跟骨关节内骨折变角度锁定钢板螺钉位置的生物力学比较：尸体和放射学研究

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics Pub Date : 2025-04-23 DOI:10.1016/j.clinbiomech.2025.106534

Vit Baba , Lukas Capek , Lubomir Kopp , Vaclav Bittner

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引用次数: 0

摘要

背景：对于严重粉碎性骨折病例，采用可变角度锁定钢板进行跟骨骨折侧钢板治疗仍然是黄金标准。本研究的目的是探讨通过改变螺钉方向来提高骨固定稳定性的可能性。它提供了尸体生物力学实验与回顾性放射学数据分析的评估和比较。方法在尸体研究中，从4例死者供体中获得8个完整的跟距骨标本。每个标本按Sanders分类制作2b型骨折，用变角度锁定钢板固定。将标本根据前路螺钉的不同方向分为两组，固定在PMMA基板上。采用双柱试验机进行推入试验，直至严重失效。回顾性队列研究，回顾74例相同构造的跟骨骨折手术治疗患者的资料。在预定的CT和x线对照下进行评估。观察螺钉置入方向和种植失败情况。结果：尸体研究证明，在Sanders 2b骨折中，上述两种螺钉配置的平均破坏力没有显著差异。初始刚度有显著差异。放射学回顾性研究显示，除2b型骨折外，所有骨折类型的螺钉位置差异显著。可变角度锁定钢板前部的螺钉配置似乎会影响结构的初始刚度和稳定性。特别是在粉碎性骨折中，向支撑骨方向置入螺钉可提高稳定性，降低内固定失败的风险。

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Biomechanical comparison of screw position in variable angle locking plate in intra-articular calcaneal fractures: Cadaveric and radiologic study

Background

Lateral plating of calcaneal fractures using variable-angle locking plates is still the golden standard for severely comminuted cases. The aim of this study is to explore the possibilities of improving stability of osteosynthesis by changing screw directions. It provides an assessment and comparison of cadaveric biomechanical experiment with retrospective radiologic data analysis.

Methods

In the cadaveric study 8 intact calcaneus-talus specimens were obtained from 4 deceased donors. Fracture type 2b according to Sanders' classification was created in each specimen and fixed with variable-angle locking plate. The specimens were divided in 2 groups differing in orientation of anterior screws and fixed in PMMA base. A push-in test was performed by a two-column testing machine until gross failure.

Retrospective cohort study was performed, reviewing data of 74 patients which underwent surgical treatment of calcaneal fractures with the same construct. Evaluation was performed at scheduled CT and X-Ray controls. Direction of inserted screws and implant failure were noted.

Findings

The cadaveric study proved that there is no significant difference in mean failure force between two abovementioned screw configurations in Sanders 2b fracture. A significant difference was observed in initial stiffness. The radiologic retrospective study showed that difference in screw position within all fracture types but type 2b is significant.

Interpretation

Screw configuration in the anterior part of variable-angle locking plate appears to affect primary stiffness and stability of the construct. Particularly in more comminuted fractures, screw inserted in the direction of sustentaculum improves the stability and lowers risk of implant failure.

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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.