Different configurations of anterior double-plate fixation in types B and C of sacroiliac joint dislocation: a finite element analysis

doi:10.3969/j.issn.2095-4344.3778

Abstract

Abstract: BACKGROUND: High-energy violence can lead to instability of pelvic ring structure. The primary purpose of surgical treatment of pelvic injury is to restore the continuity and stability of posterior pelvic ring as much as possible. To obtain anatomical reduction, anterior plate fixation can be used to maintain the stability of posterior pelvic ring.
OBJECTIVE: To investigate the correlation between the configuration of anterior double-plate fixation and the biomechanical stability and to find the optimal configuration for anterior double-plate fixation for the treatment of type B and type C sacroiliac dislocation.
METHODS: A three-dimensional finite element model of the intact pelvic ring was established and validated. Then type B and type C sacroiliac dislocation models were constructed based on the intact pelvic model. Seven kinds of anterior plates with different angular orientation from 0° to 90° were implanted in two types of ipsilateral dislocated pelvic modes. The stability of models of sacroiliac joint dislocation fixed with different anterior plate configurations was recorded and analyzed.
RESULTS AND CONCLUSION: (1) For type B and C sacroiliac joint dislocation, the maximal translation was 0.96 mm and 0.92 in 0°-fixation models. The minimum translation occurred in 75°-fixation model of 0.18 mm. (2) The maximal flexion was also found in 0°-fixation model of 2.05° in type B and of 1.9° in type C dislocation, and the minimum flexion existed in 60°-fixation model of 0.06°. (3) As for lateral bending, the minimal lateral bending occurred in 30°-fixation model of 0.01° in type B dislocation and in 45°-fixation model with the value of 0.11° in type C dislocation. (4) It is concluded that the angle of anterior double-plate fixation ranging from 45° to 75° demonstrated superior stability in both types B and C sacroiliac dislocation.

Key words: bone, pelvic ring, sacroiliac joint, dislocation, double plate, internal fixation, biomechanics, finite element analysi

CLC Number:

Shu Hui, Huang Xiaowei. Different configurations of anterior double-plate fixation in types B and C of sacroiliac joint dislocation: a finite element analysis[J]. Chinese Journal of Tissue Engineering Research, 2021, 25(12): 1810-1814.

Figures/Tables 2

2.2 B型和C型骶髂关节脱位模型对骶骨终板施加垂直载荷，会产生骶骨向下的平移位移量、屈曲成角和侧弯成角。对于B型骶髂关节脱位，在0°固定模型中，最大向下平移量最大为0.96 mm，如表2所示。而75°成角的固定模型，其向下的平移量最小为0.18 mm；但是值得注意的是，在15°，45°，60和90°的固定模型中，向下平移量相差不大。B型骶髂关节脱位中，最大的屈曲成角为2.05°，也出现在0°固定模型中；最小屈曲成角为0.06°，出现在60°固定模型中。通过分析结果可以发现，当夹角偏离60°时，屈曲成角增大。侧弯成角在0°固定模型中最大，为0.18°；在30°固定模型中最小，为0.01°；而在0°，15°和60°成角的双钢板前路固定模型中，侧弯成角相似。对于C型骶髂关节脱位，前路双钢板0°成角(平行)固定模型的向下平移量最大，为0.92 mm；而最小的向下平移量存在于75°成角固定的模型中，其值为0.18 mm；而45°，60°和90°成角固定的模型，它们的向下平移量差不多。对于屈曲角度，最大的屈曲成角出现在0°固定模型中，最大屈曲成角为1.9°；最小的屈曲成角出现在60°固定模型中，为0.06°。与B型骶髂关节脱位相比较，钢板角度与屈曲角度的相关性也有相似的趋势。最大的侧弯成角出现在15°固定的模型中，其值为0.31°；而45°固定模型中，侧弯成角最小，为0.11°。 2.3 B型和C型骶髂关节脱位类型的位移情况比较从结果可以看出，两种不同类型的骶髂关节脱位在向下平移和屈曲成角方面差异无显著性意义。而当前路钢板的成角不变时，B型骶髂关节脱位模型的侧弯成角明显低于C型骶髂关节脱位模型的侧弯成角(P=0.018，wilcoxn signed-rank检验)。 2.4 临床实践的最佳选择前路双钢板夹角在45°-75°范围内，B型和C型骶髂关节脱位均表现出较好的生物力学稳定性，尤其是在向下位移、屈曲成角等方面表现出较小的数值。45°和60°前路钢板固定模型的屈曲成角分别为0.08°和0.06°，明显低于其他双钢板前路固定。75°固定的向下移位在两种类型的脱位中都是最小的。 "

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