骨螺钉HAScrew.pptVIP

External Fixation Bone Screws Effect of Surface Coatings Standard Orthofix Bone Screws A Comparison of Hydroxyapatite-Coated, Titanium-Coated and Uncoated Orthofix Bone Screws Rizzoli Institute, University of Bologna An In Vivo Study in Sheep Orthofix fixator applied to tibia with 3 screws in each clamp 5 mm bone cylinder removed Histology and mechanical tests at 6/52 Moroni, Toksvig-Larsen, Maltarello, Orienti, Stea Giannini 1998, JBJS, 80-A, No. 4, 547 - 554 Weightbearing on bone screws Screw Insertion Does coating the bone screws increase the insertion torque? Screw type Insertion torque Uncoated 4360 N-mm Titanium 3420 N-mm Hydroxyapatite 3740 N-mm NO SIGNIFICANT DIFFERENCE Moroni et al, 1998 Does coating the bone screws increase the insertion torque? Torque measurement after insertion Extraction torque at 6/52 Screw type Extraction torque Uncoated 253 N-mm Titanium 1720 N-mm Hydroxyapatite 3360 N-mm HA screws significantly higher than uncoated (p=0.002) titanium (0.03) Moroni et al, 1998 Extraction torque @ 6/52 Visible osteolysis @ 6/52 Screw type % with any osteolysis Uncoated 80.6% Titanium 83.3% Hydroxyapatite 41.7% HA screws performed better: p ? 0.021 Moroni et al, 1998 Difference between insertion and extraction torques Screw type Insertion Extraction p Uncoated 4360 253 0.001 Titanium 3740 1720 0.003 Hydroxyapatite 3420 3360 nil Moroni et al, 1998 Difference between insertion and extraction torque HA screws: surface roughness may help initial stability No detachment of the HA coating from the screws At 10,000 X magnification, direct contact seen only between bone and HA screws (not titanium or SS) Microscopic bone fragments seen adhering to the HA threads on removal, 10,000 times magnification HA Screws No gap Titanium coated screws Gap CONCLUSION “The improvement in the stability of the interface between bone and HA coated pins should reduce the frequency of loosening of pins and the prevalence of infection.” Moroni et al, 19