Asian Spine Journal

  • 제12권6호
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  • Pages.967-972
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  • 2018
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  • 1976-1902(pISSN)
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  • 1976-7846(eISSN)
대한척추외과학회 (Korean Society of Spine Surgery)
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Biomechanical Study of Posterior Pelvic Fixations in Vertically Unstable Sacral Fractures: An Alternative to Triangular Osteosynthesis

  • Chaiyamongkol, Weera (Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University) ;
  • Kritsaneephaiboon, Apipop (Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University) ;
  • Bintachitt, Piyawat (Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University) ;
  • Suwannaphisit, Sitthiphong (Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University) ;
  • Tangtrakulwanich, Boonsin (Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University)
  • 투고 : 2018.01.25
  • 심사 : 2018.05.22
  • 발행 : 2018.12.31
⟨ 이전 논문 다음 논문 ⟩

초록

Study Design: Biomechanical study. Purpose: To investigate the relative stiffness of a new posterior pelvic fixation for unstable vertical fractures of the sacrum. Overview of Literature: The reported operative fixation techniques for vertical sacral fractures include iliosacral screw, sacral bar fixations, transiliac plating, and local plate osteosynthesis. Clinical as well as biomechanical studies have demonstrated that these conventional techniques are insufficient to stabilize the vertically unstable sacral fractures. Methods: To simulate a vertically unstable fractured sacrum, 12 synthetic pelvic models were prepared. In each model, a 5-mm gap was created through the left transforaminal zone (Denis zone II). The pubic symphysis was completely separated and then stabilized using a 3.5-mm reconstruction plate. Four each of the unstable pelvic models were then fixed with two iliosacral screws, a tension band plate, or a transiliac fixation plus one iliosacral screw. The left hemipelvis of these specimens was docked to a rigid base plate and loaded on an S1 endplate by using the Zwick Roell z010 material testing machine. Then, the vertical displacement and coronal tilt of the right hemipelves and the applied force were measured. Results: The transiliac fixation plus one iliosacral screw constructions could withstand a force at 5 mm of vertical displacement greater than the two iliosacral screw constructions (p=0.012) and the tension band plate constructions (p=0.003). The tension band plate constructions could withstand a force at $5^{\circ}$ of coronal tilt less than the two iliosacral screw constructions (p=0.027) and the transiliac fixation plus one iliosacral screw constructions (p=0.049). Conclusions: This study proposes the use of transiliac fixation in addition to an iliosacral screw to stabilize vertically unstable sacral fractures. Our biomechanical data demonstrated the superiority of adding transiliac fixation to withstand vertical displacement forces.

