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Therapieoptionen bei osteoporotischen Frakturen der Brustwirbelsäule

Treatment options for osteoporotic fractures of the thoracic spine

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Zusammenfassung

Osteoporotische Frakturen der Brustwirbelsäule können zu Deformierungen und Fehlstellungen mit Auswirkungen auf den gesamten Stütz- und Bewegungsapparat führen. Die Therapie ist in der Mehrzahl der Fälle konservativ. Die Therapiekonzepte müssen interdisziplinär und individuell erstellt werden. Feste Bestandteile des therapeutischen Konzepts sind eine antiosteoporotische Medikation, eine suffiziente Schmerztherapie und eine umfassende Trainingstherapie. Persistierende Beschwerden mit der Gefahr der Chronifizierung oder schwerwiegende Frakturmuster können Anlass zu zusätzlichen operativ-stabilisierenden Maßnahmen sein. Bei den typischen osteoporotischen Sinterungsfrakturen haben sich die Vertebroplastie und Kyphoplastie als Zement augmentierende Verfahren etabliert. Instabile Frakturen, Stenosen und vorliegende neurologische Defizite erfordern konventionelle operative Maßnahmen unter besonderer Berücksichtung der Eigenschaften des osteoporotischen Knochens.

Abstract

Osteoporotic fractures of the thoracic spine can lead to deformities, which may affect the complete musculoskeletal system. In the majority of cases conservative treatment is the therapy of choice. Interdisciplinary concepts are necessary. Antiosteoporotic medication, analgetic drugs and physiotherapy form today’s standard therapeutic regimen. Persistent pain and severe fracture patterns, however, require additional operative treatment. In cases of osteoporotic compressive fractures vertebroplasty and kyphoplasty have proven to be appropriate treatment options. Unstable fractures and stenosis with consecutive neurological deficits ultimately require spondylodesis, where the reduced bone quality in osteoporosis must be considered.

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  1. Klinik für Unfall und Wiederherstellungschirurgie mit Arbeitsbereich Orthopädie, Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Deutschland

    C.-E. Heyde, S. K. Tschöke & R. Kayser

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  1. C.-E. Heyde
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Heyde, CE., Tschöke, S.K. & Kayser, R. Therapieoptionen bei osteoporotischen Frakturen der Brustwirbelsäule. Manuelle Medizin 44, 504–512 (2006). https://doi.org/10.1007/s00337-006-0486-5

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