接骨螺钉的失效分析与强度测试
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摘要
接骨螺钉作为一种有效的骨折内固定物,在临床上广泛使用。基于接骨螺钉的临床使用现状,分别按结构和材料归纳不同螺钉的种类,综合分析临床常见的3种螺钉失效情况(松动、断裂和腐蚀)以及影响因素,总结当前常用螺钉的测试方法,分析测试过程中的要点和难点,对改进产品设计、选择材料、开展体外检测技术等具有重要意义。对接骨螺钉测试方法的发展趋势进行展望。
As an effective implant for bone fracture,bone screws are widely used in clinic. Based on the clinical application of bone screws,this study summarized different kinds of bone screws according to their structures and materials,analyzed 3 kinds of common screw failure( loosening,breaking,corrosion) and the influencing factors. The common testing methods of screws were summarized,especially the key points and difficulties during the testing process for bone screws were analyzed,which was important for improving the design of product,selection of materials and development of in vitro testing technology. The development trend for testing method of bone screws was prospected as well.
As an effective implant for bone fracture,bone screws are widely used in clinic. Based on the clinical application of bone screws,this study summarized different kinds of bone screws according to their structures and materials,analyzed 3 kinds of common screw failure( loosening,breaking,corrosion) and the influencing factors. The common testing methods of screws were summarized,especially the key points and difficulties during the testing process for bone screws were analyzed,which was important for improving the design of product,selection of materials and development of in vitro testing technology. The development trend for testing method of bone screws was prospected as well.
引文
[1]SIEGEL IM.The evolution of orthopaedic surgery[M].USA:RSM Press,2002.
[2]SAUERBIER S,SCHON R,OTTEN JE,et al.The development of plate osteosynthesis for the treatment of fractures of the mandibular body.A literature review[J].J Cranio Maxill Surg,2008,36(5):251-259.
[3]ABSHIRE BB,MCLAIN RF,VALDEVIT A,et al.Characteristics of pullout failure in conical and cylindrical pedicle screws after full insertion and back-out[J].Spine J,2001,1(6):408-414.
[4]孙劲,黄晖,付纳新,等.PLLA可吸收螺钉和金属松质骨螺钉治疗Jones骨折的疗效比较[J].中国矫形外科杂志,2013,21(24):2525-2527.
[5]林木城,潘剑雄,林昆.关于同种异体骨螺钉的临床应用研究[J].中国现代医生,2008,46(2):13-14.
[6]谭新宇.异种生物骨钉的实验研究[D].广州:广州医学院硕士学位论文,2010.
[7]魏鸿文,蔡瑞莹.可降解骨螺钉强度衰减体外测试模式的建立[J].医用生物力学,2000,15(3):129-134.WEI HW,CAI RY.THE mechanical testing model of biodegradable screws in vitro degradation[J].J Med Biomech,2000,15(3):129-134.
[8]王江泽,丁真奇.影响松质骨螺钉固定强度的相关因素[J].中国现代医生,2012,50(12):26-28.
[9]ASTM Committee F04 on Medical and Surgical Materials.ASTM F543 standard specification and test methods for metallic medical bone screws[S].West Conshohochen:ASTM International,2017.
[10]罗晨,秦晓中,曾照斌,等.不同部位植入微种植钉进行前方牵引时上颌骨旋转趋势[J].医用生物力学,2015,30(1):38-42.LUO C,QIN XZ,ZENG ZB,et al.Rotation trend of maxillary complex with mini-implant assisted protraction in different maxillary positions[J].J Med Biomech,2015,30(1):38-42.
[11]ZINDRICK MR,WILTSE LL,WIDELL EH,et al.A biomechanical study of intrapeduncular screw fixation in the lumbosacral spine[J].Clin Orthop Relat Res,1986(203):99-112.
[12]HALVORSON TL,KELLEY LA,THOMAS KA,et al.Effects of bone mineral density on pedicle screw fixation[J].Spine,1994,19(21):2415-2420.
[13]ANDREASSEN GS,HOINESS PR,SKRAAMM I,et al.Use of a synthetic bone void filler to augment screws in osteopenic ankle fracture fixation[J].Arch Orthop Traum Surg,2004,124(3):161-165.
[14]CHRISTENSEN FB,DALSTRA M,SEJLING F,et al.Titanium-alloy enhances bone-pedicle screw fixation:Mechanical and histomorphometrical results of titanium-alloy versus stainless steel[J].Eur Spine J,2000,9(2):97-103.
