Department of Orthopedic Trauma & Hand and Foot Surgery, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
Department of Trauma Surgery, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
Biomed Eng Online. 2024 Jul 12;23(1):66. doi: 10.1186/s12938-024-01262-8.
Management of inferior ramus of the pubis-ischium ramus remains controversial, and related research is sparse. The main intention of this study is to describe the biomechanical and clinical outcomes of pubis-ischium ramus fractures in Tile B pelvic injuries and to identify the feasibility and necessity of fixation of the inferior ramus of the pubis-ischium ramus.
This study comprised two parts: a biomechanical test and a retrospective clinical study. For the biomechanical tests, Tile B-type pelvic injuries were modeled in six cadaver specimens by performing pubis-ischium osteotomies and disruption of the anterior and interosseous sacroiliac ligaments. The superior and/or inferior rami of the pubis-ischium ramus were repaired with reconstruction plates and separated into three groups (A, B, and C). Specimens were placed in the standing position and were loaded axially with two-leg support for three cycles at 500 N. The displacements of sacroiliac joints at osteotomy were measured with Vernier calipers and compared using statistical software. To investigate the clinical outcomes of this technique, 26 patients were retrospectively analyzed and divided into a superior ramus fixation group (Group D) and a combined superior and inferior ramus of the pubis-ischium ramus fixation group (Group E). The main outcome measures were time of operation, blood loss, postoperative radiographic reduction grading, and functional outcomes.
In the vertical loading test, Group E showed better pelvic ring stability than Group D (P < 0.05). However, the shift of the sacroiliac joints was almost identical among the three groups. In our clinical case series, all fractures in Group E achieved bony union. Group E demonstrated earlier weight-bearing functional exercise (2.54 ± 1.45 vs 4.77 ± 2.09; P = 0.004), earlier bony union (13.23 ± 2.89 vs 16.55 ± 3.11; P = 0.013), and better functional outcomes (89.77 ± 7.27 vs 82.38 ± 8.81; P = 0.028) than Group D. The incidence of sexual dysfunction was significantly lower in Group E than that in Group D (2/13 vs 7/13; P = 0.039). Bone nonunion occurred in two patients in Group D, and two patients in Group E had heterotopic ossification. None of the patients exhibited wound complications, infections, implant failures, or bone-implant interface failures.
Fixation of the inferior ramus of a pubis-ischium ramus fracture based on conventional fixation of the anterior pelvic ring is mechanically superior in cadaveric Tile B pelvic injury and shows rapid recovery, good functional outcomes, and low incidence of complications.
耻骨坐骨支骨折的治疗仍存在争议，相关研究较少。本研究的主要目的是描述Tile B 型骨盆损伤中耻骨坐骨支骨折的生物力学和临床结果，并确定固定耻骨坐骨支下支的可行性和必要性。
本研究包括两部分：生物力学测试和回顾性临床研究。对于生物力学测试，通过耻骨坐骨切开术和破坏前、骨间骶髂韧带，在 6 个尸体标本中模拟 Tile B 型骨盆损伤。耻骨坐骨支的上支和/或下支用重建钢板修复，并分为三组（A、B 和 C）。标本置于站立位，两腿支撑下轴向加载 500N，循环 3 次。用游标卡尺测量耻骨坐骨切开处骶髂关节的位移，并使用统计软件进行比较。为了研究该技术的临床结果，回顾性分析了 26 例患者，并分为上支固定组（D 组）和上支和耻骨坐骨支下支联合固定组（E 组）。主要观察指标为手术时间、出血量、术后影像学复位分级和功能结果。
在垂直加载试验中，E 组的骨盆环稳定性优于 D 组（P<0.05）。然而，三组的骶髂关节移位几乎相同。在我们的临床病例系列中，E 组所有骨折均达到骨性愈合。E 组更早地进行负重功能锻炼（2.54±1.45 比 4.77±2.09；P=0.004），更早地骨性愈合（13.23±2.89 比 16.55±3.11；P=0.013），功能结果更好（89.77±7.27 比 82.38±8.81；P=0.028）。E 组性功能障碍的发生率明显低于 D 组（2/13 比 7/13；P=0.039）。D 组有 2 例发生骨不连，E 组有 2 例发生异位骨化。无患者发生伤口并发症、感染、植入物失败或骨-植入物界面失败。
基于传统的前骨盆环固定方法，耻骨坐骨支下支骨折的固定在尸体Tile B 型骨盆损伤中具有更好的机械稳定性，且恢复迅速，功能结果良好，并发症发生率低。