키워드

참고문헌

  1. Routt ML Jr, Kregor PJ, Simonian PT, Mayo KA. Early results of percutaneous iliosacral screws placed with the patient in the supine position. J Orthop Trauma 1995;9:207-14. https://doi.org/10.1097/00005131-199506000-00005
  2. Ebraheim NA, Coombs R, Hoeflinger MJ, Zeman C, Jackson WT. Anatomical and radiological considerations in compressive bar technique for posterior pelvic disruptions. J Orthop Trauma 1991;5:434-8. https://doi.org/10.1097/00005131-199112000-00008
  3. Albert MJ, Miller ME, MacNaughton M, Hutton WC. Posterior pelvic fixation using a transiliac 4.5-mm reconstruction plate: a clinical and biomechanical study. J Orthop Trauma 1993;7:226-32. https://doi.org/10.1097/00005131-199306000-00005
  4. Pohlemann T, Angst M, Schneider E, Ganz R, Tscherne H. Fixation of transforaminal sacrum fractures: a biomechanical study. J Orthop Trauma 1993;7:107-17. https://doi.org/10.1097/00005131-199304000-00002
  5. Keating JF, Werier J, Blachut P, Broekhuyse H, Meek RN, O'Brien PJ. Early fixation of the vertically unstable pelvis: the role of iliosacral screw fixation of the posterior lesion. J Orthop Trauma 1999;13:107-13. https://doi.org/10.1097/00005131-199902000-00007
  6. Griffin DR, Starr AJ, Reinert CM, Jones AL, Whitlock S. Vertically unstable pelvic fractures fixed with percutaneous iliosacral screws: does posterior injury pattern predict fixation failure? J Orthop Trauma 2003;17:399-405. https://doi.org/10.1097/00005131-200307000-00001
  7. Schildhauer TA, Ledoux WR, Chapman JR, Henley MB, Tencer AF, Routt ML Jr. Triangular osteosynthesis and iliosacral screw fixation for unstable sacral fractures: a cadaveric and biomechanical evaluation under cyclic loads. J Orthop Trauma 2003;17:22-31. https://doi.org/10.1097/00005131-200301000-00004
  8. Papakostidis C, Kanakaris NK, Kontakis G, Giannoudis PV. Pelvic ring disruptions: treatment modalities and analysis of outcomes. Int Orthop 2009;33:329-38. https://doi.org/10.1007/s00264-008-0555-6
  9. Kach K, Trentz O. Distraction spondylodesis of the sacrum in “vertical shear lesions” of the pelvis. Unfallchirurg 1994;97:28-38.
  10. Denis F, Davis S, Comfort T. Sacral fractures: an important problem: retrospective analysis of 236 cases. Clin Orthop Relat Res 1988;227:67-81.
  11. Schildhauer TA, Josten Ch, Muhr G. Triangular osteosynthesis of vertically unstable sacrum fractures: a new concept allowing early weight-bearing. J Orthop Trauma 2006;20(1 Suppl):S44-51.
  12. Mouhsine E, Wettstein M, Schizas C, et al. Modified triangular posterior osteosynthesis of unstable sacrum fracture. Eur Spine J 2006;15:857-63. https://doi.org/10.1007/s00586-004-0858-2
  13. Sagi HC. Technical aspects and recommended treatment algorithms in triangular osteosynthesis and spinopelvic fixation for vertical shear transforaminal sacral fractures. J Orthop Trauma 2009;23:354-60. https://doi.org/10.1097/BOT.0b013e3181a1143a
  14. Sagi HC, Militano U, Caron T, Lindvall E. A comprehensive analysis with minimum 1-year follow-up of vertically unstable transforaminal sacral fractures treated with triangular osteosynthesis. J Orthop Trauma 2009;23:313-9. https://doi.org/10.1097/BOT.0b013e3181a32b91
  15. Hao Z, Wan C, Gao X, Ji T. The effect of boundary condition on the biomechanics of a human pelvic joint under an axial compressive load: a threedimensional finite element model. J Biomech Eng 2011;133:101006. https://doi.org/10.1115/1.4005223
  16. Miller AN, Routt ML Jr. Variations in sacral morphology and implications for iliosacral screw fixation. J Am Acad Orthop Surg 2012;20:8-16. https://doi.org/10.5435/JAAOS-20-01-008
  17. Templeman D, Schmidt A, Freese J, Weisman I. Proximity of iliosacral screws to neurovascular structures after internal fixation. Clin Orthop Relat Res 1996;(329):194-8.
  18. Ebraheim NA, Xu R, Biyani A, Nadaud MC. Morphologic considerations of the first sacral pedicle for iliosacral screw placement. Spine (Phila Pa 1976) 1997;22:841-6. https://doi.org/10.1097/00007632-199704150-00002
  19. Vaccaro AR, Kim DH, Brodke DS, et al. Diagnosis and management of sacral spine fractures. Instr Course Lect 2004;53:375-85.
  20. Hu X, Pei F, Wang G, He J, Kong Q, Tu C. Application triangular osteosynthesis for vertical unstable sacral fractures. Eur Spine J 2013;22:503-9. https://doi.org/10.1007/s00586-012-2561-z
  21. Bents RT, France JC, Glover JM, Kaylor KL. Traumatic spondylopelvic dissociation: a case report and literature review. Spine (Phila Pa 1976) 1996;21:1814-9. https://doi.org/10.1097/00007632-199608010-00020
  22. Sullivan MP, Smith HE, Schuster JM, Donegan D, Mehta S, Ahn J. Spondylopelvic dissociation. Orthop Clin North Am 2014;45:65-75. https://doi.org/10.1016/j.ocl.2013.08.002
  23. Park YS, Baek SW, Kim HS, Park KC. Management of sacral fractures associated with spinal or pelvic ring injury. J Trauma Acute Care Surg 2012;73:239-42. https://doi.org/10.1097/TA.0b013e31825a79d2
  24. Chong AC, Miller F, Buxton M, Friis EA. Fracture toughness and fatigue crack propagation rate of short fiber reinforced epoxy composites for analogue cortical bone. J Biomech Eng 2007;129:487-93. https://doi.org/10.1115/1.2746369
  25. Heiner AD. Structural properties of fourth-generation composite femurs and tibias. J Biomech 2008;41:3282-4. https://doi.org/10.1016/j.jbiomech.2008.08.013

피인용 문헌

  1. Triangular Osteosynthesis Using an S1 Pedicle Screw and S2 Alar Iliac Screw for a Unilateral Vertically Displaced Sacral Fracture vol.142, pp.None, 2018, https://doi.org/10.1016/j.wneu.2020.06.161