实验性内环固定器（RingFix）在骨质疏松骨模型上稳定骨盆环损伤的生物力学评价-动脉网

Biomechanical evaluation of an experimental internal ring fixator (RingFix) for stabilization of pelvic ring injuries on an osteoporotic bone model

Nature 等信源发布 2024-09-06 21:38

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AbstractDuring the last decades, effective pain reduction and early mobilization were identified as the central priorities in therapy of insufficiency fractures of the pelvis. For operative treatment minimally-invasive stabilization techniques are favored. While there is consensus on the significance of sufficient dorsal stabilization the role of additional fixation of the anterior fracture component stays under discussion.

摘要在过去的几十年中，有效的疼痛减轻和早期动员被确定为骨盆不全骨折治疗的核心优先事项。对于手术治疗，微创稳定技术受到青睐。虽然对足够的背侧稳定的重要性达成了共识，但前部骨折组件的额外固定的作用仍在讨论中。

Within the present study we developed an internal ring fixator system (RingFix) with the question whether an in-itself-closed construct can improve stability of the entire ring structure. RingFix was evaluated on an osteoporotic bone model with a standardized FFP IIIc fracture within an established biomechanical setup regarding its primary stabilization potential.

。RingFix在骨质疏松骨模型上进行了评估，该模型在已建立的生物力学设置中具有标准化的FFP IIIc骨折，其主要稳定潜力。

Further, it was compared to transiliac–transsacral screw fixation with and without stabilization of the anterior fracture component. The transiliac–transsacral fixation with separate screw fixation of the anterior fracture showed significantly higher stability than the RingFix and the transiliac–transsacral screw fixation without anterior stabilization.

此外，将其与经髂骨-经骶骨螺钉固定进行了比较，无论是否稳定前骨折组件。经髂-经骶骨固定与前骨折的单独螺钉固定相比，稳定性显着高于RingFix和经髂-经骶骨螺钉固定而无前稳定。

Our results show that stabilization of the anterior fracture component relevantly improves the stability of the entire ring construct. As a bridging stabilizer, RingFix shows biomechanical advantages over an isolated dorsal fracture fixation, but inferior results than direct stabilization of the single fracture components..

我们的研究结果表明，前骨折组件的稳定相对提高了整个环结构的稳定性。作为桥接稳定器，RingFix在生物力学上优于孤立的背侧骨折固定，但效果不如直接稳定单个骨折组件。。

IntroductionThe observed increasing incidence of fragility fractures of the pelvis (FFP) led to a special interest in these pathologies over the last decade and opened a wide field of research1,2. With the successful implementation of specific classification systems, treatment recommendations and algorithms were contrived3,4,5.

引言在过去的十年中，观察到骨盆脆性骨折（FFP）发病率的增加引起了人们对这些病理学的特别兴趣，并开辟了广泛的研究领域1,2。随着特定分类系统的成功实施，提出了治疗建议和算法3,4,5。

The central objective in treatment of affected, typically frail patients is a sufficient pain control to allow for early remobilization. Analgesic therapy and physiotherapeutic mobilization is regarded as the primary therapy in isolated anterior (FFP I) and non-displaced posterior fractures (FFP II)3.

治疗受影响的，通常身体虚弱的患者的中心目标是足够的疼痛控制，以允许早期再活动。。

In patients with posteriorly displaced fractures (FFP III and FFP IV) or with prolonged pain and thereof immobilization, surgical treatment is recommended6. The objective of surgical intervention in those patients is not an anatomical reduction but a stable in-situ fixation to achieve sufficient pain control and to allow for immediate postoperative remobilization of the patient.

对于后移位骨折（FFP III和FFP IV）或长期疼痛及其固定的患者，建议进行手术治疗6。对这些患者进行手术干预的目的不是解剖复位，而是稳定的原位固定，以实现足够的疼痛控制并允许患者术后立即再活动。

Further, the surgical therapy should be as minimally-invasive as possible to minimize surgically-related complications in this fragile patient group with commonly reduced bone quality. While there is consensus about the necessity of a stable fixation of the posterior pelvic ring, discussion remains controversial about indications and methods for stabilization of the anterior fracture part.For minimal-invasive stabilization of the posterior pelvic ring in FFP, different percutaneous (trans-) iliosacral7,8,9,10,11,12,13 and transiliac internal fixation techniques14,15 are described.

此外，手术治疗应尽可能微创，以尽量减少这种骨质量通常降低的脆弱患者组的手术相关并发症。虽然关于骨盆后环稳定固定的必要性已达成共识，但关于稳定前骨折部分的适应症和方法的讨论仍存在争议。为了微创稳定FFP中的后盆腔环，描述了不同的经皮（经）髂骶7,8,9,10,11,12,13和经髂内固定技术14,15。

The anterior fracture component is often left without fixation2,16. However, the placement of an internal17,18 or external fixator19, percutaneous screw fixation of the superior pubic ramus16,20,21.

前部骨折组件通常没有固定2,16。。

(1)

An in-itself closed internal ring fixator construct (RingFix) does not show any advantages over in-situ stabilization of the posterior and anterior fracture components of an unstable FFP type.

与不稳定FFP类型的前后骨折组件的原位稳定相比，本身封闭的内固定器构建体（RingFix）没有任何优势。

(2)

Fixation of the anterior fracture significantly improves the stability of the entire pelvic ring construct.

