Mechanical stimulation by external application of cyclic tensile strains does not effectively enhance bone healing
Mechanical stimulation by external application of cyclic tensile strains does not effectively enhance bone healing
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DOI：
10.1097/00005131-200101000-00010
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发表时间：
2001-01-01
影响因子：
2.3
通讯作者：
Claes, L
中科院分区：
文献类型：
--
作者：
Augat, P;Merk, J;Claes, L
目的：探讨外诱导的骨折块间运动是否能促进骨折在柔性固定下的愈合过程。设计：随机，前瞻性体内动物研究，对照组。24只骨骼成熟的美利奴羊被随机分为6组，每组4只，分别接受0.2和0.8毫米的周期性碎片间运动和1、5和10赫兹的刺激频率。12只动物不接受任何外部刺激，作为对照组。设置：不受限制的失速活动，通过跟腱切开术减轻负重。干预措施：胫骨骨干截骨，间隙宽度为3毫米，用六针单侧双棒外固定架固定。截骨间隙的碎片间运动由电机驱动的执行器单元外部诱导。每天进行500次循环，在间隙内产生不均匀的拉伸应变。主要结果测量：术后9周，处死动物，用定量计算机断层扫描测量骨矿物质密度和骨痂横截面积。通过x线片评估骨痂投影面积，并通过三点弯曲试验确定机械稳定性。结果：非均匀循环拉伸应变的外部刺激对骨折愈合过程有轻微影响，但没有明显促进。不同的刺激频率对愈合过程没有影响。与0.2 mm位移相比，0.8 mm位移刺激导致骨膜骨痂增大，但骨密度降低。刺激对愈合骨的力学性能无明显影响。结论：诱导的循环拉伸应变对柔性固定下的骨愈合没有相应的促进作用。
Objective: To determine whether an externally induced interfragmentary movement enhances the healing process of a fracture under flexible fixation.Design: Randomized, prospective in vivo animal study with control group. Twenty-four skeletally mature Merino sheep were randomly assigned to six groups of four animals, which received cyclic interfragmentary movements of 0.2 and 0.8 millimeters and stimulation frequencies of 1, 5, and 10 Hertz, respectively. Twelve animals did not receive any externally applied stimulation and served as a control group.Setting: Unrestricted stall activity with weight bearing reduced by tenotomy of the Achilles tendon.Interventions: Osteotomy of the tibial diaphysis with three-millimeter gap width fixed with a six-pin, monolateral, double-bar external fixator. Interfragmentary movement of the osteotomy gap was externally induced by a motor-driven actuator unit. Five hundred cycles inducing nonuniform tensile strains within the gap were performed each day.Main Outcome Measurements: Nine weeks after surgery, the animals were killed, and bone mineral density and callus cross-sectional area were measured with quantitative computed tomography. Callus projectional area was assessed by radiographs, and mechanical stability was determined with a three-point bending testResults: External stimulation with nonuniform cyclic tensile strains did slightly affect but not significantly enhance the fracture healing process. Varying the stimulation frequency had no influence on the healing process. The stimulation with 0.8 millimeter displacement magnitude resulted in a larger periosteal callus, but a decreased bone mineral density compared with the 0.2-millimeter displacement magnitude. The stimulation had no significant influence on the mechanical properties of the healing bone.Conclusions: Induced cyclic tensile strains did not produce a relevant enhancement of bone healing under flexible fixation.