Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria.
Department of Orthopaedic Surgery, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria.
Injury. 2021 Apr;52(4):699-704. doi: 10.1016/j.injury.2020.12.041. Epub 2021 Jan 8.
Open reduction and internal fixation of both columns is considered the treatment of choice for displaced anterior column with posterior hemitransverse (ACPHT) fractures in non-geriatric patients. Plate fixation of one column combined with lag screw fixation of the other column allows to decrease operative time and approach-related morbidity compared to conventional both column plating. The aim of this biomechanical study was to evaluate whether single column plate plus other column lag screw fixation confers similar stability to both column plate fixation. Physiological loads were simulated using both the single-leg stance (SLS) as well as the sit-to-stand (STS) loading protocols.
A clinically relevant ACPHT fracture model was created using fourth-generation composite hemipelves. Fractures were stabilized with three different fixation constructs: (1) anterior column plate plus posterior column screw fixation (AP+PCS), posterior column plate plus anterior column screw fixation (PP+ACS) and anterior column plate plus posterior column plate fixation (AP+PP). Specimens were loaded from 50 to 750 N with a ramp of 100 N/s. Fracture gap motion (FGM) and relative interfragmentary rotation (RIFR) between the three main fracture fragments were assessed under loads of 750 N using an optical 3D measurement system.
STS loading generally resulted in higher mean FGM and RIFR than STS loading in the AP+PCS and AP+PP groups, while no significant differences were found in the PP+ACS group. Compared to conventional both column plate fixation (AP+PP), PP+ACS displayed significantly higher FGM and RIFR between the iliac wing and the posterior column during SLS loading. No significant differences in FGM and RIFR were identified between the AP+PCS and the AP+PP group.
Overall, single column plate plus other column lag screw fixation conferred similar stability to conventional both column plate fixation. From a clinical point of view, AP+PCS appears to be the most attractive alternative to conventional AP+PP for internal fixation of ACPHT fractures.
对于非老年患者的前柱伴后柱半横行（ACPHT）骨折，切开复位内固定被认为是首选治疗方法。与传统的双柱接骨板固定相比，单柱接骨板固定联合另一柱拉力螺钉固定可减少手术时间和与入路相关的发病率。本生物力学研究的目的是评估单柱接骨板加另一柱拉力螺钉固定是否与双柱接骨板固定具有相似的稳定性。使用单腿站立（SLS）和坐立-站立（STS）加载方案模拟生理负荷。
使用第四代复合材料半骨盆创建了一个临床相关的 ACPHT 骨折模型。骨折用三种不同的固定结构固定：（1）前柱接骨板加后柱螺钉固定（AP+PCS）、后柱接骨板加前柱螺钉固定（PP+ACS）和前柱接骨板加后柱接骨板固定（AP+PP）。标本以 100 N/s 的斜坡从 50 N 加载至 750 N。在 750 N 载荷下，使用光学三维测量系统评估三个主要骨折块之间的骨折间隙运动（FGM）和相对骨折块间旋转（RIFR）。
STS 加载一般比 AP+PCS 和 AP+PP 组的 SLS 加载产生更高的平均 FGM 和 RIFR，而在 PP+ACS 组中则没有显著差异。与传统的双柱接骨板固定（AP+PP）相比，PP+ACS 在 SLS 加载时，髂翼与后柱之间的 FGM 和 RIFR 显著较高。AP+PCS 和 AP+PP 组之间的 FGM 和 RIFR 无显著差异。
总体而言，单柱接骨板加另一柱拉力螺钉固定与传统的双柱接骨板固定具有相似的稳定性。从临床角度来看，AP+PCS 似乎是传统 AP+PP 固定 ACPHT 骨折的最有吸引力的替代方法。
