在尸体模型中研究远端螺钉和钉长度对桡骨远端骨折粉碎性关节内骨折掌侧钢板稳定性的影响

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics Pub Date : 2025-02-23 DOI:10.1016/j.clinbiomech.2025.106472

Francine Zeng , Raghunandan Nayak , Martinus Megalla , Mehreen Pasha , Shiza Bari , Dashun Liu , Joel V. Ferreira , Anthony Parrino , Craig M. Rodner

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引用次数: 0

摘要

背景掌侧钢板是桡骨远端骨折首选的手术治疗方法。许多患者采用单皮质远端固定来防止伸肌腱损伤。本研究旨在确定远端锁定螺钉和钉对粉碎性桡骨远端关节内骨折尸体稳定性的生物力学影响。方法采用掌侧锁定桡骨远端钢板固定24例尸体桡骨，根据远端固定情况分为4组：100%长度螺钉、75%长度螺钉、100%长度钉和75%长度钉。截骨术模拟背侧粉碎性关节内骨折。在1000个轴向调节循环前后，以及在轴向载荷到临床失效（2mm位移）和灾难性失效之前，我们确定了每个构造体在生理载荷（轴向压缩、背侧弯曲和掌侧弯曲）下的刚度。研究发现，在循环加载前后，各组之间掌侧和背侧弯曲刚度相等。各组在轴向载荷作用下的最终刚度相等。100% （308 N）至75%螺钉长度（351 N）的力与100% （127 N）至75%钉长度（150 N）的力相当。与螺钉长度为100%和75%的螺钉相比，临床失败的力量更大。75%长度的螺钉比100%光滑的螺钉更容易导致临床失败。导致灾难性失败的力量在所有组之间是相等的。我们建议在双皮质对应物上使用75%长度的螺钉或钉，在不影响固定的情况下防止背侧穿透。外科医生可能会考虑在复杂的桡骨远端关节内骨折中使用锁定螺钉。

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Investigating the effect of distal screw and peg length on stability in volar plating of comminuted, intra-articular distal radius fractures in a cadaveric model

Background

Volar plating is the preferred surgical treatment for distal radius fractures. Many have adopted unicortical distal fixation to prevent extensor tendon injury. This study aimed to determine the biomechanical effect of distal locking screws and pegs on stability in comminuted, intra-articular distal radius fracture cadavers.

Methods

We applied volar-locking distal radius plates to 24 cadaveric radiuses, which were divided into 4 groups based on distal fixation: 100 % length screws, 75 % length screws, 100 % length pegs, and 75 % length pegs. Osteotomies simulated dorsally comminuted, intra-articular fractures. We determined each construct's stiffness under physiologic loads (axial compression, dorsal bending, and volar bending) before and after 1000 cycles of axial conditioning, and before axial load to clinical failure (2 mm of displacement) and catastrophic failure.

Findings

Stiffness to volar and dorsal bending were equivalent between groups before and after cycling loading. Final stiffness under axial load was equivalent for all groups. Force to clinical failure was equivalent between 100 % (308 N) and 75 % screw length (351 N) constructs, and equivalent between 100 % (127 N) and 75 % peg length (150 N) constructs. Forces to clinical failure were greater for 100 % and 75 % screw lengths compared to their peg counterparts. Force to clinical failure was greater for 75 % screw lengths than 100 % smooth pegs. Force to catastrophic failure was equivalent between all groups.

Interpretation

We recommend the use of 75 % length screws or pegs over their bicortical counterparts to prevent dorsal penetration without compromising fixation. Surgeons may consider using locking screws over pegs in complex, intra-articular distal radius fractures.

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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.