Cement augmentation of an angular stable plate osteosynthesis for supracondylar femoral fractures-biomechanical investigation of a new fixation device
Cement augmentation of an angular stable plate osteosynthesis for supracondylar femoral fractures-biomechanical investigation of a new fixation device
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DOI：
10.1186/s12891-020-03215-3
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发表时间：
2020-04-11
影响因子：
2.3
通讯作者：
Bliemel, Christopher
中科院分区：
文献类型：
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作者：
Baeumlein, Martin;Klasan, Antonio;Bliemel, Christopher
背景高度骨质疏松骨中的植入物锚定具有挑战性，因为它通常会导致股骨髁上骨折的老年患者接骨失败。螺钉的骨水泥固定被认为可以防止这种接骨失败。本研究旨在研究一种新设计的骨水泥型有孔髁螺钉在生物力学环境中用于接骨板固定的效果。方法8对平均年龄77岁（62 ~ 88岁）的股骨干标本，随机分为加固组和非加固组。在两组中，根据AO / OTA分类，不稳定的33-A3骨折均采用成角稳定锁定钢板固定。所有样本均使用磷酸钙骨水泥（CPC）对有孔髁螺钉进行骨水泥加固。使用伺服液压试验机，通过循环轴向加载在失效模式下进行机械试验。结果平均2475 N（95% CI：1727-3223 N），骨水泥髁螺钉样本导致接骨失败的压力显著高于非骨水泥样本（1875 N（95% CI：1320-2430 N））（p = 0.024）。在两组中，结构变形（远端螺钉切穿髁突骨）是最常见的失效原因。样本的轴向刚度（p = 0.889）和不可逆畸形分析显示两组之间无差异（p = 0.161）。未观察到骨水泥通过关节线或内侧皮质渗漏。结论根据目前的研究结果，新引入的骨水泥型髁螺钉可能是骨水泥应用的失效载荷准确性方面骨质降低患者股骨髁上骨折固定的一个令人鼓舞的特征。
Background Implant anchorage in highly osteoporotic bone is challenging, since it often leads to osteosynthesis failure in geriatric patients with supracondylar femoral fractures. Cementation of screws is presumed to prevent such osteosynthesis failure. This study aimed to investigate the effect of a newly designed, cementable fenestrated condylar screw for plate fixation in a biomechanical setting. Methods Eight pairs of osteoporotic cadaver femora with an average age of 77 years, ranging between 62 and 88 years, were randomly assigned to either an augmented or a non-augmented group. In both groups an instable 33-A3 fracture according to the AO / OTA classification was fixed with an angular stable locking plate. All right samples received a cement augmentation of their fenestrated condylar screws with calcium phosphate bone cement (CPC). Mechanical testing was performed at a load to failure mode by cyclic axial loading, using a servohydraulic testing machine. Results With a mean of 2475 N (95% CI: 1727-3223 N), the pressure forces resulting in osteosynthesis failure were significantly higher in specimen with cemented condylar screws as compared to non-cemented samples (1875 N (95% CI: 1320-2430 N)) (p = 0.024). In both groups the deformation of the constructs, with the distal screws cutting through the condylar bone, were the most frequent cause for failure. Analysis of axial stiffness (p = 0.889) and irreversible deformity of the specimens revealed no differences between the both groups (p = 0.161). No cement leakage through the joint line or the medial cortex was observed. Conclusion Based on the present study results, the newly introduced, cementable condylar screw could be an encouraging feature for the fixation of supracondylar femoral fractures in patients with reduced bone quality in terms of load to failure accuracy of the cement application.