Fatigue behavior of Ilizarov frame versus tibial interlocking nail in a comminuted tibial fracture model: a biomechanical study.
Fatigue behavior of Ilizarov frame versus tibial interlocking nail in a comminuted tibial fracture model: a biomechanical study.
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DOI：
10.1186/1749-799x-1-16
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发表时间：
2006-12-11
影响因子：
2.6
通讯作者：
Morgan, Steven J
中科院分区：
文献类型：
--
作者：
Hasenboehler, Erik;Smith, Wade R;Morgan, Steven J
背景：粉碎性胫骨干骨折的治疗方法包括钢板、髓内钉和外固定。迄今为止，尚未报道交锁胫骨髓内钉与Ilizarov支架外固定之间的生物力学比较。在本研究中，我们比较了在轴向压缩、弯曲和扭转联合载荷下，Ilizarov框架与交锁髓内钉在粉碎性胫骨骨折模型中的疲劳行为。我们的目标是在临床相关的三个月测试期内确定每种器械的生物力学特征、稳定性和耐久性。研究假设是，在机械性能的差异可能会导致不同的临床结果，并提供适用于临床决策的信息为粉碎性胫骨干fractures.METHODS：在这项生物力学研究中，12个复合胫骨模型粉碎性骨折和25 mm骨干间隙进行了研究。其中，6个模型使用180 mm四环Ilizarov框架进行稳定，6个模型使用10 mm静态锁定Russell-Taylor Delta胫骨髓内钉进行最小扩髓和稳定。在测量疲劳前轴向压缩弯曲和扭转刚度后，以3 Hz的频率对每个模型施加轴向压缩（2.8/28 lbf; 12.46/124.6 N）和扭矩（1.7/17 lbf-in; 0.19/1.92 Nm）的正弦循环组合载荷。试验一直进行到失败（植入物断裂或>或= 5度成角和/或2 cm缩短）或直至完成252，000次循环，这相当于大约3个月的测试期。在所有12个模型中，Ilizarov框架和胫骨交锁髓内钉都能够保持胫骨缺损的骨折稳定性，并完成完整的252，000个周期。一个显着更高的刚度轴向压缩和扭转证明了胫骨交锁钉模型，而Ilizarov框架提供了一个显着增加的范围轴向micromotion.CONCLUSION：这是第一项研究，据我们所知，比较生物力学性能的髓内钉外部Ilizarov框架循环轴向负荷和扭转在粉碎性胫骨干骨折模型。需要前瞻性随机试验比较Ilizarov框架和交锁胫骨髓内钉，以阐明这些生物力学结果的临床影响。
BACKGROUND: Treatment options for comminuted tibial shaft fractures include plating, intramedullary nailing, and external fixation. No biomechanical comparison between an interlocking tibia nail with external fixation by an Ilizarov frame has been reported to date. In the present study, we compared the fatigue behaviour of Ilizarov frames to interlocking intramedullary nails in a comminuted tibial fracture model under a combined loading of axial compression, bending and torsion. Our goal was to determine the biomechanical characteristics, stability and durability for each device over a clinically relevant three month testing period. The study hypothesis was that differences in the mechanical properties may account for differing clinical results and provide information applicable to clinical decision making for comminuted tibia shaft fractures.METHODS: In this biomechanical study, 12 composite tibial bone models with a comminuted fracture and a 25 mm diaphyseal gap were investigated. Of these, six models were stabilized with a 180-mm four-ring Ilizarov frame, and six models were minimally reamed and stabilized with a 10 mm statically locked Russell-Taylor Delta tibial nail. After measuring the pre-fatigue axial compression bending and torsion stiffness, each model was loaded under a sinusoidal cyclic combined loading of axial compression (2.8/28 lbf; 12.46/124.6 N) and torque (1.7/17 lbf-in; 0.19/1.92 Nm) at a frequency of 3 Hz. The test was performed until failure (implant breakage or >or= 5 degrees angulations and/or 2 cm shortening) occurred or until 252,000 cycles were completed, which corresponds to approximately three months testing period.RESULTS: In all 12 models, both the Ilizarov frame and the interlocking tibia nail were able to maintain fracture stability of the tibial defect and to complete the full 252,000 cycles during the entire study period of three months. A significantly higher stiffness to axial compression and torsion was demonstrated by the tibial interlocking nail model, while the Ilizarov frame provided a significantly increased range of axial micromotion.CONCLUSION: This is the first study, to our knowledge, which compares the biomechanical properties of an intramedullary nail to an external Ilizarov frame to cyclic axial loading and torsion in a comminuted tibia shaft fracture model. Prospective, randomized trials comparing Ilizarov frames and interlocked tibial nails are needed to clarify the clinical impact of these biomechanical findings.