Simonian P T, Routt M L, Harrington R M, Mayo K A, Tencer A F
Department of Orthopedics at Harborview Medical Center, University of Washington, Seattle, WA.
Clin Orthop Relat Res. 1994 Dec(309):245-56.
Seven fresh cadaveric pelvic specimens were biomechanically analyzed. Testing was first performed on intact pelves and then after progressive disruption of the (1) symphysis pubis, (2) unilateral anterior and interosseous sacroiliac ligaments and capsule, (3) ipsilateral sacrospinous and sacrotuberous ligaments; and fixation with a 4.5-mm narrow dynamic compression plate at the symphysis pubis, or a 4.5-mm narrow dynamic compression plate at the anterior sacroiliac joint with and without the symphysis pubis plate, or a 7.0-mm sacroiliac lag screw anchored into the S1 vertebral body with and without the symphysis pubis plate. Symphyseal gapping occurred after isolated symphysis pubis disruption. With additional disruption of the unilateral sacroiliac joint ligaments, symphysis pubis displacement was unaffected; however, the injured sacroiliac joint gap displacement, and sacroiliac joint flexion angulation on both intact and injured sides increased as compared to the specimen in the intact state. Further disruption of the ipsilateral sacrotuberous and sacrospinous ligament complex produced little additional motion at either symphysis pubis or sacroiliac joints. Plate fixation of the symphysis pubis alone reduced symphysis pubis motion, but not sacroiliac motion. Use of sacroiliac fixation alone without a symphysis pubis plate did not affect symphysis pubis motion. The symphysis pubis plate is the key to stabilizing symphysis pubis motion, and similarly, sacroiliac joint fixation is required to control sacroiliac joint motion. Both single iliosacral screws and plates produced equivalent decreases in sacroiliac joint motion.
对七具新鲜尸体骨盆标本进行了生物力学分析。首先对完整骨盆进行测试，然后依次对（1）耻骨联合、（2）单侧骶髂前韧带和骨间韧带及关节囊、（3）同侧骶棘韧带和骶结节韧带进行逐步破坏；并分别采用以下固定方式：在耻骨联合处使用4.5毫米窄动力加压钢板，或在骶髂前关节处使用4.5毫米窄动力加压钢板，有或没有耻骨联合钢板，或在有或没有耻骨联合钢板的情况下，用一枚7.0毫米骶髂拉力螺钉固定于S1椎体。单纯耻骨联合破坏后出现耻骨联合间隙增宽。单侧骶髂关节韧带进一步破坏时，耻骨联合移位未受影响；然而，与完整状态的标本相比，损伤侧骶髂关节间隙移位以及完整侧和损伤侧的骶髂关节屈曲角度均增加。同侧骶结节韧带和骶棘韧带复合体进一步破坏后，耻骨联合或骶髂关节几乎没有产生额外的活动。仅对耻骨联合进行钢板固定可减少耻骨联合的活动，但不能减少骶髂关节的活动。单独使用骶髂关节固定而不使用耻骨联合钢板不影响耻骨联合的活动。耻骨联合钢板是稳定耻骨联合活动的关键，同样，控制骶髂关节活动也需要进行骶髂关节固定。单枚骶髂螺钉和钢板在减少骶髂关节活动方面效果相当。
