Endoscopic treatment of injuries of the anterior pelvic ring: biomechanical comparison of five different endoscopic stabilization techniques

内镜治疗骨盆前环损伤：五种不同内镜稳定技术的生物力学比较

• 批准号: 446641912
• 负责人: Privatdozent Dr. Markus Küper
• 金额: --
• 依托单位: Julius Wolff Institut für Biomechanik und Muskuloskeletale Regeneration (CVK)
• 依托单位国家: 德国
• 项目类别: Research Grants
• 财政年份: 2020
• 资助国家: 德国
• 起止时间: 2019-12-31 至 2022-12-31
• 项目状态: 已结题
• 来源: https://gepris.dfg.de/gepris/projekt/446641912?language=en
• 关键词: Endoscopic; treatment; injuries; anterior; pelvic

Injuries of the pelvic ring are severe injuries which usually need an operative stabilization of the pelvic ring. A well known surgical approach to the anterior pelvic ring is the modified Stoppa approach. This approach is associated with a relevant trauma of the soft tissue, as for a good visualization of the bony structures the abdominal wall muscles must be partially detached from the pubic rami. Approach-related complications occur with a frequency of as high as 20%. From other surgical disciplines it is known that minimally invasive approaches are able to reduce the approach related complications significantly.The most stable osteosynthesis technique of the anterior pelvic ring is the plate osteosynthesis. However, this requires an open surgical approach. Recently, we developed and presented an endoscopic approach to the symphysis (EASY) and operated the first patients with a ruptured pubic symphysis with an endoscopic plate osteosynthesis.The most widely used minimally invasive stabilization technique of the anterior pelvic ring is the external fixator, which is usually applied in the emergency setting. Other minimally invasive stabilization techniques for chronic instabilities of the pubic symphysis have been described as case reports. These techniques include dynamic stabilizations using suture anchors and they are know from arthroscopic shoulder or knee surgery, e.g. the rotator cuff repair or ACL-repair. However, there are no data available regarding biomechanical stability of these techniques in acute injuries of the pubic symphysis.Aim of this project is the comparison of five different stabilization techniques for the pubic symphysis regarding biomechanical stability. Four of them are minimally-invasive techniques and they are compared to the gold standard plate osteosynthesis. The following techniques will be tested: 1. plate osteosynthesis, 2. external fixator, 3. internal fixator, 4. suture-button-technique, 5. suture-bridge-technique. The investigations will be performed in pelvic bone models (Sawbone), validated for biomechanical testings. Beside static tests to evaluate the maximum load, especially dynamic cyclic tests are planned to simulate human walking for six weeks. The maximum dislocation of the symphysis after the respective test cycle is measured.

骨盆环损伤是一种严重的损伤，通常需要手术稳定骨盆环。一种众所周知的骨盆前环手术入路是改良的Stoppa入路。这种入路与软组织的相关创伤有关，因为为了更好地观察骨结构，腹壁肌肉必须与耻骨支部分分离。入路相关并发症的发生率高达20%。从其他外科学科中，我们知道微创入路能够显著减少入路相关并发症。骨盆前环最稳定的植骨技术是钢板植骨。然而，这需要开腹手术。最近，我们发展并提出了一种内窥镜下联合入路（EASY），并对第一例耻骨联合破裂的患者进行了内窥镜钢板固定术。目前应用最广泛的盆腔前环微创固定技术是外固定架，通常用于急诊。其他治疗耻骨联合慢性不稳定的微创稳定技术也有病例报道。这些技术包括使用缝线锚钉的动态稳定，它们在关节镜下的肩关节或膝关节手术中众所周知，例如肩袖修复或acl修复。然而，没有关于这些技术在急性耻骨联合损伤中的生物力学稳定性的数据。本项目的目的是比较五种不同的耻骨联合稳定技术对生物力学稳定性的影响。其中四种是微创技术，它们与金标准钢板接骨术相比较。以下技术将被测试：2.钢板内固定；3.外固定架；内固定器，4。suture-button-technique 5。suture-bridge-technique。研究将在骨盆骨模型（Sawbone）中进行，并进行生物力学测试验证。除了评估最大负荷的静态试验外，还计划进行为期六周的模拟人类行走的动态循环试验。测量各自测试周期后联合的最大脱位。