Culemann U, Seelig M, Lange U, Gänsslen A, Tosounidis G, Pohlemann T
Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum des Saarlandes, Kirrberger Strasse 1, 66421 Homburg/Saar.
Unfallchirurg. 2007 Jun;110(6):528-36. doi: 10.1007/s00113-007-1236-4.
Reliable osteosynthesis for fractures in the different regions of the human pelvis are described in the literature while there is no common and satisfying treatment for unstable sacral fractures. Because of the posterior pelvic rings special anatomic conditions a local plate osteosynthesis seems to be advantageous. In many fields of modern fracture treatment locking implants show superior results. The prototype of a local locking plate osteosynthesis was compared to a common local plate and two sacroiliac screws.
The implants were tested using six plastic models of the pelvis and three embalmed human specimens. A Tile C1 fracture was created by disruption of the pubic symphysis and a transforaminal osteotomy. The specimens were exposed to axial loading in an upright single-leg stance with a maximum of 800 N for the plastic models and 200 N for the human specimens. An ultrasonic-based measuring system recorded translations (X, Y, Z) and rotations (alpha, beta, gamma). Parameters such as pattern of motion, translation/rotation, load to failure and remaining dislocation were evaluated.
Concerning most of the evaluated parameters the local plate osteosynthesis was inferior compared with two sacroiliac screws. There were no significant differences between the locking implant and the local plate osteosynthesis. Compared with the two sacroiliac screws the locking implant shows biomechanically equal results but allows greater anterior rotation and remaining dislocation. Because of the lower bone quality, the results from the anatomic specimen tested were not utilisable.
The locking implant is biomechanically an alternative compared with two sacroiliac screws. Problems occurred due to the preset direction of the locking head screws.
文献中描述了针对人体骨盆不同区域骨折的可靠骨合成方法，而对于不稳定骶骨骨折尚无通用且令人满意的治疗方法。由于骨盆后环特殊的解剖条件，局部钢板骨合成似乎具有优势。在现代骨折治疗的许多领域，锁定植入物显示出更好的效果。将局部锁定钢板骨合成的原型与普通局部钢板和两枚骶髂螺钉进行了比较。
使用六个骨盆塑料模型和三个防腐处理的人体标本对植入物进行测试。通过耻骨联合分离和经椎间孔截骨术制造Tile C1骨折。让标本在单腿直立姿势下承受轴向负荷，塑料模型最大负荷为800 N，人体标本最大负荷为200 N。基于超声的测量系统记录平移（X、Y、Z）和旋转（α、β、γ）。评估运动模式、平移/旋转、破坏载荷和残余脱位等参数。
在大多数评估参数方面，局部钢板骨合成比两枚骶髂螺钉差。锁定植入物与局部钢板骨合成之间没有显著差异。与两枚骶髂螺钉相比，锁定植入物在生物力学上显示出相同的结果，但允许更大的前向旋转和残余脱位。由于骨质量较低，测试的解剖标本的结果不可用。
与两枚骶髂螺钉相比，锁定植入物在生物力学上是一种替代方案。由于锁定头螺钉的预设方向出现了问题。
