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首页> 外文期刊>Patient Safety in Surgery >Introducing the “Bone-Screw-Fastener” for improved screw fixation in orthopedic surgery: a revolutionary paradigm shift?
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Introducing the “Bone-Screw-Fastener” for improved screw fixation in orthopedic surgery: a revolutionary paradigm shift?

机译：引入“骨螺钉紧固件”以改善骨科手术中的螺钉固定：革命性的范式转变？

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Background Conventional screws used for fracture fixation in orthopedic surgery continue to rely on the historic buttress thread design. While buttress screws generally provide solid resistance against unidirectional axial loading forces, their design suffers from several limitations, as the buttress thread does not adequately resist multiaxial forces. Furthermore, the buttress screw is prone to stripping at the bone-screw interface and can cause microfracturing of the surrounding bone due to its thread design. Standard buttress screws are therefore at risk of adverse postoperative outcomes secondary to failure of bone fixation. A new patented Bone-Screw-Fastener was recently designed that is based on an interlocking thread technology. This new fastener provides distributive forces from the threads onto the bone and therefore resists loads in multiple directions. The underlying concept is represented by a “female thread” bone cutting technology designed to maximize bone volume, preserve bone architecture, and create a circumferential interlocking interface between the implant and bone that protects the thread from stripping and from failing to multiaxial forces. Presentation of the hypothesis We hypothesize that the new Bone-Screw-Fastener overcomes the classic shortcomings of conventional orthopedic screws with buttress threads by ease of insertion, improved bone preservation, increased resistance to off-axis multidirectional loading forces and to stripping of the threads. These advanced biomechanical and biological properties can potentially mitigate the classic limitations of conventional buttress screws by providing better resistance to implant failure under physiological loads, preserving bone biology, and thus potentially improving patient outcomes in the future. Testing the hypothesis The presumed superiority of the new fastener will require testing and validation in well-designed prospective multicenter randomized controlled trials (RCTs), using the conventional buttress screw as control. Implications of the hypothesis Once validated in multicenter RCTs, the new Bone-Screw-Fastener may drive a change in paradigm with regard to its innovative biomechanical principles and biologic bone preservation for surgical applications requiring screw fixation.
机译：背景技术骨科手术中用于骨折固定的常规螺钉继续依赖于历史悠久的支撑螺纹设计。虽然支撑螺钉通常提供抵抗单向轴向载荷力的牢固阻力，但是它们的设计受到一些限制，因为支撑螺钉螺纹不能充分抵抗多轴力。此外，支撑螺钉易于在骨螺钉界面处剥离，并且由于其螺纹设计而可能引起周围骨骼的微裂。因此，标准的支撑螺钉有继发于骨固定失败的不良术后后果的风险。最近基于互锁螺纹技术设计了一种新的获得专利的骨螺钉紧固件。这种新的紧固件提供了从螺纹到骨骼的分布力，因此可以抵抗多个方向的载荷。基本概念由“女性螺纹”骨切割技术代表，该技术旨在最大程度地增加骨骼体积，保留骨骼结构并在植入物和骨骼之间创建周向互锁界面，以防止螺纹剥落和破坏多轴向力。假设的提出我们假设新型的骨螺钉紧固件通过易于插入，改善的骨保留性，增强的抗离轴多向载荷力和抗螺纹剥落的能力，克服了传统的带有支撑螺纹的骨科螺钉的经典缺点。这些先进的生物力学和生物学特性可通过在生理负荷下提供更好的抵抗植入失败的能力，保留骨骼生物学从而潜在地减轻传统支撑螺钉的经典局限性，从而有可能在将来改善患者的治疗效果。测试假设新紧固件的优越性需要在设计良好的前瞻性多中心随机对照试验（RCT）中进行测试和验证，并使用常规的支撑螺钉作为对照。假设的含义一旦在多中心RCT中得到验证，新型Bone-Screw-Fastener可能会在其创新的生物力学原理和需要螺钉固定的外科应用的生物骨保护方面推动范式的改变。

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