Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
Department of Handsurgery, Upper Extremities and Foot Surgery, Krankenhaus Waldfriede, Argentinische Allee 40, 14163, Berlin, Germany.
Eur J Trauma Emerg Surg. 2023 Dec;49(6):2553-2560. doi: 10.1007/s00068-023-02341-6. Epub 2023 Aug 3.
Pelvic fractures were often associated with high-energy trauma in young patients, but data show a significant increase in osteoporotic pelvic fractures in old age due to the progressive demographic change. There is an ongoing discussion about the best fixation techniques, which are ranging from lumbopelvic fixation to sacral bars or long transiliac-transsacral (TITS) screws. This study analyzes TITS screw osteosynthesis and sacroiliac screw osteosynthesis (SI), according to biomechanical criteria of fracture stability in osteoporotic human pelvic cadavers ex vivo.
Ten osteoporotic cadaveric pelvises were randomized into two groups of 5 pelvises each. An FFP-IIc fracture was initially placed unilaterally and subsequently surgically treated with a navigated SI screw or a TITS screw. The fractured side was loaded in a one-leg stance test setup until failure. Interfragmentary movements were assessed by means of optical motion tracking.
No significant difference in axial stiffness were found between the SI and the TITS screws (21.2 ± 4.9 N and 18.4 ± 4.1 N, p = 0.662). However, there was a significantly higher stability of the fracture treatment in the cohort with TITS-screws for gap angle, flexion, vertical movement and overall stability. The most significant difference in the cycle interval was between 6.000 and 10.000 for the gap angle (1.62 ± 0.25° versus 4.60 ± 0.65°, p = 0.0001), for flexion (4.15 ± 0.39 mm versus 7.60 ± 0.81 mm, p = 0.0016), interval 11.000-15.000 for vertical shear movement (7.34 ± 0.51 mm versus 13.99 ± 0.97 mm, p < 0.0001) and total displacement (8.28 ± 0.66 mm versus 15.53 ± 1.07 mm, p < 0.0001) for the TITS and the SI screws.
The results of this biomechanical study suggest a clear trend towards greater fracture stability of the TITS screw with significantly reduced interfragmentary movement. The application of a TITS screw for the treatment of the osteoporotic pelvic ring fracture may be prioritized to ensure the best possible patient care.
骨盆骨折通常与年轻患者的高能创伤有关，但数据显示，由于人口结构的变化，老年骨质疏松性骨盆骨折的发生率显著增加。目前，人们正在讨论最佳的固定技术，这些技术包括腰骶固定、骶骨棒或长髂骨-骶骨(transiliac-transsacral, TITS)螺钉。本研究根据骨质疏松性人体骨盆尸体标本的生物力学骨折稳定性标准，分析了 TITS 螺钉内固定和骶髂螺钉内固定(sacroiliac screw osteosynthesis, SI)。
10 具骨质疏松性骨盆尸体标本随机分为两组，每组 5 具。首先在单侧放置 FFP-IIc 骨折，然后通过导航辅助 SI 螺钉或 TITS 螺钉进行手术治疗。将骨折侧置于单腿站立测试装置中进行加载，直至失效。通过光学运动跟踪评估骨折间的运动。
SI 螺钉和 TITS 螺钉的轴向刚度无显著差异(21.2 ± 4.9 N 和 18.4 ± 4.1 N，p = 0.662)。然而，对于间隙角度、屈曲、垂直运动和整体稳定性，TITS 螺钉固定骨折的稳定性明显更高。在间隙角度（1.62 ± 0.25°对 4.60 ± 0.65°，p = 0.0001）、屈曲（4.15 ± 0.39 mm 对 7.60 ± 0.81 mm，p = 0.0016）、11.000-15.000 周期间隔垂直剪切运动（7.34 ± 0.51 mm 对 13.99 ± 0.97 mm，p < 0.0001）和总位移（8.28 ± 0.66 mm 对 15.53 ± 1.07 mm，p < 0.0001）方面，TITS 螺钉和 SI 螺钉的差异有统计学意义。
本生物力学研究结果表明，TITS 螺钉的骨折稳定性明显提高，骨折间活动明显减少，这一趋势清晰。为确保患者获得最佳护理，骨质疏松性骨盆环骨折的治疗可优先考虑 TITS 螺钉。
