Notov Dmitry, Knorr Eva, Spiegl Ulrich J A, Osterhoff Georg, Höch Andreas, Kleber Christian, Pieroh Philipp
Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
Clinic for Trauma Surgery and Orthopaedics, Munich Harlaching, Sanatoriumspl. 2, 81545, München, Germany.
Patient Saf Surg. 2024 May 22;18(1):17. doi: 10.1186/s13037-024-00401-3.
Open reduction and plate fixation is a standard procedure for treating traumatic symphyseal disruptions, but has a high incidence of implant failure. Several studies have attempted to identify predictors for implant failure and discussed its impact on functional outcome presenting conflicting results. Therefore, this study aimed to identify predictors of implant failure and to investigate the impact of implant failure on pain and functional outcome.
In a single-center, retrospective, observational non-controlled cohort study in a level-1 trauma center from January 1, 2006, to December 31, 2017, 42 patients with a plate fixation of a traumatic symphyseal disruption aged ≥ 18 years with a minimum follow-up of 12 months were included. The following parameters were examined in terms of effect on occurrence of implant failure: age, body mass index (BMI), injury severity score (ISS), polytrauma, time to definitive treatment, postoperative weight-bearing, the occurrence of a surgical site infection, fracture severity, type of posterior injury, anterior and posterior fixation. A total of 25/42 patients consented to attend the follow- up examination, where pain was assessed using the Numerical Rating Scale and functional outcome using the Majeed Pelvic Score.
Sixteen patients had an anterior implant failure (16/42; 37%). None of the parameters studied were predictive for implant failure. The median follow-up time was six years and 8/25 patients had implant failure. There was no difference in the Numerical Rating Scale, but the work-adjusted Majeed Pelvic Score showed a better outcome for patients with implant failure.
implant failure after symphyseal disruptions is not predictable, but appears to be clinically irrelevant. Therefore, an additional sacroiliac screw to prevent implant failure should be critically discussed and plate removal should be avoided in asymptomatic patients.
切开复位钢板固定是治疗创伤性耻骨联合分离的标准术式，但植入物失败的发生率较高。多项研究试图确定植入物失败的预测因素，并讨论其对功能结局的影响，结果相互矛盾。因此，本研究旨在确定植入物失败的预测因素，并调查植入物失败对疼痛和功能结局的影响。
在一家一级创伤中心进行的单中心、回顾性、观察性非对照队列研究中，纳入了2006年1月1日至2017年12月31日期间42例年龄≥18岁、创伤性耻骨联合分离采用钢板固定且至少随访12个月的患者。从以下参数对植入物失败发生的影响方面进行检查：年龄、体重指数（BMI）、损伤严重程度评分（ISS）、多发伤、确定性治疗时间、术后负重、手术部位感染的发生情况、骨折严重程度、后方损伤类型、前后固定方式。共有25/42例患者同意参加随访检查，采用数字评分量表评估疼痛情况，采用马吉德骨盆评分评估功能结局。
16例患者出现前方植入物失败（16/42；37%）。所研究的参数均不能预测植入物失败。中位随访时间为6年，25例患者中有8例出现植入物失败。数字评分量表方面无差异，但经工作调整的马吉德骨盆评分显示植入物失败的患者结局更好。
耻骨联合分离后植入物失败不可预测，但似乎在临床上并无关联。因此，对于预防性植入物失败而增加骶髂螺钉的做法应进行严格讨论，对于无症状患者应避免取出钢板。
