本文的目的是回顾有关肱骨远端骨折钢板(DHFPs)的研究,以了解系统地改变钢板或螺钉变量的生物力学影响。问题是DHFP通常用于手术,尽管并发症仍然可能发生,目前尚不清楚植入物配置是否总是使用生物力学标准进行优化。对PubMed数据库进行了系统搜索,以确定DHFP的英语生物力学优化研究,这些DHFP参数改变了板和/或螺钉变量,以分析其对工程性能的影响。关节内和关节外骨折(EAF)数据根据常用的生物力学结果指标进行分离和整理。结果确定了52项合格的DHFP研究,评估各种板和螺钉变量。评估的最常见的板变量是几何形状,孔类型,number,和位置。评估螺钉变量的研究较少,数字和角度是最常见的。然而,没有研究检查非金属材料的板或螺钉,这可能对未来的研究感兴趣。此外,文章使用了生物力学结果指标的各种组合,如碎片间骨折运动,骨头,板,或螺钉应力,失效的加载周期数,和总刚度(Os)或破坏强度(Fs)。然而,没有研究评估骨板下的骨应力来检查骨应力屏蔽,“这可能会影响临床骨骼健康。治疗肱骨远端关节内和关节外骨折的外科医生应认真考虑两种预轮廓,长,厚,锁定,和由长固定的平行板,厚,和板对板螺钉,这些螺钉位于沿着板的近端部分的交错水平处,还有一个额外的跨骨折钢板螺钉。此外,研究工程师可以通过在未来的工作中细读建议来改进新的研究(例如,研究替代非金属材料或“应力屏蔽”),临床后果(例如,锁定板的好处),和学习质量(例如,计算研究的实验验证)。
The goal of this article was to
review studies on distal humerus fracture plates (DHFPs) to understand the biomechanical influence of systematically changing the plate or screw variables. The problem is that DHFPs are commonly used surgically, although complications can still occur, and it is unclear if implant configurations are always optimized using biomechanical criteria. A systematic search of the PubMed database was conducted to identify English-language biomechanical
optimization studies of DHFPs that parametrically altered plate and/or screw variables to analyze their influence on engineering performance. Intraarticular and extraarticular fracture (EAF) data were separated and organized under commonly used biomechanical outcome metrics. The results identified 52 eligible DHFP studies, which evaluated various plate and screw variables. The most common plate variables evaluated were geometry, hole type, number, and position. Fewer studies assessed screw variables, with number and angle being the most common. However, no studies examined nonmetallic materials for plates or screws, which may be of interest in future research. Also, articles used various combinations of biomechanical outcome metrics, such as interfragmentary fracture motion, bone, plate, or screw stress, number of loading cycles to failure, and overall stiffness (Os) or failure strength (Fs). However, no study evaluated the bone stress under the plate to examine bone \"stress shielding,\" which may impact bone health clinically. Surgeons treating intraarticular and extraarticular distal humerus fractures should seriously consider two precontoured, long, thick, locked, and parallel plates that are secured by long, thick, and plate-to-plate screws that are located at staggered levels along the proximal parts of the plates, as well as an extra transfracture plate screw. Also, research engineers could improve new studies by perusing recommendations in future work (e.g., studying alternative nonmetallic materials or \"stress shielding\"), clinical ramifications (e.g., benefits of locked plates), and study quality (e.g., experimental validation of computational studies).