三种骶髂螺钉固定方式治疗单侧TileC型骶骨骨折的稳定性比较

Comparison of stability of sacroiliac screws in the treatment for unilateral Tile C sacral fracturesbetween different modalities in a 3-dimensional finite element model

目的对使用骶髂螺钉固定单侧TileC型骶骨骨折的稳定性进行比较性研究，从而为急诊快速螺钉置入方案的制定提供预案和参考。方法使用三维有限元方法，建立TileC型骨盆损伤（右侧骶骨纵行骨折）模型，模拟使用3种骶髂螺钉固定方式进行固定，并在模拟站立位状态下对骨盆后环的竖直稳定性和后旋稳定性进行量化和比较。结果S1、S2双层面2枚骶髂螺钉固定组合的稳定性明显优于S1或S2的单层面1枚骶髂螺钉；在S2层面1枚骶髂螺钉固定的稳定性优于S1层面。结论针对TileC型骨盆损伤的单侧骶骨纵行骨折，要尽可能选择双层面骶髂螺钉固定；如果使用单层面单枚骶髂螺钉固定治疗该类骶骨骨折，最好选择S2层面。

Objective To study the stability of sacroiliac screws fixation for the treatment of unilateral vertical sacral fractures in order to provide pratical manipulation and reference for rapid insertion of sacroiliac screws in case of emergency. Methods A 3-dimensional finite element model of Tile C pelvic ring injury （ unilateral type Denis Ⅱ fracture of sacrum） was made in a 36 year of a female patient. The unilateral sacral fractures were fixed in 3 types with sacroiliac screws in models respectively. The shift and angle displacement of the central superior surface of sacrum in the case of upright standing on both feet were measured and compared. Results The stability fixation with two sacroiliac screws for double planes of S1 and S2 segments was markedly superior to fixation with one sacroiliac screw for single plane of S1 or S2 segment; The vertical and rotational stability of sacroiliac screw fixation in S2 was superior to that in S1. Conclusions Fixation with two sacroiliac screws for double planes of S1 and S2 segments should be utilized for the fixation in unilateral sacral fractures of Tile C pelvic ring injury as possible. If only one sacroiliac screw is implanted, the fixation in S2 segment is more recommended than that in S1.