Lodde Moritz F, Klimek Matthias, Herbst Elmar, Peez Christian, Riesenbeck Oliver, Raschke Michael J, Roßlenbroich Steffen
Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, 48149 Münster, Germany.
Bioengineering (Basel). 2025 Jan 1;12(1):27. doi: 10.3390/bioengineering12010027.
(1) Background: The incidence of fragility fractures of the pelvis (FFP) has increased significantly over the past decades. Unilateral non-displaced fractures, defined as FFP II, are the most common type of fracture. When conservative treatment fails, surgical treatment is indicated. We hypothesize that the use of bilateral SI screws (BSIs) or a transsacral screw (TSI) is superior compared to a unilateral screw (USI) because of a significant reduction in the risk of adjacent fractures and a reduction in fracture progression. (2) Methods: A finite element model of a female pelvic ring was constructed. The ligaments were simulated as tension springs. The load was applied through the sacrum with the pelvis fixed to both acetabula. An FFP IIc was simulated and fixed with either a USI or BSI or TSI. The models were analyzed for a quantitative statement of stress and fracture dislocation. (3) Results: The BSI and TSI resulted in less dislocation compared to the USI. The stress distribution on both sides of the sacrum was favorable in the BSI and TSI groups. The BSI resulted in a higher rotational stability compared to the TSI. (4) Conclusions: The use of either a BSI or TSI for fixation of unilateral FFP is biomechanically favorable compared to the use of a USI. In addition, the use of a BSI or TSI reduces the stress on the contralateral uninjured side of the sacrum. This may reduce the risk of an adjacent fracture or fracture progression.
（1）背景：在过去几十年中，骨盆脆性骨折（FFP）的发病率显著增加。单侧无移位骨折，定义为FFP II型，是最常见的骨折类型。保守治疗失败时，需进行手术治疗。我们假设，由于相邻骨折风险显著降低以及骨折进展减少，使用双侧骶髂螺钉（BSI）或经骶骨螺钉（TSI）比单侧螺钉（USI）更具优势。（2）方法：构建女性骨盆环有限元模型。韧带模拟为拉力弹簧。在骨盆固定于双侧髋臼的情况下，通过骶骨施加负荷。模拟FFP IIc型骨折，并用USI、BSI或TSI进行固定。对模型进行分析，以定量评估应力和骨折脱位情况。（3）结果：与USI相比，BSI和TSI导致的脱位更少。BSI组和TSI组骶骨两侧的应力分布良好。与TSI相比，BSI具有更高的旋转稳定性。（4）结论：与使用USI相比，使用BSI或TSI固定单侧FFP在生物力学上更具优势。此外，使用BSI或TSI可减轻骶骨对侧未受伤侧的应力。这可能会降低相邻骨折或骨折进展的风险。
