AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland.
Department for Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, Germany.
Medicina (Kaunas). 2021 Dec 16;57(12):1368. doi: 10.3390/medicina57121368.
: The stability of the pelvic ring mainly depends on the integrity of its posterior part. Percutaneous sacroiliac (SI) screws are widely implanted as standard of care treatment. The main risk factors for their fixation failure are related to vertical shear or transforaminal sacral fractures. The aim of this study was to compare the biomechanical performance of fixations using one (Group 1) or two (Group 2) standard SI screws versus one SI screw with bone cement augmentation (Group 3). : Unstable fractures of the pelvic ring (AO/OTA 61-C1.3, FFP IIc) were simulated in 21 artificial pelvises by means of vertical osteotomies in the ipsilateral anterior and posterior pelvic ring. A supra-acetabular external fixator was applied to address the anterior fracture. All specimens were tested under progressively increasing cyclic loading until failure, with monitoring by means of motion tracking. Fracture site displacement and cycles to failure were evaluated. : Fracture displacement after 500 cycles was lowest in Group 3 (0.76 cm [0.30] (median [interquartile range, IQR])) followed by Group 1 (1.42 cm, [0.21]) and Group 2 (1.42 cm [1.66]), with significant differences between Groups 1 and 3, = 0.04. Fracture displacement after 1000 cycles was significantly lower in Group 3 (1.15 cm [0.37]) compared to both Group 1 (2.19 cm [2.39]) and Group 2 (2.23 cm [3.65]), ≤ 0.04. Cycles to failure (Group 1: 3930 ± 890 (mean ± standard deviation), Group 2: 3676 ± 348, Group 3: 3764 ± 645) did not differ significantly between the groups, = 0.79. : In our biomechanical setup cement augmentation of one SI screw resulted in significantly less displacement compared to the use of one or two SI screws. However, the number of cycles to failure was not significantly different between the groups. Cement augmentation of one SI screw seems to be a useful treatment option for posterior pelvic ring fixation, especially in osteoporotic bone.
骨盆环的稳定性主要取决于其后部的完整性。经皮骶髂（SI）螺钉被广泛植入作为标准的治疗方法。其固定失败的主要危险因素与垂直剪切或经椎间孔骶骨骨折有关。本研究的目的是比较使用一根（第 1 组）或两根（第 2 组）标准 SI 螺钉与一根 SI 螺钉加骨水泥增强（第 3 组）的固定的生物力学性能。
在 21 个人工骨盆中，通过同侧前后骨盆环的骨切开术模拟不稳定骨盆环骨折（AO/OTA 61-C1.3，FFP IIc）。在上骼臼上方应用外固定器来解决前侧骨折。所有标本均在逐渐增加的循环载荷下进行测试，直至失效，并通过运动跟踪进行监测。评估骨折部位的位移和失效周期。
在 500 次循环后，第 3 组（0.76cm [0.30]（中位数[四分位间距，IQR]））的骨折位移最低，其次是第 1 组（1.42cm [0.21]）和第 2 组（1.42cm [1.66]），第 1 组和第 3 组之间有显著差异， = 0.04。在 1000 次循环后，第 3 组（1.15cm [0.37]）的骨折位移明显低于第 1 组（2.19cm [2.39]）和第 2 组（2.23cm [3.65]）， ≤ 0.04。失效周期（第 1 组：3930 ± 890（均值 ± 标准差），第 2 组：3676 ± 348，第 3 组：3764 ± 645）在组间无显著差异， = 0.79。
在我们的生物力学设置中，一根 SI 螺钉的骨水泥增强与使用一根或两根 SI 螺钉相比，位移明显减少。然而，各组之间失效周期无显著差异。一根 SI 螺钉的骨水泥增强似乎是一种有用的治疗选择，特别是在后骨盆环固定中，在骨质疏松的骨骼中更是如此。
