Resident at Cantonal Hospital Lucerne, Lucerne, Switzerland.
Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Location Marburg, Germany.
Injury. 2019 Aug;50(8):1411-1417. doi: 10.1016/j.injury.2019.06.025. Epub 2019 Jun 28.
Fragility fractures of the pelvis (FFP) show a notable rise in prevalence. Minimally invasive surgical fixation of FFP is increasingly advocated for its obvious advantages with reference to early mobilization and weight bearing. Concerns regarding the holding power of osteosynthetic materials in osteoporotic bone led to the development of cementing techniques. However, the role of cement augmentation in the surgical treatment of FFP has yet to be defined. Therefore, the aim of this study was to conduct a systematic review of the current literature concerning studies that are comparing the performance of cement augmented versus non-augmented sacroiliac (SI) screws.
We conducted a systematic literature review from 01/01/2000 onwards. Inclusion criteria were randomized controlled studies, case series (n>3), biomechanical studies and reviews, comparing augmented and non-augmented SI screws. Only papers in German or English language were included.
Out of 1247 initial hits, eleven studies met the inclusion criteria. Out of those, six were biomechanical studies and five were clinical case series. Most biomechanical studies showed cement augmented screws to have a greater mechanical stability, both regarding pull-out force and resistance to cyclic loading. The five case studies reported on a total of 98 patients with 122 screw fixations. Three cases of cement leakage into neuroforamina occurred, however, none of these patients showed clinical symptoms.
In clinical case series, cement augmentation of SI screws appears to be a safe surgical technique without relevant complications and biomechanical studies demonstrate greater pull-out forces of augmented SI screws but no advantage in regard of cyclic loading. Hence, applicability of the mechanical testing results on the clinical situation are debatable. So far, there are neither retrospective nor randomized controlled studies comparing the performance of cemented and non-cemented SI screws in FFP. Therefore, the clinical benefit of SI screw cement augmentation is unclear and their use remains experimental.
骨盆脆性骨折（FFP）的患病率显著上升。微创固定技术具有早期活动和负重的明显优势，越来越受到推崇。鉴于骨质疏松骨骼中骨合成材料的固定力问题，开发了粘合技术。然而，水泥增强在 FFP 手术治疗中的作用尚未确定。因此，本研究旨在对目前关于比较骨水泥增强与非增强骶髂（SI）螺钉性能的研究进行系统评价。
我们从 2000 年 1 月 1 日开始进行系统的文献回顾。纳入标准为随机对照研究、病例系列（n>3）、生物力学研究和综述，比较增强和非增强的 SI 螺钉。仅纳入德语或英语的论文。
在 1247 篇初始文章中，有 11 项研究符合纳入标准。其中 6 项为生物力学研究，5 项为临床病例系列。大多数生物力学研究表明，骨水泥增强螺钉具有更大的机械稳定性，无论是在拔出力还是在抗循环载荷方面。5 项病例研究共报告了 98 例患者的 122 例螺钉固定。有 3 例出现水泥渗漏到神经孔，但这些患者均无临床症状。
在临床病例系列中，SI 螺钉的骨水泥增强似乎是一种安全的手术技术，没有相关的并发症，生物力学研究表明增强的 SI 螺钉具有更大的拔出力，但在循环载荷方面没有优势。因此，机械测试结果在临床情况下的适用性存在争议。到目前为止，还没有前瞻性或随机对照研究比较 FFP 中骨水泥增强和非增强的 SI 螺钉的性能。因此，SI 螺钉骨水泥增强的临床获益尚不清楚，其应用仍处于试验阶段。
