Graul Isabel, Marintschev Ivan, Pizanis Antonius, Orth Marcel, Kaiser Mario, Pohlemann Tim, Fritz Tobias
Jena University Hospital, Department of Trauma, Hand and Reconstructive Surgery, Friedrich Schiller University Jena, 07740 Jena, Germany.
Department of Trauma, Orthopedics and Spine Surgery, Catholic Hospital "St. Johann Nepomuk", 99097 Erfurt, Germany.
J Clin Med. 2025 Feb 24;14(5):1497. doi: 10.3390/jcm14051497.
Sacroiliac screw fixation in elderly patients with pelvic fractures remains a challenging procedure for stabilization due to impaired bone quality. To improve it, we investigated the biomechanical properties of combined oblique sacroiliac and transiliosacral screw stabilization versus the additional cement augmentation of this construct in a cadaver model of osteoporotic bone, specifically with respect to the maximal force stability and fracture-site motion in the displacement and rotation of fragments. Standardized complete sacral fractures with intact posterior ligaments were created in osteoporotic cadaver pelvises and stabilized with a triangle of two oblique sacroiliac screws from each side with an additional transiliosacral screw in S1 ( = 5) and using the same pelvises with additional cement augmentation ( = 5). A short cyclic loading protocol was applied, increasing the axial force up to 125 N. Sacral fracture-site motion in displacement and rotation of the fragments was measured by optical motion tracking. A maximum force of 65N +/- 12.2 N was achieved using the triangular screw stabilization of the sacrum. Cement augmentation did not provide any significant gain in maximum force (70 N +/- 29.2 N). Only low fragment displacement was observed (2.6 +/- 1.5 mm) and fragment rotation (1.3 +/- 1.2°) without increased stability (3.0 +/- 1.5 mm; = 0.799; 1.7 +/- 0.4°; = 0.919) following the cement augmentation. Triangular stabilization using two obliques and an additional transiliosacral screw provides sufficient primary stability of the sacrum. Still, the stability achieved seems very low, considering the forces acting in this area. However, additional cement augmentation did not increase the stability of the sacrum. Given its lack of beneficial abilities, it should be used carefully, due to related complications such as cement leakage or nerve irritation. Improving the surgical methods used to stabilize the posterior pelvic ring will be a topic for future research.
由于骨质受损，老年骨盆骨折患者的骶髂螺钉固定术仍是一项具有挑战性的稳定手术。为了改进该手术，我们在骨质疏松骨的尸体模型中研究了联合斜向骶髂螺钉和经髂骶螺钉固定与该结构额外骨水泥强化的生物力学特性，特别是在骨折块移位和旋转时的最大力稳定性及骨折部位运动方面。在骨质疏松的尸体骨盆上制造标准化的完整骶骨骨折，且后韧带完整，用两侧各两枚斜向骶髂螺钉加一枚S1节段的经髂骶螺钉组成的三角形结构进行固定（n = 5），并在相同骨盆上额外进行骨水泥强化（n = 5）。应用短周期加载方案，将轴向力增加至125 N。通过光学运动追踪测量骶骨骨折部位在骨折块移位和旋转时的运动。使用骶骨三角形螺钉固定时，最大力达到65 N±12.2 N。骨水泥强化并未在最大力方面带来显著增加（70 N±29.2 N）。骨水泥强化后，仅观察到较低的骨折块移位（2.6±1.5 mm）和骨折块旋转（1.3±1.2°），稳定性未增加（3.0±1.5 mm；P = 0.799；1.7±0.4°；P = 0.919）。使用两枚斜向螺钉和一枚额外经髂骶螺钉的三角形固定可为骶骨提供足够的初始稳定性。然而，考虑到该区域所承受的力，所实现的稳定性似乎非常低。此外，骨水泥强化并未增加骶骨的稳定性。鉴于其缺乏有益作用，且存在骨水泥渗漏或神经刺激等相关并发症，应谨慎使用。改进用于稳定骨盆后环的手术方法将是未来研究的一个课题。
