Experimental Study on Admissible Forces at the Incudomalleolar Joint
Experimental Study on Admissible Forces at the Incudomalleolar Joint
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DOI：
10.1097/mao.0b013e318259b34b
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发表时间：
2012-08-01
影响因子：
2.1
通讯作者：
Eiber, Albrecht
中科院分区：
文献类型：
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作者：
Lauxmann, Michael;Heckeler, Christoph;Eiber, Albrecht
假设：在镫骨假体固定过程中，导致砧踝关节断裂的力可以通过测量砧骨长突处的载荷-挠度来确定。与其他组织一样，可以定义3个力的范围：微破裂、破裂和短期maximum.Background：镫骨手术中的关键步骤是将镫骨假体附着到长的砧骨突上。目前尚不清楚在预置过程中发生的哪些力会增加砧踝关节损伤或砧脱位的风险。本研究的目的是评估的容许范围内的力量，在长期的过程中的砧骨，将是可容忍的破坏前的结构，并将它们与发生在surgery.Methods的力量进行比较：在9个新鲜冷冻或新鲜颞骨的外侧-内侧和前后方向的载荷-挠度曲线进行了测量。用测力传感器测量力，并且从其上安装有测力传感器的电驱动平移台的编码器信息获取位移。通过定制的针将砧骨的长突连接到测力传感器。结果：中耳严重损伤时的破裂力前后方向为894（724-1018）mN，左右方向为695（574-771）mN。在前后方向上施加约568（469-686）mN的力和在406（254-514）mN的外-内方向上施加力时发生微破裂。在前后方向上测得的短期最大力为1，321（1，051 - 1，533）mN，在外-内方向上测得的短期最大力为939（726- 1，132）mN.Conclusion：可以以较高的准确度定义砧踝关节的断裂力。这些结果被用来计算镫骨手术中砧骨脱位或半脱位的风险。与使用金属夹和SMA假体相比，预置手术的损伤风险明显更高。
Hypothesis: The forces that cause rupture of the incudomalleolar joint during the fixation of stapedial prostheses can be determined by means of load-deflection measurements at the long process of the incus. As in other tissues, 3 ranges of forces can be defined: micro rupture, rupture, and short-term maximum.Background: A crucial step in stapes surgery is the attachment of the stapedial prosthesis to the long process of the incus. It is unknown which forces occur during the crimping process that increase the risk of damage to the incudomalleolar joint or incus luxation. The goal of this study was to assess the admissible range of forces at the long process of the incus that would be tolerable before damaging the structures and to compare them with the forces occurring during surgery.Methods: Load-deflection curves in the lateral-medial and anterior-posterior direction were measured in 9 freshly frozen or fresh temporal bones. The force was measured with a load cell, and displacement was taken from the encoder information of the electrically driven translation stage on which the load cell was mounted. The long process of the incus was coupled to the load cell via a customized needle. We also monitored with video recordings for visual confirmation of findings.Results: The rupture force at which the middle ear was found to be severely injured was 894 (724-1018) mN in the anterior-posterior direction and 695 (574-771) mN in the lateral-medial direction. Micro-ruptures occurred at forces around 568 (469-686) mN in the anterior-posterior direction and in the lateral-medial direction at 406 (254-514) mN. Short-term maximum forces of 1,321 (1,051-1,533) mN were measured in the anterior-posterior direction and 939 (726-1,132) mN in the lateral-medial direction.Conclusion: Rupture forces of the incudomalleolar joint could be defined with high accuracy. These results were used to calculate risks of incus luxation or subluxation during stapes surgery. Compared with the use of clip and SMA prostheses, the risk of damage from a crimping procedure is significantly higher.