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首页> 外文期刊>Journal of Hand Surgery. American Volume >A Biomechanical Analysis of 2 Constructs for Metacarpal Spiral Fracture Fixation in a Cadaver Model: 2 Large Screws Versus 3 Small Screws
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A Biomechanical Analysis of 2 Constructs for Metacarpal Spiral Fracture Fixation in a Cadaver Model: 2 Large Screws Versus 3 Small Screws

机译：尸体螺旋骨折固定2种构建体的生物力学分析：2个大螺钉与3个小螺钉

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Purpose Surgeons confronted with a long spiral metacarpal fracture may choose to fix it solely with lagged screws. A biomechanical analysis of a metacarpal spiral fracture model was performed to determine whether 3 1.5-mm screws or 2 2.0-mm screws provided more stability during bending and torsional loading. Methods Second and third metacarpals were harvested from 12 matched pairs of fresh-frozen cadaveric hands and spiral fractures were created. One specimen from each matched pair was fixed with 2 2.0-mm lagged screws whereas the other was fixed with 3 1.5-mm lagged screws. Nine pairs underwent combined cyclic cantilever bending and axial compressive loading followed by loading to failure. Nine additional pairs were subjected to cyclic external rotation while under a constant axial compressive load?and were subsequently externally rotated to failure under a constant axial compressive load. Paired t tests were used to compare cyclic creep, stiffness, displacement, rotation, and peak load levels. Results Average failure torque for all specimens was 7.2 ± 1.7 Nm. In cyclic torsional testing, the group with 2 screws exhibited significantly less rotational creep than the one with 3 screws. A single specimen in the group with 2 screws failed before cyclic bending tests were completed. No other significant differences were found between test groups during torsional or bending tests. Conclusions Both constructs were biomechanically similar except that the construct with 2 screws displayed significantly less loosening during torsional cyclic loading, although the difference was small and may not be clinically meaningful. Clinical relevance Because we found no obvious biomechanical advantage to using 3 1.5-mm lagged screws to fix long spiral metacarpal fractures, the time efficiency and decreased implant costs of using 2-2.0 mm lagged screws may be preferred.
机译：目的外科医生面对长螺旋髓质骨折可以选择用滞后的螺钉来固定它。进行了款式螺旋骨折模型的生物力学分析，以确定3 1.5mm螺钉或2 2.0mm螺钉是否在弯曲和扭转负载期间提供了更多的稳定性。方法从12种匹配的新鲜冷冻的尸体双手收获第二和第三个髓质，产生螺旋骨折。每个匹配对的一个样品用2个2.0毫米滞后的螺钉固定，而另一个固定用3个1.5毫米滞销螺钉固定。九双接受循环悬臂弯曲和轴向压缩载荷，然后加载失效。在恒定的轴向压缩载荷下，九对循环外旋转循环外部旋转。随后在恒定的轴向压缩载荷下外旋转到故障。配对T测试用于比较循环蠕变，刚度，位移，旋转和峰值负荷水平。结果所有标本的平均故障扭矩为7.2±1.7 nm。在循环扭转测试中，带有2个螺钉的组比带有3个螺钉的旋转爬行显着较小。在完成循环弯曲测试之前，具有2个螺钉的组中的单个标本失败。在扭转或弯曲试验期间测试组之间没有发现其他显着差异。结论两种构建体都是生物力学上类似的，除了用2个螺钉显示的构造显着较少在扭转循环加载期间松动，尽管差异很小并且可能没有临床有意义。临床相关性，因为我们发现没有明显的生物力学优势来使用3 1.5毫米滞后的螺钉来固定长螺旋型骨折，时间效率和使用2-2.0mm滞销螺钉的植入成本降低。

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