反向肩关节置换术中用于钢板固定螺钉的拉出强度：一项尸体研究

Q4 Medicine

Seminars in Arthroplasty Pub Date : 2025-05-07 DOI:10.1053/j.sart.2025.04.003

Masashi Kano MD , Shoji Fukuta MD, PhD , Jun Kawamata MD , Katsutoshi Miyatake MD, PhD , Kosaku Higashino MD, PhD , Keizo Wada MD, PhD , Koichi Tomita MD, PhD , Koichi Sairyo MD, PhD

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引用次数: 0

摘要

背景先前的研究表明双皮质螺钉固定在生物力学上优于单皮质螺钉固定。然而，在反向肩关节置换术（RSA）中用于肩关节固定的螺钉的拔出强度尚无数据。本研究的目的是确定RSA中单皮质和双皮质钢板螺钉固定在生物力学强度上的差异。方法采用14具新鲜冷冻尸体（男7名，女7名）的双肩胛骨，比较小梁金属反肩系统（Zimmer Biomet, Warsaw， IN， USA）使用的上、下螺钉的拉力。每个标本的一侧肩胛骨单皮质置入螺钉，另一侧肩胛骨双皮质置入螺钉。采用万能试验机对各螺杆的拉拔强度进行评估。结果单皮质内固定上螺钉的平均拔出强度为716.5±300.4 N，双皮质内固定为1241.3±475.9 N，下螺钉的平均拔出强度分别为272.3±125.8 N和666.2±481.7 N。双皮质固定的上、下螺钉的拔出强度明显高于单皮质固定。男性单皮质内固定上端螺钉的拉力为854.2±314.0 N，双皮质内固定为1374.7±466.8 N，女性分别为578.7±209.6 N和1107.8±446.5 N；下位螺钉的拉力男性分别为285.5±139.0 N和922.3±549.5 N，女性分别为259.2±109.5 N和410.2±176.4 N。虽然男性的拔出强度更高，但除了劣质双皮质螺钉外，差异无统计学意义。劣质螺钉与优质螺钉的拔出强度之比为0.48。单皮质内固定与双皮质内固定的拔出强度之比，优势螺钉为0.58，劣势螺钉为0.41。女性螺钉的拉力是男性的0.69。结论与其他区域一样，双皮质螺钉固定对RSA关节盂假体的作用强于单皮质螺钉固定。在单皮质和双皮质固定中，上螺钉的拔出强度明显高于下螺钉。下双皮质螺钉的固定在女性中比在男性中受损更明显。因此，对于女性和骨质量较差的患者，推荐采用双皮质下螺钉固定。

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Pullout strength of screws used for baseplate fixation in reverse shoulder arthroplasty: a cadaveric study

Background

Previous studies have shown that bicortical screw fixation is biomechanically superior to unicortical screw fixation. However, no data are available on the pullout strength of screws used for glenoid fixation in reverse shoulder arthroplasty (RSA). The purpose of this study was to determine the differences in biomechanical strength between unicortical and bicortical fixation of the baseplate screws in RSA.

Methods

Both scapulae from 14 fresh frozen cadavers (7 men, 7 women) were used to compare the pullout strength of the superior and inferior screws used with the Trabecular Metal Reverse Shoulder System (Zimmer Biomet, Warsaw, IN, USA). Screws were inserted unicortically in one scapula of each specimen and bicortically in the other scapula. The pullout strength of each screw was evaluated using a universal testing machine.

Results

Mean pullout strength of the superior screws was 716.5 ± 300.4 N for unicortical fixation and 1241.3 ± 475.9 N for bicortical fixation, and that of the inferior screws was 272.3 ± 125.8 N and 666.2 ± 481.7 N, respectively. Pullout strength of the superior and inferior screws was significantly higher for bicortical fixation than for unicortical fixation. Pullout strength of the superior screws was 854.2 ± 314.0 N in unicortical fixation and 1374.7 ± 466.8 N in bicortical fixation in men, and 578.7 ± 209.6 N and 1107.8 ± 446.5 N, respectively, in women; the pullout strength of the inferior screws was 285.5 ± 139.0 N and 922.3 ± 549.5 N, respectively, in men, and 259.2 ± 109.5 N and 410.2 ± 176.4 N in women. Although the pullout strength was higher in men, the difference was not statistically significant, except for inferior bicortical screws. The ratio of the pullout strength for an inferior screw to that of a superior screw was 0.48. The ratio of the pullout strength for unicortical fixation to that of bicortical fixation was 0.58 for superior screws and 0.41 for inferior screws. The pullout strength of screws in women was 0.69 of that in men.

Conclusion

Bicortical screw fixation is stronger than unicortical screw fixation for the glenoid component in RSA, as in other regions. Pullout strength of the superior screws was significantly higher than that of the inferior screws in both unicortical and bicortical fixation. Fixation of inferior bicortical screws was impaired more significantly in women than in men. Therefore, bicortical fixation of the inferior screw is recommended for women and for patients with poor bone quality.

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来源期刊

Seminars in Arthroplasty Medicine-Surgery

CiteScore

1.00

自引率

0.00%

发文量

104

期刊介绍： Each issue of Seminars in Arthroplasty provides a comprehensive, current overview of a single topic in arthroplasty. The journal addresses orthopedic surgeons, providing authoritative reviews with emphasis on new developments relevant to their practice.