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Der subkutane ventrale Fixateur interne (SVFI) am Becken

The pelvic subcutaneous cross-over internal fixator

  • Medizin aktuell/Technische Innovationen
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Zusammenfassung

Der subkutane ventrale Fixateur interne ist ein minimalinvasives Osteosyntheseverfahren für instabile vordere Beckenringfrakturen. Über Miniinzisionen wird beidseits eine polyaxiale USS-II-Pedikelschraube supraazetabulär im Os ileum verankert und durch einen zuvor subkutan eingeschobenen vorgebogenen Fixateurstab winkelstabil mit der Gegenseite verbunden. In einer klinischen Studie zeigte ein Kollektiv von 19 Patienten durchschnittlich 2,54 Jahre postoperativ 31,6% ausgezeichnete bis gute, 63,2% mäßige und 5,3% schlechte Ergebnisse. An Komplikationen traten eine Wundinfektion, eine Implantatlockerung sowie 7 temporäre Läsion des N. cutaneus femoris lateralis auf. Vorteile sehen wir in der einfachen und weichteilschonenden Operationstechnik, dem geringen Risiko intraoperativer Gefäß-Nerven-Verletzungen sowie dem Fehlen von Pininfekten. Insbesondere polytraumatisierte Patienten profitieren von der verkürzten Operationsdauer, dem verbesserten Patientenkomfort sowie der Möglichkeit der Bauchlagerung. Das neue Verfahren verbindet die Vorteile interner Verfahren mit der minimalinvasiven Technik, um eine frühzeitige Mobilisation unter Vollbelastung bei instabilen Beckenfrakturen zur ermöglichen.

Abstract

The pelvic subcutaneous cross-over internal fixator is a minimally invasive technique for the fixation of instable anterior pelvic ring fractures. A USS-II-VAS screw is anchored bilaterally in the supra-acetabular region of the os ileum by a mini-incision approach. An angled fixation rod is inserted subcutaneously and after successful closed reduction attached to the screws forming a locking internal fixation. In a retrospective study of the clinical and radiological outcomes of 19 patients after an average follow-up of 2.54 years, results were excellent and good in 31.6%, moderate in 63.2% and poor in 5.3%. Complications were one wound infection, one loosening of the VAS screw and seven temporary lesions of the lateral femoral cutaneous nerve. The main benefits are a simple surgical technique preventing damage to soft tissue, a low risk of neurovascular lesions and the avoidance of pin infections. Moreover patients with multiple trauma profit from a shorter time of surgery and greater comfort allowing a prone position. The new procedure combines the advantages of internal osteosynthesis and a minimally invasive technique, providing early mobilization under full-weight bearing for instable pelvic fractures.

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Authors and Affiliations

  1. Abteilung für Unfall-, Wiederherstellungs- und Handchirurgie, Krankenhaus Barmherzige Brüder Regensburg, Prüfeningerstr. 86, 93049, Regensburg, Deutschland

    M. Kuttner, A. Klaiber, T. Lorenz, B. Füchtmeier & R. Neugebauer

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  1. M. Kuttner
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  2. A. Klaiber
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  3. T. Lorenz
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  4. B. Füchtmeier
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  5. R. Neugebauer
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Correspondence to M. Kuttner.

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Kuttner, M., Klaiber, A., Lorenz, T. et al. Der subkutane ventrale Fixateur interne (SVFI) am Becken. Unfallchirurg 112, 661–669 (2009). https://doi.org/10.1007/s00113-009-1623-0

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