Sažetak
Uvod/Cilj. Broj slučajeva povrede karlice je u porastu na globalnom nivou, najviše zbog saobraćajnih nezgoda, ali i zbog sve većeg broja sportsko-rekreativnih povreda. Nestabilna povreda karlice tipa C po Tile-u (Tile C-type unstable pelvic trauma-TCUPT) je povreda koja se dešava tokom saobraćajnih nezgoda ili prilikom pada sa velike visine. Cilj rada bio je da se ispita primena sistema unutrašnje fiksacije (internal fixation-INFIX) za prednji karlični prsten (anterior pelvic ring-APR) uz istovremenu primenu INFIX zadnjeg karličnog prstena (posterior pelvic ring-PPR) primenom sakroilijačnog zavrtnja (sacroiliac screw-SS) (INFIX PPR SS) kod TCUPT. Metode. Ispitanici (ukupno 89) selektovani su među bolesnicima sa TCUPT u periodu od decembra 2020. do decembra 2023. godine. Izvršena je retrospektivna analiza podataka ispitanika, nakon čega su ispitanici podeljeni na dve grupe na osnovu različitih terapijskih protokola kojima su podvrgnuti: grupa A (INFIX sistem za APR + INFIX PPR SS, n = 46) i grupa B (spoljni fiksator za APR + INFIX PPR SS, n = 43). Rezultati. U poređenju sa grupom B, grupa A imala je kraće vreme: do početka prve aktivnosti nakon operacije, zarastanja preloma i oporavka funkcije zgloba, kao i kraću dužinu boravka u bolnici (t = 6,623, 4,796, 7,992 i 5,227, redom, p < 0,05). Nije bilo značajne razlike između dve grupe po pitanju dužine trajanja operacije i obima krvarenja (t = 1,433, 1,123, redom, p > 0,05). Rezultati redukcije preloma bili su bolji u grupi A nego u grupi B (Z = 2,058, p < 0,05). Stopa incidencije komplikacija bila je niža u grupi A nego u grupi B (2,17% vs. 18,60%) (χ2 = 4,917; p < 0,05). Zaključak. Kod bolesnika sa TCUPT, primenom INFIX sistema za APR sa istovremenom primenom INFIX PRR SS, postižu se dobri rezultati redukcije preloma.
Ključne reči
prelomi, fiksacija, unutrašnja;
prelom, otvorena redukcija;
karlične kosti;
ortopedske procedure;
lečenje, ishod
Reference
Abo-Elsoud M, Awad MI, Abdel Karim M, Khaled S, Abdel-moneim M. Internal fixator vs external fixator in the manage-ment of unstable pelvic ring injuries: A prospective compara-tive cohort study. World J Orthop 2023; 14(7): 562–71.
Zhu D, Liu D, Song B, Feng W, Zhang X, Wang Q. Therapeutic effect of an external fixator in the treatment of unstable pel-vic fractures in children. Orthop Traumatol Surg Res 2022; 108(6): 103150.
Bagga R, Shetty AP, Kanna RM, Rajasekaran S. INFIX/EXFIX: Innovation managing pelvic fractures in difficult scenarios. J Postgrad Med 2019; 65(3): 177–80.
Bajada S, Mohanty K. Psychometric properties including relia-bility, validity and responsiveness of the Majeed pelvic score in patients with chronic sacroiliac joint pain. Eur Spine J 2016; 25(6): 1939–44.
Barrientos-Mendoza C, Brañes J, Wulf R, Kremer A, Barahona M, León S. The role of anterior supra-acetabular external fixator as definitive treatment for anterior ring fixation in unstable pelvic fractures. Eur J Trauma Emerg Surg 2022; 48(5): 3737–46.
Berk T, Zderic I, Schwarzenberg P, Halvachizadeh S, Teuben M, Richards G, et al. Cerclage augmentation of S1-S2 transsacral screw fixation in osteoporotic posterior pelvis ring injuries: A biomechanical feasibility study. J Orthop Res 2023; 41(12): 2740–8.
