磷酸钙骨水泥固定桡骨远端关节内骨折的生物力学分析

T. Higgins, S. Dodds, S. Wolfe
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引用次数: 57

摘要

背景:磷酸钙骨水泥已被用于治疗桡骨远端不稳定骨折,目的是避免因长时间固定在石膏或外固定物中造成的僵硬和并发症。本研究的目的是比较强化磷酸钙骨水泥固定后骨折碎片的稳定性与其他经皮骨折治疗方法的稳定性。方法:采用截骨和破骨术建立7对新鲜冷冻上肢背侧骨丢失的桡骨远端关节内骨折(AO型C2)模型。每对腕部用外固定架和三根克氏针固定,对侧腕部用磷酸钙骨水泥(Norian SRS)和三根克氏针(增强型磷酸钙骨水泥)固定。依次增加负荷,总负荷可达100牛,然后施加于手腕的主要屈肌和伸肌。采用optotrack三维系统测量断裂碎片运动。结果:在<80 N时,所有标本均以骨水泥单独固定失败。通过方差分析,与增强磷酸钙水泥相比,增强外固定架在测试的六个轴中的四个轴上(例如,屈伸关节的平均运动[和标准差]分别为3.0°±2.93°和11.1°±13.08°)显著增加了桡骨碎片的稳定性;P = 0.001)。在三个轴上,增强磷酸钙骨水泥比单独克氏针提供了更大的桡骨碎片稳定性(例如,屈伸关节的平均运动分别为11.1°±13.08°和36.5°±13.03°;P = 0.001)。结论:仅磷酸钙骨水泥在没有辅助金属丝固定的情况下不足以承受手腕的生理性屈伸运动。当补充克氏针时,骨水泥固定比单独克氏针更稳定,但明显低于增强外固定。临床意义:在进行骨折固定强度研究时,必须模拟正常手腕运动时遇到的剪切和旋转力。根据本研究的生理生物力学测试,我们建议如果选择磷酸钙骨水泥固定不稳定的桡骨远端骨折,则需要补充固定。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A Biomechanical Analysis of Fixation of Intra-Articular Distal Radial Fractures with Calcium-Phosphate Bone Cement
Background: Calcium phosphate cement has been used to treat unstable fractures of the distal end of the radius with the intent of avoiding the stiffness and morbidity associated with prolonged immobilization in a cast or external fixation. The purpose of this study was to compare the stability of the fracture fragments after fixation with augmented calcium phosphate cement with that after alternative methods of percutaneous fracture treatment.Methods: Both an osteotomy and osteoclasis were used to create a model of an intra-articular fracture of the distal part of the radius (AO type C2) with dorsal bone loss in seven pairs of fresh-frozen upper extremities. One wrist from each pair was fixed with an external fixator and three Kirschner wires, and the contralateral wrist was fixed with calcium phosphate cement (Norian SRS) and three Kirschner wires (augmented calcium phosphate cement). Sequentially increasing loads, up to a total of 100 N, were then applied to the major flexors and extensors of the wrist. Fracture fragment motion was measured by the Optotrak three-dimensional system.Results: Fixation with cement alone failed at the bone-cement interface at <80 N in all specimens. With use of an analysis of variance, augmented external fixation was found to provide significantly increased stability to the radial fragment compared with that provided by augmented calcium phosphate cement in four of the six axes tested (e.g., mean motion [and standard deviation] in flexion-extension was 3.0° ± 2.93° versus 11.1° ± 13.08°, respectively; p = 0.001). Augmented calcium phosphate cement was found to provide greater stability for the radial fragment than were Kirschner wires alone in three axes (e.g., mean motion in flexion-extension was 11.1° ± 13.08° versus 36.5° ± 13.03°, respectively; p = 0.001).Conclusions: Calcium phosphate cement alone is insufficient to withstand physiologic flexion-extension motion of the wrist without supplemental wire fixation. When supplemented with Kirschner wires, fixation with bone cement is more stable than are Kirschner wires alone, but it is significantly less stable than augmented external fixation.Clinical Relevance: When performing studies of fracture fixation strengths, it is essential to simulate the shear and rotational forces encountered during normal wrist motion. On the basis of the physiologic biomechanical testing in this study, we recommend supplemental fixation if calcium phosphate cement is chosen for fixation of unstable distal radial fractures.
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