使用在張力帶鋼絲及固定遠端橈骨骨折的新型鋼釘之研發及生物力學研究

張力帶鋼絲（Tension band wire）固定方式主要應用於特定部位之骨折，如髕骨(patella)、尺骨鷹嘴突(Ulnar olecranon process)、足踝(malleolus)及鎖骨末端(distal clavicle)骨折，可提供骨折處良好之固定效果。一般常用之手術方式是使用二支平行的鋼針(Kirschner wire)加上一個8字型的鋼絲環，固定於骨折的張力面，轉換骨折受肌肉之拉力與剪力為促進癒合的壓負載。但在臨床追蹤中，常見的手術後併發症為：鋼針向後滑脫(Back-out)，此併發症會造成病患不適感與活動不便，以及影響患處美觀。為了改善傳統手術固定方式的缺失，本研究設計新型鋼釘來防止向後滑脫，減少手術後併發症。此外，台灣已步入高齡化的社會，罹患骨質疏鬆症之人口也逐漸增加，常見的骨折損傷為：腕部橈尺骨遠端骨折，一般治療腕部橈尺骨遠端骨折的方式，常是以經皮鋼針鎖定，再以石膏加以固定，手術後恢復過程中，折彎之鋼針會暴露於皮膚外，待骨折癒合後再拔除，容易造成患處釘孔感染(pin-tract infection)及鋼針脫位，新型設計之鋼釘也可以使用在橈尺骨遠端骨折的固定，固定後鋼釘頭埋入皮膚內避免感染與滑脫。本研究主要目的是進行新型鋼釘之生物力學試驗以及評估新型鋼釘之成效。根據相關之力學試驗，證實新設計之鋼釘確實可以防止鋼釘後突的副作用，且證實新型鋼針之力學特性優於現行常用之傳統式鋼針，可提供足夠的固定效益，提高手術固定之穩定性，此外，根據拉出試驗之結果，證實新型鋼針之力學特性優於現行常用的傳統式鋼針，可提供足夠的固定力量，以勝任遠端橈骨骨折之固定，而利用此項新型鋼針可以提高手術的便利性，防止鋼釘滑脫，而且螺帽可以埋入皮膚內，減低患處感染的風險以及鋼針脫位後造成之骨折移位。

關鍵字

張力帶鋼絲；自鎖式；釘孔感染

並列摘要

The tension band wiring technique is accepted worldwide in the operative treatment of many fracture around joints. It provided secure stability in fracture fixation. The method essentially involves placing a figure-of-8 wire loop over the tension side of the fracture. Besides, two Kirscher wires were frequently placed into the fracture site. The two pins are used to act as an internal splint neutralizing rotational and bending displacement forces. The wire loop is used to act as a tension band to convert the distractive and shear forces tending to separate the fragment into compressive forces across the fracture site. However, in clinical observation, back-out of the Kirschner wires is a common complication that made patient discomfort and pain. The purpose of this study is to design a wire-self-locking screw-pin to prevent the back-out of the pins. This design will prevent of this complication and provide rigid fixation to allow early mobilization that quickly restores functional status. Besides, this new pin can also be applied in fixation of distal radial fracture. Usually we fixed distal radial fracture with percutaneous pinning. Pin-tract infection and back-out of pins were the common problems. The new pin can avoid these problems by burying the head of the pin into skin. The study also provides a biomechanical evaluation of this new-design pin before clinical application. According to the results of our tests, the bending stiffness of the whole construct after fracture fixation with new pin is better than that of using the Kirscher wire. The pull-out strength of this new pin is much better than the Kirscher wire. This study demonstrates that this new pin can provide enough and greater strength in fixation of tension band wiring and distal radial fracture. Besides, the concept of the new pin can avoid the potential risk of complications of back-out of the pins and pin-tract infection.

並列關鍵字

tension band wire ； self-locking ； pin-tract infection

參考文獻

1. Hutchinson DT, Horwitz DS, Ha G, Thomas CW, Bachus KN. Cyclic loading of olecranon fracture fixation constructs. J Bone Joint Surg Am. 2003, 85-A(5):831-7.

2. Harrell RM, Tong J, Weinhold PS, Dahners LE. Comparison of the mechanical properties of different tension band materials and suture techniques. J Orthop Trauma. 2003, 7(2):119-22.

3. Karlsson MK, Hasserius R, Besjakov J, Karlsson C, Josefsson PO. Comparison of tension-band and figure-of-eight wiring techniques for treatment of olecranon fractures. J Shoulder Elbow Surg. 2002, 11(4):377-82.

4. Fortis AP, Milis Z, Kostopoulos V, Tsantzalis S, Kormas P, Tzinieris N, Boudouris T. Experimental investigation of the tension band in fractures of the patella. Injury. 2002, 33(6):489-93.

5. Gicquel P, Maximin MC, Boutemy P, Karger C, Kempf JF, Clavert JM. Biomechanical analysis of olecranon fracture fixation in children. J Pediatr Orthop. 2002, 22(1):17-21.

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使用在張力帶鋼絲及固定遠端橈骨骨折的新型鋼釘之研發及生物力學研究

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