Résistance à l’arrachement des vis iliaques cimentées dans les fixations spino-pelviennes - 30/06/21

Pull-out strength evaluation of cement augmented iliac screws in osteoporotic spino-pelvic fixation

Doi : 10.1016/j.rcot.2021.04.022

Ludwig Oberkircher ^a,^⁎ , Adrian Masaeli ^a, Juliana Hack ^a, Jens Figiel ^b, Christopher Bliemel ^a, Steffen Ruchholtz ^a, Antonio Krüger ^c
^a Philipps University Marburg, Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Location Marburg, Baldingerstrasse, 35037 Marburg, Germany
^b Philipps University Marburg, Department of Diagnostic and Interventional Radiology, University Hospital Giessen and Marburg, Location Marburg, Baldingerstrasse, 35037 Marburg, Germany
^c Department of Trauma Surgery, Orthopaedics, Spine Surgery and Pediatric Trauma Surgery, Asklepios Hospital Lich, Goethestrasse 4, 35423 Lich, Germany

^⁎Auteur correspondant. Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, location Marburg, Baldingerstrasse, 35033 Marburg, Germany.Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, location Marburg, BaldingerstrasseMarburg35033Germany

En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Wednesday 30 June 2021
This article has been published in an issue click here to access

Abstract

Introduction

Spino-pelvic fixation has been widely accepted for surgical treatment of sacral tumor, scoliosis surgery and pelvic fractures. Cement augmentation of screws is an option to improve implant stability in osteoporotic bone quality. Aim of the present study is to compare iliac screw fixation without cement fixation and two cement application options in a biomechanical testing.

Hypothesis

Cement augmentation of iliac screws leads to superior pull-out strength.

Material and methods

Thirty female and osteoporotic human iliac bones were used. Three operation treatment groups were generated: Screw fixation (cannulated screws) without cement augmentation (Operation treatment [OT] A), screw fixation with cement augmentation before screw placement (cannulated screws) (OT B) and screw fixation with perforated screws and cement augmentation after screw placement (OT C). Pull-out tests were performed with a rate of 6mm/min. A load versus displacement curve was generated. Maximum pull-out force (N) was measured in the load-displacement curve.

Results

Paired group 1 (OT A vs. OT B): Screw fixation without cement augmentation: 592.6N±335.07 and screw fixation with cement augmentation before screw placement: 996N±287.43 (p=0.0042). Paired group 2 (OT A vs. OT C): Screw fixation without cement augmentation: 716.2N±385.86 and fenestrated screw fixation with cement augmentation after screw placement: 1324.88N±398.76 (p=0.0489). Paired group 3 (OT B vs. OT C): Screw fixation with cement augmentation before screw placement: 1077.2±486.66 and fenestrated screw fixation with cement augmentation after screw placement: 1298.2N±726.19 (p=0.3286).

Discussion

Regarding iliac screw fixation for spino-pelvic ostesynthesis in osteoporotic bone, cement augmentation is significantly superior to solid iliac screw fixation respecting pull-out-strength. Nevertheless, further biomechanical studies are needed to verify these findings.

Level of evidence

Not applicable; Biomechanical cadaver study.

El texto completo de este artículo está disponible en PDF.

Keywords : Pelvis, Fracture, Cement, Biomechanical, Spino-pelvic fixation, Iliac screw

☆	Cet article peut être consulté in extenso dans la version anglaise de la revue Orthopaedics & Traumatology: Surgery & Research sur Science Direct (sciencedirect.com) en utilisant le DOI ci-dessus.