骶骨骨折固定中加长与短型骶髂螺钉的力学比较：有限元分析。
Mechanical comparison between lengthened and short sacroiliac screws in sacral fracture fixation: a finite element analysis.
机构信息
Orthopaedics Department, Yantai Shan Hospital, 91#, Jiefang Road, Yantai 264008, PR China.
出版信息
Orthop Traumatol Surg Res. 2013 Sep;99(5):601-6. doi: 10.1016/j.otsr.2013.03.023. Epub 2013 Jul 12.
OBJECTIVE
To compare the stability of lengthened sacroiliac screw and standard sacroiliac screw for the treatment of unilateral vertical sacral fractures; to provide reference for clinical applications.
METHODS
A finite element model of Tile type C pelvic ring injury (unilateral Denis type II fracture of the sacrum) was produced. The unilateral sacral fractures were fixed with lengthened sacroiliac screw and sacroiliac screw in six different types of models respectively. The translation and angle displacement of the superior surface of the sacrum (in standing position on both feet) were measured and compared.
RESULTS
The stability of one lengthened sacroiliac screw fixation in S1 or S2 segment is superior to that of one sacroiliac screw fixation in the same sacral segment. The stability of one lengthened sacroiliac screw fixation in S1 and S2 segments respectively is superior to that of one sacroiliac screw fixation in S1 and S2 segments respectively. The stability of one lengthened sacroiliac screw fixation in S1 and S2 segments respectively is superior to that of one lengthened sacroiliac screw fixation in S1 or S2 segment. The stability of one sacroiliac screw fixation in S1 and S2 segments respectively is markedly superior to that of one sacroiliac screw fixation in S1 or S2 segment. The vertical and rotational stability of lengthened sacroiliac screw fixation and sacroiliac screw fixation in S2 is superior to that of S1.
CONCLUSION
In a finite element model of type C pelvic ring disruption, S1 and S2 lengthened sacroiliac screws should be utilized for the fixation as regularly as possible and the most stable fixation is the combination of the lengthened sacroiliac screws of S1 and S2 segments. Even if lengthened sacroiliac screws cannot be systematically used due to specific conditions, one sacroiliac screw fixation in S1 and S2 segments respectively is recommended. No matter which kind of sacroiliac screw is used, if only one screw can be implanted, the fixation in S2 segment is more recommended than that in S1.
LEVEL OF EVIDENCE
Experimental study Level III.
目的
比较延长骶髂螺钉与标准骶髂螺钉治疗单侧垂直骶骨骨折的稳定性，为临床应用提供参考。
方法
制作 Tile 型 C 型骨盆环损伤（单侧 Denis Ⅱ型骶骨骨折）有限元模型。分别采用延长骶髂螺钉和骶髂螺钉固定单侧骶骨骨折 6 种不同类型的模型，测量并比较双侧站立位上位骶骨（S1、S2 节段）的平移和角度位移。
结果
1 枚延长骶髂螺钉固定 S1 或 S2 节段的稳定性优于同一骶骨节段的 1 枚骶髂螺钉固定，1 枚延长骶髂螺钉固定 S1、S2 节段的稳定性优于 1 枚延长骶髂螺钉固定 S1、S2 节段，1 枚延长骶髂螺钉固定 S1、S2 节段的稳定性优于 1 枚延长骶髂螺钉固定 S1 或 S2 节段，1 枚骶髂螺钉固定 S1、S2 节段的稳定性明显优于 1 枚骶髂螺钉固定 S1 或 S2 节段。延长骶髂螺钉和骶髂螺钉固定 S2 的垂直和旋转稳定性优于 S1。
结论
在 C 型骨盆环破裂的有限元模型中，应尽可能常规使用 S1 和 S2 延长骶髂螺钉固定，最稳定的固定是 S1 和 S2 延长骶髂螺钉的组合。即使由于特殊情况不能系统使用延长骶髂螺钉，也建议分别在 S1 和 S2 节段各固定 1 枚骶髂螺钉。无论使用哪种骶髂螺钉，如果只能植入 1 枚螺钉，S2 节段的固定比 S1 节段更推荐。
证据水平
实验研究 III 级。
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