一种新型声发射螺丝刀降低了外科医生松质螺钉剥离率-一项生物力学研究

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics Pub Date : 2025-02-19 DOI:10.1016/j.clinbiomech.2025.106467

Bryan Joseph Wright , Stephen Grigg , John McCrory , Rhys Pullin , Jan Egil Brattgjerd

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引用次数: 0

摘要

背景：骨科医生通过拧紧松质螺钉来提高他们的扭矩敏感技能。尽管如此，经验丰富的外科医生在骨质减少的松质骨中表现出惊人的高螺钉剥离率。目前尚不清楚声发射技术是否能够在螺钉购买过程中检测微结构损伤产生的能量波，从而降低这些比率。我们的目的是评估外科医生，无论他们的经验如何，是否通过结合他们的技能和创新声发射螺丝刀的反馈来降低松质螺钉剥离率。方法13名经验0 ~ 23年的骨科医生将468枚大碎片松质螺钉经钢板置入合成骨质疏松症骨内。第一阶段，外科医生在没有声发射反馈的情况下分别拧紧9颗螺钉。第二阶段，每个人用声发射反馈改良螺丝刀拧紧18个螺丝。最后阶段，外科医生每人拧紧9颗螺钉，同样没有声发射反馈。在螺丝刀上使用应变计来验证螺钉剥离。在第1阶段，外科医生取出115颗螺钉中的36颗（31%），在第2阶段，取出227颗螺钉中的37颗（16%），在第3阶段，取出114颗螺钉中的26颗（23%）。与第一阶段相比，第二阶段的螺钉剥离率显著降低(p <；0.001)。在混合效应逻辑回归模型中，个体外科医生和外科医生的经验对螺钉剥离概率均无影响。声学发射技术优于外科医生的扭矩敏感技术，证明了其在实时帮助外科医生减少松质骨螺钉剥离率方面的潜力，而不管他们的经验如何。

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A novel acoustic emission screwdriver reduces surgeons´ cancellous screw stripping rate - A biomechanical study

Background

Orthopedic surgeons refine their torque sensitive skills from tightening cancellous screws. Still, experienced surgeons exhibit surprisingly high screw stripping rates in osteopenic cancellous bone. Whether Acoustic-Emission technology, detecting energy waves from microstructural damage during screw purchase, can reduce these rates is unclear. Our aim was to evaluate if surgeons, irrespective of their experience, reduced cancellous screw stripping rate by combining their skills with feedback from an innovative Acoustic-Emission screwdriver.

Methods

Thirteen orthopedic surgeons with 0–23 years´ experience inserted 468 large fragment cancellous screws through plates into synthetic osteoporotic bone. The 1st stage, surgeons tightened 9 screws each without Acoustic-Emission feedback. The 2nd stage, each tightened 18 screws using the Acoustic-Emission feedback modified screwdriver. The last stage, surgeons tightened 9 screws each, again without Acoustic-Emission feedback. A strain gauge on the screwdriver was used to verify screw stripping.

Findings

Surgeons stripped 36 out of 115 screws (31 %) in stage 1, 37 out of 227 screws (16 %) in stage 2, and 26 out of 114 screws (23 %) in stage 3. A significant reduced screw stripping rate was found in stage 2 compared to in stage 1 (p < 0.001). Neither the individual surgeon nor experience of the surgeon contributed to screw stripping probability in a mixed effect logistical regression model.

Interpretations

Acoustic-Emission technology is superior to the torque sensitive skills of surgeons, demonstrating its potential to assist surgeons in real time, regardless of their experience, in reducing screw stripping rates in cancellous bone.

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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.