Stöckle U, Göing T, König B, Haase N, Duda G, Haas N P
Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Charité, Campus Virchow, Humboldt Universität zu Berlin.
Unfallchirurg. 2000 Aug;103(8):618-25. doi: 10.1007/s001130050594.
In haemodynamically unstable patients with an unstable pelvic ring injury the primary stabilisation of the pelvis and thus reduction of pelvic volume is important for the success of the treatment. The pelvic C-clamp is an approved emergency device for these unstable pelvic ring injuries. A secondary procedure though is necessary in most of the cases with a hig rate of wound problems in already traumatized soft tissue areas. The ventrally placed external fixator is a simple and quick procedure with little soft tissue damage. Though primary stability is sufficient even for C-type injuries, biomechanic stability of the posterior pelvic ring is often insufficient for mobilization. Based on biomechanic considerations, a new dorsal oblique pelvic external fixator was developed for pelvic C-type injuries. With the advantages of the supraacetabular fixator and two additional Schanz screws the ventral fixator should stabilize the posterior pelvic ring with comparable stability to the pelvic C-clamp. A primary and already definitive minimal invasive stabilization of the posterior pelvic ring was the aim. In the first series several variations of this asymmetric fixator with two different Schanz screw applications were tested biomechanically. In a second series the favorite version was tested versus the supraacetabular fixator and the pelvic C-clamp. Both of the biomechanic test series were performed with artificial pelves in the one leg stance model in the material testing machine. SI disruption and sacral fracture were the posterior instability types in 6 pelves each. There was no statistically significant difference between the dorsal oblique fixator and the pelvic C-clamp. But the new fixator was significantly more stable than the supraacetabular fixator or the new fixator without pretension.
对于血流动力学不稳定且伴有骨盆环损伤的患者,骨盆的初步稳定以及骨盆容积的减小对于治疗成功至关重要。骨盆C形夹是用于这些不稳定骨盆环损伤的一种经批准的急救装置。然而,在大多数情况下,由于已经受伤的软组织区域伤口问题发生率较高,二次手术是必要的。腹侧放置的外固定架是一种简单快捷的手术,对软组织损伤较小。虽然对于C型损伤,初步稳定性就足够了,但骨盆后环的生物力学稳定性往往不足以进行活动。基于生物力学考虑,为骨盆C型损伤开发了一种新型背侧斜形骨盆外固定架。结合髋臼上固定架和另外两枚斯氏针的优点,腹侧固定架应能以与骨盆C形夹相当的稳定性稳定骨盆后环。目标是对骨盆后环进行一次初步且已确定的微创稳定。在第一个系列中,对这种带有两种不同斯氏针应用方式的不对称固定架的几种变体进行了生物力学测试。在第二个系列中,将最受欢迎的版本与髋臼上固定架和骨盆C形夹进行了测试。两个生物力学测试系列均在材料试验机的单腿站立模型中使用人工骨盆进行。骶髂关节脱位和骶骨骨折是6个骨盆中各自的后环不稳定类型。背侧斜形固定架与骨盆C形夹之间没有统计学上的显著差异。但新固定架比髋臼上固定架或无预紧力的新固定架明显更稳定。