Bilateral sakroiliak çıkıkların transiliak kilitli plak ile internal tespiti: Pelvis modellerinde biyomekanik çalışma

Öz

Amaç: Çalışmanın amacı, bilateral sakroiliak çıkıklarda yeni bir iliosakral tespit yönteminin (transiliak kilitli plak üstünden bilateral S1 pedikül tespiti) mekanik özelliklerini analiz etmek ve bunu daha önceden tanımlanmış diğer teknikler ile karşılaştırmaktı. Çalışma planı: Yirmi bir adet pelvik modelde bilateral sakroiliak çıkık oluşturuldu ve modeller üç farklı tespit yöntemi grubuna ayrıldı. Grup 1’de 3.5 mm’lik kilitli plak ile posterior gergi bandı plaklama yöntemiyle uygun delikler üstünden 3.5 mm’lik sabit açılı kilitli vidalar ile bilateral S1 pedikül tespiti yapıldı. Grup 2’de 3.5 mm’lik kilitli plak ile posterior gergi bandı yöntemi ile kombine edilmiş bilateral spongiöz iliosakral vida tespiti, Grup 3’te ise yalnızca bilateral iliosakral spongiöz vida tespiti gerçekleştirildi. Yetmezlik oluşturan nihai kuvvet miktarları ve 10 mm yer değiştirmeye yol açan kuvvet miktarları saptanarak, üç grubun karşılaştırması yapıldı. Bulgular: Üç grup için ortalama yetmezlik oluşturan kuvvet miktarları, sırası ile, 1775, 2084 ve 2230 Newton (N) ve 10 mm yer değiştirmeye yol açan ortalama kuvvet miktarları, sırası ile, 1033, 1884 ve 2013 N olarak bulundu. Grup 2 ve 3’ün en kuvvetli tespit yöntemleri olduğu saptanmasına karşın iki grup arasında istatistiksel anlamlı bir fark bulunmadı (p=0.452). 10 mm yer değiştirmeye yol açan kuvvet miktarları incelendiğinde ise Grup 2 ve 3’ün Grup 1’den daha dayanıklı olduğu belirlendi. Aynı şekilde, Grup 2 ve 3 arasında istatistiksel anlamlı bir fark kaydedilmedi (p=0.397). Çıkarımlar: İliosakral vidalama, posterior gergi bandı üstünden bilateral S1 pedikül vidalamasından daha üstün bir tespit yöntemidir. Bununla birlikte, sakroiliak vida tespiti ile kombine edilmiş gergi bandı plaklama posterior pelvik halka yaralanmalarında stabiliteyi arttırmamaktadır.

Anahtar Kelimeler

• Gergi bandı plakalama; iliosakral vida tespiti; pelvik halka; sakroiliak çıkık.

Internal fixation of bilateral sacroiliac dislocation with transiliac locked plate: a biomechanical study on pelvic models

Abstract

Objective: The purpose of this study was to analyze and compare the mechanical characteristics of a new iliosacral fixation technique (bilateral S1 pedicle fixation through a transiliac locked plate) for bilateral sacroiliac dislocations with other previously described methods.
Methods: Bilateral sacroiliac dislocations were created in 21 pelvic models and divided into three different fixation method groups. Group 1 was fixed using posterior tension band plating with a 3.5 mm locked plate combined with fixed-angle locked 3.5 mm screw fixation of bilateral S1 vertebra pedicles through suitable holes of the plate. Group 2 underwent posterior tension band plating with a 3.5 mm locked plate combined with bilateral spongious iliosacral screw fixation and Group 3 bilateral iliosacral spongious screw fixation alone. The ultimate load to failure and load for 10 mm of displacement for all three groups were compared.
Results: The average loads to failure for Groups 1, 2 and 3 were 1775, 2084 and 2230 N, respectively, and average loads for 10 mm of displacement were 1033, 1884 and 2013 N, respectively. Group 2 and 3 had the strongest fixation constructs although there was no statistically significant difference between these two groups (p=0.452). Group 2 and 3 were superior to Group 1 in terms of loads for 10 mm of displacement. There was no significant difference between Group 2 and 3 in this regard (p=0.397).
Conclusion: Iliosacral screws are superior to bilateral S1 pedicle fixation through posterior tension band plating. However, the combination of tension band plating with iliosacral screw fixation does not improve the stability of the posterior pelvic ring.

Keywords

• Iliosacral screw fixation
• pelvic ring
• sacroiliac dislocation
• tension band plating

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