PDF(Pubmed)
Abstract：
The controlled dynamization of fractures can promote natural fracture healing by callus formation, while overly rigid fixation can suppress healing. The advent of locked plating technology enabled new strategies for the controlled dynamization of fractures, such as far cortical locking (FCL) screws or active plates with elastically suspended screw holes. However, these strategies did not allow for the use of non-locking screws, which are typically used to reduce bone fragments to the plate. This study documents the first in vivo study on the healing of ovine tibia osteotomies stabilized with an advanced active plate (AAP). This AAP allowed plate application using any combination of locking and non-locking screws to support a wide range of plate application techniques. At week 9 post-surgery, tibiae were harvested and tested in torsion to failure to assess the healing strength. The five tibiae stabilized with an AAP regained 54% of their native strength and failed by spiral fracture through a screw hole, which did not involve the healed osteotomy. In comparison, tibiae stabilized with a standard locking plate recovered 17% of their strength and sustained failure through the osteotomy. These results further support the stimulatory effect of controlled motion on fracture healing. As such, the controlled dynamization of locked plating constructs may hold the potential to reduce healing complications and may shorten the time to return to function. Integrating controlled dynamization into fracture plates that support a standard fixation technique may facilitate the clinical adoption of dynamic plating.
摘要：
骨折的控制动力学可以通过骨痂的形成促进骨折的自然愈合，而过于僵硬的固定会抑制愈合。锁定电镀技术的出现为裂缝的受控动力学提供了新的策略，例如远皮质锁定（FCL）螺钉或具有弹性悬挂螺钉孔的活动板。然而,这些策略不允许使用非锁定螺钉，通常用于减少骨板碎片。这项研究记录了关于用高级活动板（AAP）稳定的绵羊胫骨截骨术愈合的第一个体内研究。该AAP允许使用锁定和非锁定螺钉的任何组合来支持广泛的板应用技术的板应用。手术后第9周,收获胫骨，并在扭转失败的情况下进行测试，以评估愈合强度。用AAP稳定的五个胫骨恢复了其天然强度的54％，并因通过螺钉孔的螺旋断裂而失败，这不涉及愈合的截骨术。相比之下,用标准锁定钢板稳定的胫骨恢复了17％的强度，并通过截骨术持续失败。这些结果进一步支持受控运动对骨折愈合的刺激作用。因此，锁定钢板构造的受控动力学可能具有减少愈合并发症的潜力，并可能缩短恢复功能的时间。将受控动力学集成到支持标准固定技术的骨折钢板中可以促进动态钢板的临床采用。
