1367.
[25]王法琪,严亚波,温鑫鑫,等.显微CT分辨率对松质骨微观结构及生物力学测量的影响[J].现代生物医学进展,2015,15(10):1877-1880,1835.
[26]Matsukawa K,Yato Y,Hynes RA,et al.Comparison of pedicle screw fixation strength among different transpedicular trajectories:a finite element study[J].Clin Spine Surg,2017,30(7):301-307.
[27]倪鹏辉,张鹰,杨晶,等.临床骨科中应用的有限元分析法:新理论与新进展[J].中国组织工程研究,2016,20(31):4693-4699.