Faust L, Lebert L, Pachmann F, Böcker W, Neuerburg C, Keppler A M
Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany.
Arch Orthop Trauma Surg. 2024 Dec 16;145(1):50. doi: 10.1007/s00402-024-05707-6.
Increasing incidences for fragility fractures of the pelvis (FFP) have been reported and surgical treatment remains demanding. While conventional screw osteosynthesis is a common method, complications may arise due to altered bone morphology in the osteoporotic pelvic bone. The iFuse implant system is a novel implant, first introduced for treatment of degenerative sacroiliac joint dysfunction, which offers promising biomechanical characteristics with potential benefits for treatment of FFP. Yet data on the use for FFP is limited. The objective of this study is to compare early postoperative mobility of patients treated with screw osteosynthesis only versus patients treated with additional iFuse stabilization based on insole force sensor gait analysis. We hypothesized that additional iFuse implantation leads to superior postoperative mobility.
In the prospective observational study, 37 orthogeriatric patients with FFP types II-IV were included. Postoperative mobility of patients treated with conventional screw osteosynthesis only (group 1) and patients with additional iFuse implantation (group 2) was compared. Mobility was examined using insole force sensors (Loadsol, Novel GmbH).
Postoperative comparison of gait analysis showed no significant difference in average (APF) and maximum peak force (MPF) between group 1 (n = 19, APF 64.9% ± 13.3, MPF 76.0% ± 14.1) and group 2 (n = 18, APF 67.6% ± 9.9, MPF 78.2% ± 10.1). Gait symmetry measured by FTI (force-time integral) ratio was significantly higher in group 2 (48.5% ± 3.3) than in group 1 (44.9% ± 5.4; p = 0.023). Median Barthel Index was higher in group 2 (55) compared to group 1 (45), yet not significantly (p = 0.058). Postoperative pain levels showed no significant differences between both groups.
Comparison of early postoperative mobility showed similar mobility outcomes in both groups. Patients with additional iFuse implantation had a more balanced gait pattern, whereas no significance was found in peak force parameters. Additional iFuse implantation showed promising results regarding patient mobility, therefore our hypothesis was partly confirmed. In future long-term examinations with larger patient cohorts should be aimed for.
据报道，骨盆脆性骨折（FFP）的发病率不断上升，手术治疗仍然具有挑战性。虽然传统的螺钉接骨术是一种常用方法，但由于骨质疏松性骨盆骨的骨形态改变，可能会出现并发症。iFuse植入系统是一种新型植入物，最初用于治疗退行性骶髂关节功能障碍，具有良好的生物力学特性，可能对FFP的治疗有益。然而，关于其在FFP治疗中的应用数据有限。本研究的目的是基于鞋垫力传感器步态分析，比较仅接受螺钉接骨术治疗的患者与接受额外iFuse稳定治疗的患者术后早期的活动能力。我们假设额外植入iFuse会带来更好的术后活动能力。
在这项前瞻性观察研究中，纳入了37例II-IV型FFP的老年骨科患者。比较了仅接受传统螺钉接骨术治疗的患者（第1组）和额外植入iFuse的患者（第2组）的术后活动能力。使用鞋垫力传感器（Loadsol，Novel GmbH）检查活动能力。
步态分析的术后比较显示，第1组（n = 19，平均峰值力（APF）64.9%±13.3，最大峰值力（MPF）76.0%±14.1）和第2组（n = 18，APF 67.6%±9.9，MPF 78.2%±10.1）之间的平均峰值力和最大峰值力无显著差异。通过FTI（力-时间积分）比率测量的步态对称性在第2组（48.5%±3.3）显著高于第1组（44.9%±5.4；p = 0.023）。第2组的Barthel指数中位数（55）高于第1组（45），但差异不显著（p = 0.058）。两组术后疼痛水平无显著差异。
术后早期活动能力的比较显示两组的活动能力结果相似。额外植入iFuse的患者步态模式更平衡，而峰值力参数无显著差异。额外植入iFuse在患者活动能力方面显示出有希望的结果，因此我们的假设得到了部分证实。未来应针对更大的患者队列进行长期检查。