[15]HASEGAWA T,INUFUSA A,IMAI Y,et al.Hydroxyapatite-coating of pedicle screws improves resistance against pull-out force in the osteoporotic canine lumbar spine model:A pilot study[J].Spine J,2005,5(3):239-243.
[16]HSU C C,CHAO C K,WANG J L,et al.Increase of pullout strength of spinal pedicle screws with conical core:Biomechanical tests and finite element analyses[J].J Orthop Res,2005,23(4):788-794.
[17]POLLY Jr DW,ORCHOWSKI JR,ELLENBOGEN RG.Revision pedicle screws:Bigger,longer shims.What is best?[J].Spine,1998,23(12):1374-1379.
[18]郭维鹏,李亚兰,蒋文涛,等.钛植入体过盈装配对下颌骨骨重建影响的数值研究[J].医用生物力学,2015,30(5):421-426.GUO WP,LI YL,JIANG WT,et al.Numerical study of effects from interference fit in titanium implants on mandibular bone remodeling[J].J Med Biomech,2015,30(5):421-426.
[19]PFEIFFER FM,ABERNATHIE DL.A comparison of pullout strength for pedicle screws of different designs:A study using tapped and untapped pilot holes[J].Spine,2006,31(23):E867-E870.
[20]宋富立,靳安民,王瑞,等.椎弓根螺钉内固定术后螺钉松动原因临床分析[J].中国脊柱脊髓杂志,2005,15(5):319.
[21]BARBER JW,BODEN SD,GANEY T,et al.Biomechanical study of lumbar pedicle screws:Does convergence affect axial pullout strength?[J].J Spinal Disord,1998,11(3):215-220.
[22]李进波,陈镇才,郑炎强.四肢骨干骨折钢板螺钉内固定失效原因分析及治疗体会[J].中国骨与关节损伤杂志,2016,31(6):40-41.
[23]PERREN SM,CORDEY J,BAUMGART F,et al.Technical and biomechanical aspects of screws used for bone surgery[J].Int J Orthop Trauma,1992,2:31-48.
[24]HUGHES AN,JORDAN BA.The mechanical properties of surgical bone screws and some aspects of insertion practice[J].Injury,1972,4(1):25.
[25]王红菊,李宵,张培,等.镁锌合金骨螺钉表面防降解改性涂层的制备与性能[J].机械工程材料,2013,37(2):33-39.
[26]COHEN J.Corrosion testing of orthopaedic implants[J].J Bone Joint Surg,1962,44(2):307-316.
[27]Technical Committee ISO/TC 150.ISO 6475 Implants for surgery:Metal bone screws with asymmetrical tread and spherical under-surface.Mechanical requirements and test methods[S].Geneva:International Organization for Standardization,1989.
[28]ASTM Committee F04 on Medical and Surgical Materials.ASTM F2502 standard specification and test methods for absorbable plates and screws for internal fixation implants[S].West Conshohochen:ASTM International,2011.
[29]ASTM Committee F04 on Medical and Surgical Materials.ASTM F1264 standard specification and test methods for intramedullary fixation devices[S].West Conshohochen:ASTM International,2016.
[2]SAUERBIER S,SCHON R,OTTEN JE,et al.The development of plate osteosynthesis for the treatment of fractures of the mandibular body.A literature review[J].J Cranio Maxill Surg,2008,36(5):251-259.
[3]ABSHIRE BB,MCLAIN RF,VALDEVIT A,et al.Characteristics of pullout failure in conical and cylindrical pedicle screws after full insertion and back-out[J].Spine J,2001,1(6):408-414.
[4]孙劲,黄晖,付纳新,等.PLLA可吸收螺钉和金属松质骨螺钉治疗Jones骨折的疗效比较[J].中国矫形外科杂志,2013,21(24):2525-2527.
[5]林木城,潘剑雄,林昆.关于同种异体骨螺钉的临床应用研究[J].中国现代医生,2008,46(2):13-14.
[6]谭新宇.异种生物骨钉的实验研究[D].广州:广州医学院硕士学位论文,2010.
[7]魏鸿文,蔡瑞莹.可降解骨螺钉强度衰减体外测试模式的建立[J].医用生物力学,2000,15(3):129-134.WEI HW,CAI RY.THE mechanical testing model of biodegradable screws in vitro degradation[J].J Med Biomech,2000,15(3):129-134.
[8]王江泽,丁真奇.影响松质骨螺钉固定强度的相关因素[J].中国现代医生,2012,50(12):26-28.
