CAJ | 학술논문

目的对使用骶髂螺钉固定双侧骶骨骨折的稳定性进行比较性研究.方法使用三维有限元方法,建立双侧骶骨纵行骨折模型,模拟使用4种骶髂螺钉固定方式进行固定:左右各1枚骶髂螺钉对S1进行固定(S1层面双向固定)、左右各1枚骶髂螺钉对S2进行固定(S2层面双向固定)、左右各1枚骶髂螺钉分别对S2和S1进行固定(双层面单螺钉双向固定)和左右各2枚骶髂螺钉分别对S1和S2进行固定(双层面双螺钉双向固定).使用ABAQUS 6.9.1(美国SIMULIA公司)软件模拟双足站立位状态下自骶骨上表面竖直向下加载600N力载荷,测量S1上表面的中点的下移距离和后旋角度以及髋骨最高点的角位移,按照移位越小稳定性越好的原则对各种固定方式进行比较.结果双层面双螺钉双向固定组合明显优于S1、S2层面双向固定组合,也明显优于双层面单螺钉双向固定组合.在竖直稳定性和外翻稳定性方面,S2层面双向固定下移距离和外翻角度分别为0.531 mm和0.156°(左侧)、0.163°(右侧),优于S1层面双向固定的0.673 mm和0.200°(左侧)、0.232°(右侧)；在后旋稳定性方面,S1层面双向固定的后旋角度为0.269°优于S2层面双向固定的0.287°.另外,双层面单螺钉双向固定的后旋稳定性弱于S1、S2层面双向固定,而其下移距离和外翻角度均介于S1层面双向固定和S2层面双向固定之间.结论针对双侧骶骨纵行骨折,可根据左右两侧的后旋稳定性、竖直稳定性和外翻稳定性的具体情况决定具体的螺钉固定层面；为了使后环的稳定性最大化,最好使用S1和S2双层面双螺钉双向骶髂螺钉的固定组合.
목적 대사용저가라정고정쌍측저골골절적은정성진행비교성연구.방법 사용삼유유한원방법,건립쌍측저골종행골절모형,모의사용4충저가라정고정방식진행고정:좌우각1매저가라정대S1진행고정(S1층면쌍향고정)、좌우각1매저가라정대S2진행고정(S2층면쌍향고정)、좌우각1매저가라정분별대S2화S1진행고정(쌍층면단라정쌍향고정)화좌우각2매저가라정분별대S1화S2진행고정(쌍층면쌍라정쌍향고정).사용ABAQUS 6.9.1(미국SIMULIA공사)연건모의쌍족참립위상태하자저골상표면수직향하가재600N력재하,측량S1상표면적중점적하이거리화후선각도이급관골최고점적각위이,안조이위월소은정성월호적원칙대각충고정방식진행비교.결과 쌍층면쌍라정쌍향고정조합명현우우S1、S2층면쌍향고정조합,야명현우우쌍층면단라정쌍향고정조합.재수직은정성화외번은정성방면,S2층면쌍향고정하이거리화외번각도분별위0.531 mm화0.156°(좌측)、0.163°(우측),우우S1층면쌍향고정적0.673 mm화0.200°(좌측)、0.232°(우측)；재후선은정성방면,S1층면쌍향고정적후선각도위0.269°우우S2층면쌍향고정적0.287°.령외,쌍층면단라정쌍향고정적후선은정성약우S1、S2층면쌍향고정,이기하이거리화외번각도균개우S1층면쌍향고정화S2층면쌍향고정지간.결론 침대쌍측저골종행골절,가근거좌우량측적후선은정성、수직은정성화외번은정성적구체정황결정구체적라정고정층면；위료사후배적은정성최대화,최호사용S1화S2쌍층면쌍라정쌍향저가라정적고정조합.
Objective To compare the stability of sacroiliac screws fixation for the treatment of bilateral vertical sacral fractures to provide reference for clinic application. Methods A finite element model of Tile C pelvic ring injury ( bilateral type Denis Ⅱ fracture of sacrum ) was produced.The bilateral sacral fractures were fixed with sacroiliac screws in 4 types of models respectively: two bidirectional sacroiliac screws fixation in the S1 segment,two bidirectional sacroiliac screws fixation in the S2 segment,one sacroiliac screw fixation in the S1 segment and one sacroiliac screw fixation in the S2 segment,two bidirectional sacroiliae screws fixation in S1 and S2 segments respectively.By the ABAQUS 6.9.1 software,in the case of standing on both feet,600 N vertical load was imitated to be imposed to the superior surface of the sacrum and downward translation and backward angle displacement of the middle part of the sacral superior surface and everted angle displacement of the top of iliac bones were extracted for analysis.The stability of sacroiliac screws fixation was compared according to the principle of the better stability the smaller displacement.Results The stability of 2 bidirectional sacroiliac screws fixation in S1 and S2 segments respectively was markedly superior to that of 2 bidirectional sacroiliac serews fixation in S1 or S2 segment and was also markedly superior to that of one sacroiliac screw fixation in S1 segment and one sacroiliac screw fixation in S2 segment.The vertical and everted stability (the downward translation:0.531 mm; the everted angle displacement:0.156°( left side),0.163°( right side) )of sacroiliac screws fixation in two bidirectional sacroiliac screws fixation in the S2 segment was superior to that of two bidirectional sacroiliac screws fixation in the S1 segment ( the downward translation:0.673 mm ; the everted angle displacement:0.200° ( left side),0.232°(right side) ).The rotational stability of two bidirectional saeroiliac screws fixation in the S1 segment (the backward angle displacement:0.269°) was superior to that of two bidirectional sacroiliac screws fixation in the S2 segment (the backward angle displacement:0.287°). Moreover,the rotational stability of one sacroiliac screw fixation in the S1 segment and one sacroiliac screw fixation in the S2 segment was inferior to that of two bidirectional sacroiliac screws fixation in the S1 segment or two bidirectional sacroiliac screws fixation in the S2 segment,and the vertical and everted stability of one sacroiliac screw fixation in the S1 segment and one sacroiliac screw fixation in the S2 segment was between that of two bidirectional sacroiliac screws fixation in the S1 segment and two bidirectional sacroiliac screws fixation in the S2 segment.Conclusions Two bidirectional sacroiliac screws fixation in S:and S2 segments respectively is recommended to be utilized for fixing bilateral sacral fractures of Tile C pelvic ring injury as far as possible.It is suggested to choose sacral segments in which sacroiliac screws fixed according to vertical,rotational and everted stability degree of sacral fractures.