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4-Punkt-Stabilisierung einer Sakruminsuffizienzfraktur mittels Fixateur interne

4-point internal fixator stabilization of a sacral insufficiency fracture

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Zusammenfassung

Sakruminsuffizienzfrakturen (SIF) entstehen aufgrund einer Diskrepanz zwischen physiologischer Belastung und Belastbarkeit. Neben der Osteoporose als Hauptdispositionsfaktor führen diverse andere Erkrankungen zu einem Verlust der elastischen Widerstandskräfte des Knochens und können diese charakteristischen, meist bilateralen, transalaren Stressfrakturen verursachen. Die meisten Patienten beklagen tiefe Rückenschmerzen und zunehmende Mobilisationsschwierigkeiten.

Die konservative Therapie stützt sich auf eine forcierte Analgetika- und schmerzadaptierte Bewegungstherapie. Aufgrund der deutlichen Funktionseinschränkung und persistierender Beschwerden wird in vielen Fällen doch die Indikation zur operativen Therapie gestellt. Es stehen diverse operative Verfahren zur Verfügung. Signifikante Stabilitätsunterschiede bestehen dabei zwischen den einzelnen Verfahren nicht. Wir präsentieren den Fall eines 56-jährigen Mannes, bei dem der Progress einer bekannten B-CLL („B-cell chronic lymphocytic leukemia“) zur Entwicklung von Osteolysen des hinteren Beckenrings mit der Folge einer Sakruminsuffizienzfraktur führte. Aufgrund einer zunehmenden Mobilitätseinschränkung und fehlender Besserung unter Analgetikatherapie wurde die Indikation zur minimal-invasiven Stabilisierung des hinteren Beckenrings gestellt. Der Patient konnte postoperativ mobilisiert werden. Die Beschwerden waren merklich gebessert.

Abstract

Sacral insufficiency fractures develop due to a discrepancy between physiological load and load-bearing capacity. Besides osteoporosis as the main predisposing factor, other diseases lead to a loss of the bony elastic resistivity and therefore are able to cause these characteristic bilateral sacral stress fractures. Most patients complain of low back pain and show difficulties in mobilization.

The non-operative therapy is based on analgesics and pain-adapted mobilization. Due to the noticeable functional deficit and persistent discomfort, surgery is necessary in many cases. Various operative methods are available, without significant differences regarding stability. We present the case of a 56-year-old man, in whom the progression of B-cell chronic lymphocytic leukemia (B-CLL) led to the development of osteolysis in the posterior pelvic ring and caused a sacral insufficiency fracture. Due to the progressive deterioration of mobilization and the persistent severe pain, we decided to stabilize the posterior pelvic ring. After surgery the patient could be mobilized and the pain was significantly reduced.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. M. Spalteholz und R.H. Gahr geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Klinik für Unfallchirurgie und Orthopädie/Traumazentrum, Klinikum St. Georg gGmbH, Delitzscher Straße 141, 04129, Leipzig, Deutschland

    M. Spalteholz & R.H. Gahr

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Spalteholz, M., Gahr, R. 4-Punkt-Stabilisierung einer Sakruminsuffizienzfraktur mittels Fixateur interne. Unfallchirurg 118, 181–187 (2015). https://doi.org/10.1007/s00113-014-2590-7

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