Goldsztajn Flavio, Mariolani Jose Ricardo L, Belangero William Dias
Departamento de Ortopedia, Américas Medical City, Rio de Janeiro, RJ, Brasil.
Laboratório de Biomateriais em Ortopedia, Escola de Ciências Médicas, Universidade de Campinas, Campinas, SP, Brasil.
Rev Bras Ortop (Sao Paulo). 2020 Aug;55(4):497-503. doi: 10.1055/s-0039-1697973. Epub 2020 Jan 9.
Sacroiliac joint dislocations are caused by high energy trauma and commonly treated with the iliosacral screw fixation or the anterior plating of the sacroiliac joint (SIJ). However, there is a lack of consensus regarding which procedure is the most successful in treating sacroiliac joint dislocations. This aims to compare stiffness and maximum load of pelvises with sacroiliac joint dislocations treated with both procedures in a synthetic bone model. Synthetic pelvises were mounted and divided into 2 treatment groups ( = 5): a model with two orthogonal plates placed anteriorly to the SIJ (PPS group) and another with two iliosacral screws fixating the SIJ (SPS group), both with pubic symphysis fixation. The maximum load supported by each sample was observed and the stiffness was calculated from the curve load vs displacement. The mean values of load to failure and stiffness for each group were compared with the Mann-Whitney U test ( < 0.05 was considered significant for all analysis). The mean load to failure supported by the PPS group was 940 ± 75 N and the SPS was 902 ± 56 N, with no statistical difference. The SPS group showed higher values of stiffness (68.6 ± 11.1 N/mm) with statistical significant difference in comparison to the PPS sample (50 ± 4.0 N/mm). The mode of failure was different in each group tested. Despite lower stiffness, the anterior plating fixation of the sacroiliac joint can be very useful when the iliosacral screw fixation cannot be performed. Further studies are necessary to observe any differences between these two procedures on the clinical and surgical setting.
骶髂关节脱位由高能量创伤引起，通常采用髂骶螺钉固定或骶髂关节前路钢板固定治疗。然而，对于哪种手术治疗骶髂关节脱位最成功，目前尚无共识。本研究旨在比较在合成骨模型中，采用这两种手术治疗的骶髂关节脱位骨盆的刚度和最大负荷。
将合成骨盆安装好并分为2个治疗组（每组n = 5）：一组是在骶髂关节前方放置两块正交钢板的模型（PPS组），另一组是用两枚髂骶螺钉固定骶髂关节的模型（SPS组），两组均固定耻骨联合。观察每个样本所承受的最大负荷，并根据负荷与位移曲线计算刚度。采用Mann-Whitney U检验比较每组的破坏负荷和刚度的平均值（所有分析中P < 0.05被认为具有统计学意义）。
PPS组的平均破坏负荷为940 ± 75 N，SPS组为902 ± 56 N，无统计学差异。SPS组的刚度值较高（68.6 ± 11.1 N/mm），与PPS组样本（50 ± 4.0 N/mm）相比有统计学显著差异。每组测试的破坏模式不同。
尽管刚度较低，但当无法进行髂骶螺钉固定时，骶髂关节前路钢板固定可能非常有用。有必要进行进一步研究，以观察这两种手术在临床和手术环境中的差异。
