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三种用于单侧耻骨支骨折的微创固定方法的生物力学比较

Biomechanical comparison of three minimally invasive fixations for unilateral pubic rami fractures.

作者信息

Zhao Yong, Ma Yupeng, Zou Dexin, Sun Xiujiang, Cheng Gong, Lian Wei, Dong Shengjie, Zhao Yuchi, Qu Wenqing, Wu Hao

机构信息

Orthopaedics Department, Yantai Shan Hospital, 91#, Jiefang Road, Yantai, 264008, Shandong Province, People's Republic of China.

CT/MR Department, Yantai Shan Hospital, 91#, Jiefang Road, Yantai, 264008, Shandong Province, People's Republic of China.

出版信息

BMC Musculoskelet Disord. 2020 Sep 4;21(1):594. doi: 10.1186/s12891-020-03604-8.

DOI:10.1186/s12891-020-03604-8
PMID:32887595
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7487546/
Abstract

BACKGROUND

To compare the mechanical characteristics of a percutaneous superior pubic intramedullary screw, percutaneous bridging plate and percutaneous screw-rod system of the anterior ring for the treatment of unilateral vertical pubic fractures to provide a reference for clinical application.

METHODS

A finite element model of pelvic anterior ring injury (unilateral vertical pubic fracture) was produced. The fractures were fixed with a percutaneous superior pubic intramedullary screw, percutaneous bridging plate and percutaneous screw-rod system of the anterior ring and their combinations in 5 types of models. The fracture stabilities under vertical, bilateral and anterior-posterior load were quantified and compared based on the displacement of the hip joints' midpoint as quantificational index of fracture stability.

RESULTS

In the condition of bilateral and anterior-posterior load, the vertical, bilateral and anterior-posterior displacements of the hip joints' midpoint of different models were significantly different respectively. In general, the displacements of the 5 pelvic anterior ring fixations were ranked from maximum to minimum as follows: bridging plate, pelvic anterior screw-rod system, combination of bridging plate and pelvic anterior screw-rod system, superior pubic intramedullary screw and combination of superior pubic intramedullary screw and pelvic anterior screw-rod system.

CONCLUSION

For the fixation in unilateral pubic fractures of pelvic ring injury, the percutaneous superior pubic intramedullary screw is optimal, the percutaneous pelvic anterior screw-rod system is the second choice, and percutaneous bridging plate ranks the third. The percutaneous pelvic anterior screw-rod system can significantly increase fixation stability of the percutaneous superior pubic intramedullary screw and the percutaneous bridging plate.

摘要

背景

比较经皮耻骨上髓内螺钉、经皮桥接钢板及前环经皮螺钉-棒系统治疗单侧耻骨垂直骨折的力学特性，为临床应用提供参考。

方法

建立骨盆前环损伤（单侧耻骨垂直骨折）的有限元模型。在5种模型中，分别采用经皮耻骨上髓内螺钉、经皮桥接钢板及前环经皮螺钉-棒系统及其组合固定骨折。以髋关节中点位移作为骨折稳定性的量化指标，对垂直、双侧及前后向载荷下的骨折稳定性进行量化比较。

结果

在双侧及前后向载荷条件下，不同模型髋关节中点的垂直、双侧及前后向位移分别存在显著差异。总体而言，5种骨盆前环固定方式的位移由大到小依次为：桥接钢板、骨盆前螺钉-棒系统、桥接钢板与骨盆前螺钉-棒系统组合、耻骨上髓内螺钉及耻骨上髓内螺钉与骨盆前螺钉-棒系统组合。

结论

对于骨盆环损伤单侧耻骨骨折的固定，经皮耻骨上髓内螺钉最佳，经皮骨盆前螺钉-棒系统次之，经皮桥接钢板居第三。经皮骨盆前螺钉-棒系统可显著提高经皮耻骨上髓内螺钉和经皮桥接钢板的固定稳定性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1745/7487546/507e843c163f/12891_2020_3604_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1745/7487546/92661cf0858f/12891_2020_3604_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1745/7487546/6d0b29dcfa25/12891_2020_3604_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1745/7487546/0fc0193e3533/12891_2020_3604_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1745/7487546/ea1c8fb2c4c9/12891_2020_3604_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1745/7487546/507e843c163f/12891_2020_3604_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1745/7487546/92661cf0858f/12891_2020_3604_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1745/7487546/6d0b29dcfa25/12891_2020_3604_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1745/7487546/0fc0193e3533/12891_2020_3604_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1745/7487546/ea1c8fb2c4c9/12891_2020_3604_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1745/7487546/507e843c163f/12891_2020_3604_Fig5_HTML.jpg

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Fixation of Anterior Pelvic Ring Injuries.骨盆前环损伤的固定。
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Good functional outcome in patients suffering fragility fractures of the pelvis treated with percutaneous screw stabilisation: Assessment of complications and factors influencing failure.
前骨盆环损伤的 ESIN 与其他微创技术的比较：有限元分析和病例对照研究。
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