单皮质近端锁定螺钉与双皮质近端锁定螺钉用于预防植入前骨折：桡骨远端骨质疏松模型的生物力学分析

Q3 Medicine

Journal of Hand Surgery Global Online Pub Date : 2024-11-01 DOI:10.1016/j.jhsg.2024.07.004

Mitchell C. Harris MD , Ryan J. Bickley MD , Pooyan Abbasi MSc , Gabriel J. Yohe MS , Kenneth R. Means MD , Scott M. Tintle MD , Aviram M. Giladi MD, MS

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引用次数: 0

摘要

目的骨质疏松患者在桡骨远端固定术后有发生假体周围骨折的风险。理论上，在钢板近端孔中使用单皮质螺钉可以消除远端骨皮质中的孔，从而减少应力骤增的形成。这种结构在骨科文献中被提出来预防假体周围骨折，但尚未在骨质疏松的桡骨远端模型中进行过测试。未进行截骨。除A组使用双皮质近端锁定螺钉、B组使用单皮质近端锁定螺钉外，其他固定结构完全相同。骨矿物质密度通过射线测量进行估算。结果双皮质螺钉组和单皮质螺钉组的四点弯曲刚度没有显著差异（110.8 N/mm vs 106.2 N/mm）。8 vs 106.2 N/mm，顶点外侧弯曲；105.4 vs 107.1 N/mm，顶点背侧弯曲）或扭转刚度（430.6 vs 427.6 N-mm/度，内旋；430.8 vs 429.7 N-mm/度，外旋）无显著差异。结论本研究表明，痊愈的骨质疏松桡骨远端沃尔钢板在近端使用单皮质锁定螺钉与双皮质螺钉在顶点背侧弯曲的刚度或失效载荷方面没有统计学差异。临床意义在桡骨远端钢板近端孔中使用单皮质锁定螺钉与双皮质锁定螺钉相比，在防止骨质疏松症患者骺端植入物周围骨折方面，单皮质锁定螺钉在生物力学上没有明显优势。

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Unicortical Versus Bicortical Proximal Locking Screw for Prevention of Peri-Implant Fracture: A Biomechanical Analysis of an Osteoporotic Distal Radius Model

Purpose

Osteoporotic patients are at risk of peri-implant fractures after distal radius fixation. A unicortical screw in the proximal hole of the plate can theoretically decrease stress riser formation by eliminating the hole in the far bone cortex. This construct has been proposed in orthopedic literature to prevent peri-implant fractures but has not been tested in an osteoporotic distal radius model.

Methods

Eleven paired cadaver radii were harvested and plated with four-hole titanium volar distal radius plates. No osteotomies were created. The fixation constructs were identical except that group A used a bicortical proximal locking screw and group B used a unicortical proximal locking screw. Bone mineral density was estimated using radiographic measurements. The samples were potted and tested for four-point bending stiffness, torsion stiffness, and load to failure.

Results

Between the bicortical and unicortical screw groups, there was no significant difference in four-point bending stiffness (110.8 vs 106.2 N/mm, apex volar bending; 105.4 vs 107.1 N/mm, apex dorsal bending) or torsional stiffness (430.6 vs 427.6 N-mm/degree, internal rotation; 430.8 vs 429.7 N-mm/degree, external rotation). There was also no significant difference in load to failure with apex dorsal four-point bending (795.3 vs 770.0 N).

Conclusions

This study shows that a healed osteoporotic distal radius volar plate construct with a proximal unicortical locking screw is not statistically different from a bicortical screw in stiffness or load to failure in apex dorsal bending. Although a unicortical locking screw has been proposed as a mechanism to prevent stress risers at the proximal aspect of the distal radius plate, this study suggests no significant difference when compared with a bicortical locking screw.

Clinical relevance

There is no significant biomechanical advantage to unicortical over bicortical locking screws in the proximal hole of a distal radius plate to prevent diaphyseal peri-implant fractures in osteoporotic patients.

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