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Die minimal-invasive Stabilisierung des dorsalen Beckenrings mit dem transiliakalen Fixateur interne (TIFI)

Operative Technik und erste klinische Ergebnisse

The minimally invasive stabilization of the dorsal pelvic ring with the transiliacal internal fixator (TIFI)—Surgical technique and first clinical findings

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Zusammenfassung

Der transiliakale Fixateur interne (TIFI) ist eine Technik zur minimal-invasiven Stabilisierung von Iliosakralfugensprengungen sowie lateralen und transforaminalen Sakrumfrakturen. Über Mini-Inzisionen werden beidseits 7,0 mm USS-Pedikelschrauben (Universal-Spine-System, Synthes) 1–2 cm kranial der Spina iliaca posterior superior parallel zur Linea glutea posterior eingebracht. Der Schraubenverbindungsstab wird subfaszial eingeschoben und mit den Pedikelschrauben winkelstabil verbunden.

In einer prospektiven Studie traten bei einem Kollektiv von 31 Patienten mit vertikal instabilen Beckenbrüchen, die mit dem TIFI stabilisiert wurden, 2 Wundinfektionen sowie 1 Implantatlockerung auf. Implantatfehllagen sowie implantatbedingte Gefäß-Nerven-Läsionen wurden nicht beobachtet. 2 Jahre postoperativ zeigten sich bei den Typ-C-Instabilitäten 50% gute bis sehr gute Ergebnisse. Die ersten Erfahrungen zeigen somit, dass sich mit dem TIFI sowohl IS-Fugensprengungen als auch laterale und transforaminale Sakrumfrakturen stabilisieren lassen. Eine geschlossene Reposition und minimal-invasive Implantationstechnik sind dabei möglich. Bei einem sehr geringen Risiko von intraoperativen Gefäß- und Nervenverletzungen bietet der TIFI eine ausreichende biomechanische Stabilität.

Abstract

The Trans Iliacal Internal Fixator (TIFI) is a minimally invasive technique for the stabilization of sacro-iliac joint ruptures and fractures lateral to the sacral ala or through the sacral foramen. In this study, 7.0 mm pedicle screws of the Universal-Spine-System (USS, Synthes) were inserted 1–2 cm on the cranial side of the posterior superior iliac spine and parallel to the superior gluteal line. The connecting bar was inserted subfascially and fixed with the locking head pedicle screws to form an fixed-angle construction. In a prospective study 31 patients with vertical shear injuries of the pelvis were treated with the TIFI. There were two wound infections and one loosening of a pedicle screw. None of the screws were incorrectly positioned and no neuro-vascular lesions were caused by the implant. 2 years postoperatively we found 50% good and excellent results for type C pelvic ring injuries.

Early findings show that the TIFI is well suited to stabilization of sacro-iliac joint ruptures and fractures of the lateral sacrum. Closed reduction and minimally invasive insertion technique are possible. The implant leads to sufficient biomechanical stability but there is a very low intraoperative risk of neuro-vascular lesion.

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Authors and Affiliations

  1. Abteilung für Unfallchirurgie, Klinikum der Universität Regensburg

    B. Füchtmeier, C. Neumann, R. Hente, C. Roll & M. Nerlich

  2. Abteilung für Unfallchirurgie, Ostholstein-Kliniken GmbH Eutin

    M. Maghsudi

  3. Abteilung für Unfallchirurgie, Klinikum der Universität Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg

    B. Füchtmeier

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  1. B. Füchtmeier
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  2. M. Maghsudi
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  3. C. Neumann
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  4. R. Hente
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  5. C. Roll
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  6. M. Nerlich
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Correspondence to B. Füchtmeier.

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Füchtmeier, B., Maghsudi, M., Neumann, C. et al. Die minimal-invasive Stabilisierung des dorsalen Beckenrings mit dem transiliakalen Fixateur interne (TIFI). Unfallchirurg 107, 1142–1151 (2004). https://doi.org/10.1007/s00113-004-0824-9

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