后路单钉棒治疗骶髂关节脱位的生物力学特性及其有效性

背景:目前骶髂螺钉广泛应用于治疗骶髂关节脱位,但是生物力学性能较差,不能达到坚强内固定。目的:探讨应用单钉棒治疗骶髂关节脱位的力学强度及临床疗效。方法:①取成年防腐标本12具,男女各半,分别切断骶髂关节韧带及耻骨联合结构,制作骶髂关节脱位、耻骨联合分离模型,将标本随机等分为骶髂螺钉固定组和骨盆后路单钉棒固定组,分别采用骶髂螺钉固定和骨盆后路单钉棒固定方法固定。②设定单钉棒系统临床适应证,收集16例骶髂关节脱位患者的临床资料,采用Mears的影像评定标准和骨盆骨折Majeed疗效评分评定固定效果。结果与结论:在相同载荷下,骶髂关节标本后路单钉棒固定组的位移、轴向刚度、极限载荷和屈服载荷均大于骶髂螺钉组(P<0.05)。16例患者随访时间平均为23.2个月(3～45个月)。根据Mears的影像评定标准,固定后解剖复位13例,满意3例。骨盆骨折Majeed疗效评分为60～100分,平均82分;其中C1型骨折的疗效优良率为82%,C2型为80%。提示与骶髂螺钉比较,应用后路单钉棒治疗骶髂关节脱位,其内固定强度更为可靠,临床疗效也更满意。

Biomechanical properties and the effectiveness of posterior nail-rod for the treatment of sacroiliac joint dislocation

BACKGROUND:Sacroiliac screw has been widely used in the treatment of the sacroiliac joint dislocation,but it cannot achieve strong mechanical intensity due to its poor biomechanical properties.OBJECTIVE:To explore the mechanical intensity and clinical efficacy of posterior nail-rod for the treatment of sacroiliac joint dislocation.METHODS:①Twelve cadaveric pelvis specimens,six males and six females,were selected to make the sacroiliac joint dislocation model and pubic symphysis separation model by cutting off the sacroiliac joint ligaments and pubic symphysis structure.Specimens were randomly divided into two groups:iliosacral screw fixation group and pelvis posterior single nail-rod fixation group,specimens in the two groups were fixed with iliosacral screw and pelvis posterior single nail-rod respectively.②The clinical indications of ingle nail-rod system were set up,and the clinical data of 16 sacroiliac joint dislocation patients were collected,Mears image evaluation standard and pelvic fractures Majeed curative effect were used to assess data statistics and score.RESULTS AND CONCLUSION:In the same load,the displacement,axial stiffness,ultimate-load and yield-load of the posterior single nail-rod group were larger than those of iliosacral screw group(P < 0.05).All the 16 patients were followed-up for an average of 23.2 months(3-45 months).According to Mears image standard,there were 13 cases of anatomical replacement,and 3 cases in satisfaction.Pelvic fractures Majeed score was 60 to 100 points,82 points in average;the good rate of C 1 type fracture was 82%,and good rate of C 2 type fracture was 80%.Compared with iliosacral screw fixation,the single nail-rod fixation for the treatment of sacroiliac joint dislocation has reliable strength stiffness and clinical curative effect.