大芯锁定螺钉提高股骨去骨术髓内钉的精确性。生物力学研究

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics Pub Date : 2025-02-04 DOI:10.1016/j.clinbiomech.2025.106449

Anders Grønseth , Jan Egil Brattgjerd , Joachim Horn

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引用次数: 0

摘要

背景：为了纠正增加的股骨前倾，外科医生对有症状的青少年实施股骨旋转截骨术。在这种情况下使用髓内钉作为固定，尺寸过小的锁定螺钉通过允许钉子切换来降低旋转精度。然而，更合适的锁定螺栓在多大程度上提高股骨旋转截骨术的旋转精度仍不清楚。因此，我们验证了一个假设，即适当大小的锁定螺栓可以增强旋转刚度并限制位移，从而减少股骨旋转截骨术中钉的切换。方法：我们评估了12例人工股骨的旋转刚度、角位移和零载荷下的松弛性，并对其进行了横向间隙截骨。在植入儿童髓内钉后，用常规的4.5 mm锁定螺钉或0.3 mm大芯直径的锁定螺栓固定股骨。根据预先设定的方案进行了4 Nm内外扭矩的非破坏性准静态旋转测试。我们发现锁紧螺栓的平均旋转刚度明显高于锁紧螺钉，增加了150% (0.4 Nm/度比1.0 Nm/度，P <；0.001)。锁紧螺栓的平均角位移明显低于锁紧螺钉，减少61%(21.9度对8.6度，P <；0.001)。此外，锁紧螺栓的松动度比锁紧螺钉低69%（3.2度对10.4度，P = 0.0027）。具有更大芯直径的锁定螺栓提高了旋转稳定性和固定精度，使其成为股骨旋转截骨术中髓内钉治疗的重要进展。这些发现也可能对骨折治疗有启示。

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Increasing the precision of intramedullary nailing in femoral derotation osteotomies by larger core locking bolts. A biomechanical study

Background

To correct increased femoral anteversion, surgeons perform femoral derotational osteotomies in symptomatic adolescents. Using an intramedullary nail as fixation in this setting, undersized locking screws reduce rotational precision by allowing nail toggling. However, the extent to which better-fitting locking bolts improve rotational precision in femoral derotational osteotomies remains unclear. Accordingly, we tested the hypothesis that adequately sized locking bolts enhance rotational stiffness and limit displacement, thereby decreasing nail toggling in femoral derotational osteotomies in vitro.

Methods

We evaluated rotational stiffness, angular displacement, and laxity at zero-loading in 12 synthetic femurs with a transverse gap osteotomy to the shaft. After inserting a pediatric intramedullary nail, femurs were fixed with either conventional 4.5 mm locking screws or locking bolts with a 0.3 mm larger core diameter. Non-destructive quasi-static rotational testing of 4 Nm external and internal torque was performed according to a predefined protocol.

Findings

We found significantly higher mean rotational stiffness with locking bolts than with locking screws, demonstrating a 150 % increase (0.4 Nm/degree vs. 1.0 Nm/degree, P < 0.001). Mean angular displacement was significantly lower with locking bolts than with locking screws, exhibiting a 61 % decrease (21.9 vs. 8.6 degrees, P < 0.001). Additionally, laxity with locking bolts was 69 % lower than with locking screws (3.2 degrees vs. 10.4 degrees, P = 0.0027).

Interpretation

Locking bolts with a larger core diameter enhances rotational stability and fixation precision, making them a valuable advancement in intramedullary nailing for femoral derotational osteotomies. These findings may also have implications for fracture treatment.

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来源期刊

Clinical Biomechanics 医学-工程：生物医学

CiteScore

3.30

自引率

5.60%

发文量

189

审稿时长

12.3 weeks

期刊介绍： Clinical Biomechanics is an international multidisciplinary journal of biomechanics with a focus on medical and clinical applications of new knowledge in the field. The science of biomechanics helps explain the causes of cell, tissue, organ and body system disorders, and supports clinicians in the diagnosis, prognosis and evaluation of treatment methods and technologies. Clinical Biomechanics aims to strengthen the links between laboratory and clinic by publishing cutting-edge biomechanics research which helps to explain the causes of injury and disease, and which provides evidence contributing to improved clinical management. A rigorous peer review system is employed and every attempt is made to process and publish top-quality papers promptly. Clinical Biomechanics explores all facets of body system, organ, tissue and cell biomechanics, with an emphasis on medical and clinical applications of the basic science aspects. The role of basic science is therefore recognized in a medical or clinical context. The readership of the journal closely reflects its multi-disciplinary contents, being a balance of scientists, engineers and clinicians. The contents are in the form of research papers, brief reports, review papers and correspondence, whilst special interest issues and supplements are published from time to time. Disciplines covered include biomechanics and mechanobiology at all scales, bioengineering and use of tissue engineering and biomaterials for clinical applications, biophysics, as well as biomechanical aspects of medical robotics, ergonomics, physical and occupational therapeutics and rehabilitation.