| Objective:The differences in biomechanical stability and clinical efficacy of one LC-Ⅱscrew,two LC-Ⅱ screws and reconstructive plate for fixation of C1.1 pelvic fractures were analyzed and compared.Explore the biomechanical properties of various internal fixation methods and provide a theoretical basis for the selection of clinical internal fixation methods.Using the combination of basic research and clinical analysis,it provides a potential optimization plan for the minimally invasive treatment of C1.1 pelvic fractures in clinical practice.Methods:This study includes two parts: biomechanical experiment and clinical case-control study.Biomechanical experiment: The experimental materials were 12 fresh cadavers（12 pelvis specimens）provided by the Anatomy Teaching and Research Office of Jilin University.After excluding pathological bones and specimens with large differences in bone density through clinical experience judgment and imaging tests,9 specimens were obtained.With adult embalmed pelvis specimen.A C1.1 pelvic fracture model was made,and then the pelvic specimens were randomly divided into three groups according to the fixation method:（1）One LC-Ⅱ screw group,（2）Two LC-Ⅱ screws group,（3）Traditional steel plate group.The fixed pelvis specimens in each group were loaded vertically,the displacement values of the pelvic specimens under different loads were measured and recorded,and the relationship between the loading stroke and the loading force of the pelvis was recorded in the form of a continuous curve.The displacement and stiffness of each group under different loads were compared and statistically analyzed.Clinical controlled study: This study collected and screened the data of 37 patients with C1.1 pelvic fractures who underwent surgical treatment from March2018 to October 2021 in the Department of Traumatology,China-Japan Friendship Hospital,Jilin University.Among them,10 cases were fixed with one LC-Ⅱ screw under robot navigation,10 cases were fixed with two LC-Ⅱ screws under robot navigation,and 17 cases were fixed with plate in the posterior pelvis.The incision length,intraoperative blood loss,operation time,Majeed function score,etc.were collected in each group,and the differences among the groups were compared.Results:1.Biomechanical experiment:（1）.When low-energy loads such as 200 N,400 N,and 600 N were applied,the three groups of specimens had similar displacements of the ilium;when the applied load was 800 N,the plate group and one LC-II screw group were respectively combined with two LC-II screws.There was no significant difference compared with the Ⅱ screw group（P >0.05）,and the traditional plate fixation group was better than the one LC-Ⅱ screw fixation group（P < 0.05）.There was no significant difference in displacement between the plate fixation group and the two LC-Ⅱ screw fixation group（P > 0.05）,but the plate fixation group and the two LC-Ⅱ screw fixation group were better than the one LC-Ⅱ screw fixation group.（P < 0.05）.（2）.The stiffness of the two LC-Ⅱ screw fixation group and the steel plate fixation group is about twice that of the one screw fixation group.There was no significant difference in the stiffness of the two internal fixation methods between the two LC-Ⅱ screw fixation group and the plate fixation group（P > 0.05）,both of which were better than one LC-Ⅱ screw fixation（P < 0.05）.2.Clinical controlled studies:（1）.Operation time: The average operation time of the plate fixation group,the two LC-Ⅱ screw fixation group and the one LC-Ⅱ screw group was similar,and there was no significant difference between the three groups（P > 0.05）.（2）.Incision length: The average incision length in the plate fixation group was about 8 times the average incision length in the one LC-Ⅱ screw group,and 4 times the average incision length in the two LC-Ⅱ screw group.After statistical test,there were significant differences in incision length between the plate fixation group,the two LC-II screw fixation group and the one LC-Ⅱ screw fixation group（P < 0.05）.（3）.Intraoperative blood loss: The average blood loss in the plate fixation group was about 10 times that in the one LC-Ⅱ screw group and the two LC-Ⅱ screw group,and the average blood loss in the two LC-Ⅱ screw group was the same as that in the one LC-Ⅱ screw group.Similar,after statistical test,the blood loss in the plate group was significantly different from that in the one screw and two LC-Ⅱ screw groups（P < 0.05）.There was no significant difference in bleeding volume between groups（P > 0.05）.（4）.Majeed score: The Majeed scores were similar between the three groups in postoperative follow-up,and there was no significant difference in the degree of postoperative functional recovery between the three groups（P > 0.05）.Conclusion:1.The biomechanical stability of one LC-Ⅱ screw,two LC-Ⅱ screws,and traditional plate fixation for C1.1 pelvic fractures is similar under low-energy loading.Under high-energy loading,the biomechanical stability of two LC-Ⅱ screws for C1.1pelvic fractures was significantly better than that of one LC-Ⅱ screw,and the biomechanical strength of traditional steel plates could be achieved.2.Compared with plate fixation,LC-Ⅱ screw fixation of C1.1 pelvic fractures has the advantages of less trauma,reduced incision length,and reduced blood loss.The application of digital robotic intraoperative positioning and navigation system significantly improves the accuracy of LC-Ⅱ screw placement and achieves the best surgical effect,which is the main trend of future development.3.For C1.1 pelvic fractures,two LC-Ⅱ screws are preferred for fixation;for patients with C1.1 pelvic fractures with poor clinical tolerance and low body weight,one LC-Ⅱ screw is also recommended for fixation.Good therapeutic effect can be achieved. |
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