Grüneweller Niklas, Leunig Julia, Zderic Ivan, Gueorguiev Boyko, Colcuc Christian, Wähnert Dirk, Vordemvenne Thomas
Bielefeld University, Medical School and University Medical Center OWL, Protestant Hospital of the Bethel Foundation, Department of Trauma and Orthopedic Surgery, Burgsteig 13, 33617 Bielefeld, Germany.
AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland.
J Clin Med. 2024 Aug 13;13(16):4744. doi: 10.3390/jcm13164744.
(1) : Pelvic fractures, and particularly instabilities of the dorsal pelvic ring, are becoming increasingly prevalent, particularly in orthogeriatric patients. Spino-pelvic triangular osteosynthesis is an effective approach to achieve sufficient stabilization in vertically unstable fractures. This study compares two types of osteosynthesis: the conventional one and a novel instrumentation where the iliosacral screw is placed through a fenestrated iliac screw. (2) : Sixteen artificial osteoporotic L5+pelvis models with an unstable sacral fracture have been instrumented with either an iliac screw connected with a rod to a L5 pedicle screw and an iliosacral screw (TF) or a fenestrated ilium screw connected with a rod to a L5 pedicle screw and an iliosacral screw passing through the fenestra of the iliac screw (TFS). Biomechanical testing was performed using cyclic loading until failure. (3) : Both configurations yielded comparable results with regard to initial stiffness, implant loosening, and cycles to failure. The TFS exhibited markedly higher values for cycles to failure and markedly lower values for loosening. However, due to the characteristics of the artificial bone model, these findings were not significant. (4) : The novel triangular fixation systems demonstrated comparable results to the standard triangular osteosynthesis configuration.
(1)：骨盆骨折，尤其是骨盆后环不稳定，正变得越来越普遍，在老年骨科患者中尤为如此。脊柱骨盆三角骨固定术是在垂直不稳定骨折中实现充分稳定的有效方法。本研究比较了两种骨固定术：传统的骨固定术和一种新型器械，即通过带孔髂骨螺钉置入骶髂螺钉。(2)：16个伴有不稳定骶骨骨折的人工骨质疏松L5+骨盆模型，分别用与L5椎弓根螺钉相连的髂骨螺钉和骶髂螺钉（TF），或与L5椎弓根螺钉相连的带孔髂骨螺钉以及穿过髂骨螺钉孔的骶髂螺钉（TFS）进行器械固定。使用循环加载直至失效进行生物力学测试。(3)：两种构型在初始刚度、植入物松动和失效循环次数方面产生了可比的结果。TFS的失效循环次数值明显更高，而松动值明显更低。然而，由于人工骨模型的特性，这些发现并不显著。(4)：新型三角固定系统与标准三角骨固定构型的结果相当。