[9]ASTM Committee F04 on Medical and Surgical Materials.ASTM F543 standard specification and test methods for metallic medical bone screws[S].West Conshohochen:ASTM International,2017.
[10]罗晨,秦晓中,曾照斌,等.不同部位植入微种植钉进行前方牵引时上颌骨旋转趋势[J].医用生物力学,2015,30(1):38-42.LUO C,QIN XZ,ZENG ZB,et al.Rotation trend of maxillary complex with mini-implant assisted protraction in different maxillary positions[J].J Med Biomech,2015,30(1):38-42.
[11]ZINDRICK MR,WILTSE LL,WIDELL EH,et al.A biomechanical study of intrapeduncular screw fixation in the lumbosacral spine[J].Clin Orthop Relat Res,1986(203):99-112.
[12]HALVORSON TL,KELLEY LA,THOMAS KA,et al.Effects of bone mineral density on pedicle screw fixation[J].Spine,1994,19(21):2415-2420.
[13]ANDREASSEN GS,HOINESS PR,SKRAAMM I,et al.Use of a synthetic bone void filler to augment screws in osteopenic ankle fracture fixation[J].Arch Orthop Traum Surg,2004,124(3):161-165.
[14]CHRISTENSEN FB,DALSTRA M,SEJLING F,et al.Titanium-alloy enhances bone-pedicle screw fixation:Mechanical and histomorphometrical results of titanium-alloy versus stainless steel[J].Eur Spine J,2000,9(2):97-103.
[15]HASEGAWA T,INUFUSA A,IMAI Y,et al.Hydroxyapatite-coating of pedicle screws improves resistance against pull-out force in the osteoporotic canine lumbar spine model:A pilot study[J].Spine J,2005,5(3):239-243.
[16]HSU C C,CHAO C K,WANG J L,et al.Increase of pullout strength of spinal pedicle screws with conical core:Biomechanical tests and finite element analyses[J].J Orthop Res,2005,23(4):788-794.
[17]POLLY Jr DW,ORCHOWSKI JR,ELLENBOGEN RG.Revision pedicle screws:Bigger,longer shims.What is best?[J].Spine,1998,23(12):1374-1379.
[18]郭维鹏,李亚兰,蒋文涛,等.钛植入体过盈装配对下颌骨骨重建影响的数值研究[J].医用生物力学,2015,30(5):421-426.GUO WP,LI YL,JIANG WT,et al.Numerical study of effects from interference fit in titanium implants on mandibular bone remodeling[J].J Med Biomech,2015,30(5):421-426.
[19]PFEIFFER FM,ABERNATHIE DL.A comparison of pullout strength for pedicle screws of different designs:A study using tapped and untapped pilot holes[J].Spine,2006,31(23):E867-E870.
[20]宋富立,靳安民,王瑞,等.椎弓根螺钉内固定术后螺钉松动原因临床分析[J].中国脊柱脊髓杂志,2005,15(5):319.
[21]BARBER JW,BODEN SD,GANEY T,et al.Biomechanical study of lumbar pedicle screws:Does convergence affect axial pullout strength?[J].J Spinal Disord,1998,11(3):215-220.
[22]李进波,陈镇才,郑炎强.四肢骨干骨折钢板螺钉内固定失效原因分析及治疗体会[J].中国骨与关节损伤杂志,2016,31(6):40-41.
[23]PERREN SM,CORDEY J,BAUMGART F,et al.Technical and biomechanical aspects of screws used for bone surgery[J].Int J Orthop Trauma,1992,2:31-48.
[24]HUGHES AN,JORDAN BA.The mechanical properties of surgical bone screws and some aspects of insertion practice[J].Injury,1972,4(1):25.
[25]王红菊,李宵,张培,等.镁锌合金骨螺钉表面防降解改性涂层的制备与性能[J].机械工程材料,2013,37(2):33-39.
[26]COHEN J.Corrosion testing of orthopaedic implants[J].J Bone Joint Surg,1962,44(2):307-316.
[27]Technical Committee ISO/TC 150.ISO 6475 Implants for surgery:Metal bone screws with asymmetrical tread and spherical under-surface.Mechanical requirements and test methods[S].Geneva:International Organization for Standardization,1989.
[28]ASTM Committee F04 on Medical and Surgical Materials.ASTM F2502 standard specification and test methods for absorbable plates and screws for internal fixation implants[S].West Conshohochen:ASTM International,2011.
[29]ASTM Committee F04 on Medical and Surgical Materials.ASTM F1264 standard specification and test methods for intramedullary fixation devices[S].West Conshohochen:ASTM International,2016.