Comstock C P, van der Meulen M C, Goodman S B
Division of Orthopaedic Surgery, Stanford University School of Medicine, CA 94305-5326, USA.
J Orthop Trauma. 1996;10(8):517-22. doi: 10.1097/00005131-199611000-00001.
Early reduction and rigid fixation of unstable vertical shear pelvic fractures has been shown to decrease the incidence of late sequelae and facilitate early mobilization. The results of fixation of the posterior pelvic ring without anterior fixation are unknown. The purpose of this study was to perform a biomechanical comparison of the most frequently used techniques of posterior fixation for unstable pelvic sacroiliac dislocations in conjunction with ipsilateral rami fractures, i.e., an unstable vertical shear injury. The four methods of posterior fixation tested included sacroiliac (SI) screws, anterior SI plates, transiliac bars, and a combination of SI screws and transiliac bars. Six cadaveric pelvises were tested in axial compression and torsion on a biaxial servohydraulic testing machine. Compared to the intact pelvis, single posterior methods of fixation provided approximately 70-85% resistance to axial and torsional loading. By combining SI screws with transiliac bars, approximately 90% of intact pelvic stability was achieved. Our results suggest that rigid posterior fixation of sacroiliac dislocations alone may obviate the need for additional complex anterior surgical procedures to fix rami fractures.
不稳定垂直剪切型骨盆骨折的早期复位及坚强固定已被证明可降低晚期后遗症的发生率并促进早期活动。单纯进行后骨盆环固定而不进行前固定的效果尚不清楚。本研究的目的是对不稳定骨盆骶髂关节脱位合并同侧耻骨支骨折（即不稳定垂直剪切损伤）最常用的后固定技术进行生物力学比较。所测试的四种后固定方法包括骶髂（SI）螺钉、骶髂关节前钢板、髂骨棒以及SI螺钉与髂骨棒联合使用。在双轴伺服液压试验机上对六个尸体骨盆进行轴向压缩和扭转测试。与完整骨盆相比，单一的后固定方法对轴向和扭转载荷提供约70 - 85%的阻力。通过将SI螺钉与髂骨棒联合使用，可实现约90%的完整骨盆稳定性。我们的结果表明，仅对骶髂关节脱位进行坚强的后固定可能无需额外进行复杂的前侧手术来固定耻骨支骨折。
