Biomechanical Concepts for Fracture Fixation.
Biomechanical Concepts for Fracture Fixation.
复制标题
DOI：
10.1097/bot.0000000000000467
复制
发表时间：
2015-12-01
影响因子：
2.3
通讯作者：
Schemitsch, Emil H
中科院分区：
文献类型：
--
作者：
Bottlang, Michael;Schemitsch, Christine E;Schemitsch, Emil H
应用正确的固定结构对于骨折愈合和长期稳定性至关重要;然而，这是一个复杂的问题，有许多重要因素。本综述描述了一些常见的骨折类型，并对其目前可用的骨折固定结构进行了评价。在复杂肘关节不稳定的情况下，需要稳定固定或使用适当尺寸的植入物进行桡骨头置换，并结合韧带修复以恢复稳定性。对于垂直或多平面不稳定的不稳定骶骨骨折，“标准”髂骶螺钉固定是不够的。假体周围股骨骨折，特别是温哥华B1骨折，使用90/90固定与单一锁定钢板相比，稳定性增加。远端皮质骨锁定结合了动力化和锁定钢板的概念，以实现股骨远端骨折的上级愈合。最后，没有理想的结构来稳定下胫联合骨折;然而，这些骨折应该使用一种允许下胫联合充分活动的器械来固定。一般来说，骨科医生应选择一种能够恢复稳定性并促进骨折部位愈合的骨折固定结构，同时降低固定失败的可能性。
Application of the correct fixation construct is critical for fracture healing and long-term stability; however, it is a complex issue with numerous significant factors. This review describes a number of common fracture types and evaluates their currently available fracture fixation constructs. In the setting of complex elbow instability, stable fixation or radial head replacement with an appropriately sized implant in conjunction with ligamentous repair is required to restore stability. For unstable sacral fractures with vertical or multiplanar instabilities, "standard" iliosacral screw fixation is not sufficient. Periprosthetic femur fractures, in particular Vancouver B1 fractures, have increased stability when using 90/90 fixation versus a single locking plate. Far cortical locking combines the concept of dynamization with locked plating to achieve superior healing of a distal femur fracture. Finally, there is no ideal construct for syndesmotic fracture stabilization; however, these fractures should be fixed using a device that allows for sufficient motion in the syndesmosis. In general, orthopaedic surgeons should select a fracture fixation construct that restores stability and promotes healing at the fracture site, while reducing the potential for fixation failure.