Chen T, Bosscher G, Fox D, Arnoldy C, Bleedorn J. Transarticular elastic external skeletal fixator correction of a stifle rotational deformity and patellar luxation in a dog. Vet Surg 2021; 50(2): 455–63.
Dall BE, Eden SV, Cho W, Karkenny A, Brooks DM, Hayward GM 2nd, et al. Biomechanical analysis of motion following sa-croiliac joint fusion using lateral sacroiliac screws with or without lumbosacral instrumented fusion. Clin Biomech (Bris-tol, Avon) 2019; 68: 182–9.
Hack J, Kranz Y, Knauf T, Bäumlein M, Malcherczyk D, Ruchholtz S, et al. Stability of internal versus external fixation in osteo-porotic pelvic fractures - a biomechanical analysis. Injury 2020; 51(11): 2460–4.
Höch A, Zeidler S, Pieroh P, Josten C, Stuby FM, Herath SC. Trends and efficacy of external emergency stabilization of pel-vic ring fractures: results from the German Pelvic Trauma Registry. Eur J Trauma Emerg Surg 2021; 47(2): 523–31.
Horiguchi A, Ojima K, Shinchi M, Hirano Y, Hamamoto K, Ito K, et al. Usefulness of a high-speed surgical air drill in pubectomy during delayed anastomotic urethroplasty for pelvic fracture urethral injury. Int J Urol 2020; 27(11): 1002–7.
Janati A, Amir-Behghadami M, Arab-Zozani M. Letter to the ed-itor on the article "Cement augmentation of sacroiliac screws in fragility fractures of the pelvic ring-A synopsis and system-atic review of the current literature". Injury 2020; 51(4): 1138–9.
König A, Oberkircher L, Beeres FJP, Babst R, Ruchholtz S, Link BC. Cement augmentation of sacroiliac screws in fragility frac-tures of the pelvic ring-A synopsis and systematic review of the current literature. Injury 2019; 50(8): 1411–7.
Rega PP, Fink B. Optimising pelvic fracture stabilisation in obese victims. BMJ Mil Health 2020; 166(3): 202.
Rommens PM, Graafen M, Arand C, Mehling I, Hofmann A, Wagner D. Minimal-invasive stabilization of anterior pelvic ring fractures with retrograde transpubic screws. Injury 2020; 51(2): 340–6.
Schmal H, Larsen MS, Stuby F, Strohm PC, Reising K, Goodwin Burri K. Effectiveness and complications of primary C-clamp stabilization or external fixation for unstable pelvic fractures. Injury 2019; 50(11): 1959–65.
Stewart RG, Hammer N, Kieser DC. External fixation of unsta-ble pelvic fractures: a systematic review and meta-analysis. ANZ J Surg 2019; 89(9): 1022–7.
Tang J, Shi Z, Hu J, Wu H, Yang C, Le G, et al. Optimal se-quence of surgical procedures for hemodynamically unstable patients with pelvic fracture: A network meta-analysis. Am J Emerg Med 2019; 37(4): 571–8.
Tu P, Wang H, Joskowicz L, Chen X. A multi-view interactive virtual-physical registration method for mixed reality based surgical navigation in pelvic and acetabular fracture fixation. Int J Comput Assist Radiol Surg 2023; 18(9): 1715–24.
Vaidya R, Blue K, Oliphant B, Tonnos F. Combined Pelvic Ring Disruption and Acetabular Fracture: Outcomes Using a Se-quential Reduction Protocol and an Anterior Subcutaneous Pelvic Fixator (INFIX). J Orthop Trauma 2019; 33 Suppl 2: S66–71.
Venayre B, Koyama Y, Kurosawa D, Hammer N, Lingslebe U, Mu-rakami E, et al. Quantitative evaluation of the sacroiliac joint fixation in stress reduction on both sacroiliac joint cartilage and ligaments: A finite element analysis. Clin Biomech (Bris-tol, Avon) 2021; 85: 105350.
Yimin W, Jingtao L, Lei H, Lihai Z. Analysis and multiple in-dex evaluation of SPO distribution of bone traction needles for pelvic fracture reduction. Med Eng Phys 2023; 119: 104031.