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

骨盆环损伤是严重的损伤，通常需要手术固定骨盆环。改良的Stoppa入路是骨盆前环的一种著名的手术入路。该入路与相关的软组织损伤有关，因为为了更好地显示骨性结构，腹壁肌肉必须与耻骨支部分分离。与入路相关的并发症发生率高达20%。从其他外科学科来看，微创入路能够显著减少入路相关并发症。骨盆前环最稳定的接骨技术是钢板接骨术。然而，这需要一种开放的外科手术方法。最近，我们开发和提出了一种内窥镜下耻骨联合入路(EASY)，并用内窥镜钢板内固定器对第一例耻骨联合断裂的患者进行了手术。骨盆前环最广泛使用的微创稳定技术是外固定器，通常在急诊情况下使用。其他治疗耻骨联合慢性不稳定的微创稳定技术已被描述为病例报告。这些技术包括使用缝线锚的动态稳定，它们是从关节镜下的肩或膝关节手术中得知的，例如肩袖修复或前交叉韧带修复。然而，目前还没有关于这些技术在耻骨联合急性损伤中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固定技术的生物力学稳定性。其中四项是微创技术，并与黄金标准钢板接骨术进行了比较。将测试以下技术：1.钢板接骨术，2.外固定器，3.内固定器，4.缝合扣法，5.缝合桥接法。研究将在骨盆骨模型(锯骨)中进行，并经过生物力学测试验证。除了静态试验来评估最大负荷，特别是动态循环试验，还计划模拟人类行走六周。测量了在各自的测试周期后联合的最大位移量。

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.