。

Data availability

数据可用性

Raw data were generated at University Medical Center of Johannes Gutenberg University Mainz, Germany. Derived data supporting the findings of this study are available from the corresponding author [C.A.] on request.

。支持本研究结果的衍生数据可应要求从通讯作者[C.A.）处获得。

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Arduini，M.，Saturnino，L.，Piperno，A.，Iundusi，R。＆Tarantino，U。骨盆脆性骨折：治疗和初步结果。老年临床。Exp.Res.27（补充1），S61–S67（2015）。文章

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Arand, C. et al. Anatomical evaluation of the transpubic screw corridor based on a 3D statistical model of the pelvic ring. Sci. Rep. 11(1), 16677 (2021).Article

Arand，C.等人。基于骨盆环3D统计模型的经骨盆螺钉通道的解剖学评估。Sci。代表11（1），16677（2021）。文章

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Download referencesAcknowledgementsParts of the present study are also part of the doctoral thesis of Christian Hartung.FundingOpen Access funding enabled and organized by Projekt DEAL. Funding statement was provided by Mainzer Trauma-Stiftung (Grant No. 2018-01).Author informationAuthors and AffiliationsDepartment of Orthopaedics and Traumatology, University Medical Center, Langenbeckstraße 1, 55131, Mainz, GermanyCharlotte Arand, Christian Hartung, Dorothea Mehler, Erol Gercek, Jochen Wollstädter & Pol M.

下载参考文献致谢本研究的部分内容也是Christian Hartung博士论文的一部分。资金开放获取资金由Projekt交易启用和组织。资金声明由Mainzer Trauma Stiftung提供（批准号2018-01）。作者信息作者和附属机构大学医学中心骨科和创伤科，Langenbeckstraße 155131，美因茨，GermanyCharlotte Arand，Christian Hartung，Dorothea Mehler，Erol Gercek，Jochen Wollstädter＆Pol M。

RommensDepartement of Orthopedics and Tramatology, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, SwitzerlandDaniel WagnerAuthorsCharlotte ArandView author publicationsYou can also search for this author in.

洛桑大学医院骨科和骨科RommensDepartment of Orthopedics and Tramatology，Rue du Bugnon 461011，Lausanne，SwitzerlandDaniel WagnerAuthorsCharlotte ArandView author Publications您也可以在中搜索这位作者。

PubMed Google ScholarChristian HartungView author publicationsYou can also search for this author in

PubMed Google ScholarChristian HartungView作者出版物您也可以在

PubMed Google ScholarDorothea MehlerView author publicationsYou can also search for this author in

PubMed Google ScholarDorothea MehlerView作者出版物您也可以在

PubMed Google ScholarErol GercekView author publicationsYou can also search for this author in

PubMed Google ScholarErol GercekView作者出版物您也可以在

PubMed Google ScholarJochen WollstädterView author publicationsYou can also search for this author in

PubMed巧克力谷歌奖学金Jochen Wollstädter查看作者出版物您也可以在

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PubMed Google ScholarContributionsC.A. designed and prepared the study, conducted testing, evaluated and analyzed data and wrote the manuscript. C.H. conducted testing and revised the manuscript. D.M. conducted testing and revised the manuscript. E.G. revised the manuscript. J.W.

PubMed谷歌学术贡献中心。A、设计和准备研究，进行测试，评估和分析数据并撰写手稿。C、 H.进行了测试并修改了手稿。D、 M.进行了测试并修改了手稿。E、 G.修改了手稿。J、 W。

evaluated and analyzed data statistically and revised the manuscript. D.W. designed and prepared the study, revised the manuscript. P.M.R. designed and prepared the study, revised the manuscript.Corresponding authorCorrespondence to.

。D、 W.设计并准备了这项研究，修改了手稿。P、 M.R.设计并准备了这项研究，修改了手稿。对应作者对应。

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Reprints and permissionsAbout this articleCite this articleArand, C., Hartung, C., Mehler, D. et al. Biomechanical evaluation of an experimental internal ring fixator (RingFix) for stabilization of pelvic ring injuries on an osteoporotic bone model.

转载和许可本文引用本文Arand，C.，Hartung，C.，Mehler，D。等人。用于稳定骨质疏松骨模型骨盆环损伤的实验性内环固定器（RingFix）的生物力学评估。

Sci Rep 14, 20823 (2024). https://doi.org/10.1038/s41598-024-71138-3Download citationReceived: 28 February 2024Accepted: 26 August 2024Published: 06 September 2024DOI: https://doi.org/10.1038/s41598-024-71138-3Share this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard.

《科学报告》1420823（2024）。https://doi.org/10.1038/s41598-024-71138-3Download引文接收日期：2024年2月28日接受日期：2024年8月26日发布日期：2024年9月6日OI：https://doi.org/10.1038/s41598-024-71138-3Share本文与您共享以下链接的任何人都可以阅读此内容：获取可共享链接对不起，本文目前没有可共享的链接。复制到剪贴板。

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KeywordsPelvic ring fractureInsufficiency fractureRing fixatorMinimally-invasive fracture fixation

关键词骨盆环骨折功能不全骨折环固定器终末侵袭性骨折固定

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BoneFracture repairTrauma

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