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Einfluss der Sakrumfraktur auf das funktionelle Langzeitergebnis von Beckenringverletzungen

Influence of sacral fracture on the long-term outcome of pelvic ring injuries

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Zusammenfassung

In der Akutphase umfasst die Behandlung der Beckenringverletzung mit Beteiligung des iliosakralen Komplexes die effiziente Blutungskontrolle und Stabilisierung des Beckenrings. Für das Langzeitresultat sind jedoch neurologische Ausfälle, Fehlverheilungen des hinteren Beckenrings mit tieflumbalen Schmerzen und urologische Komplikationen entscheidend.

Zwischen 1991 und 2000 wurden in unserer Klinik 173 Patienten mit Sakrumfrakturen behandelt. Diese wurden im Rahmen einer lateralen Kompressionsfraktur (AO-Klassifikation Typ B2) oder einer „vertical-shear-“ (Typ-C-)Verletzung mit einer Dislokation von <1 cm konservativ behandelt. Frakturen mit einer Dislokation von >1 cm wurden operativ (n=33, 19%) versorgt.

112 Patienten wurden nach durchschnittlich 4,9 Jahren nachkontrolliert. Von den 39 Patienten mit neurologischen Ausfällen (35%) zeigten lediglich 4 eine vollständige neurologische Erholung. Chronische tieflumbale Schmerzen traten selten (n=8, 7%) und nur bei einer Typ-C-Verletzung auf.

Die geringe Inzidenz an lumbalen Schmerzen rechtfertigt die konservative Therapie wenig dislozierter (<1 cm) Sakrumfrakturen. Entscheidend für das Langzeitergebnis sind neurologische Defizite, die bei 30% aller Patienten persistieren.

Abstract

Initial treatment of pelvic ring fractures with involvement of the iliosacral complex is directed at bleeding control and fixation of the pelvic ring. However, long-term outcome is determined by persisting neurological deficits, malunion of the posterior pelvic ring with low back pain, and urological lesions.

Between 1991 and 2000, 173 patients with sacral fractures were treated at our institution. Sacral fractures as part of type B2 (“lateral compression”) or type C (“vertical shear”) pelvic ring fractures were treated conservatively, if dislocation was less than 1 cm. Fractures with a dislocation of more than 1 cm were treated operatively (n=33, 19%).

A total of 112 patients were examined after an average of 4.9 years. Of the 39 patients with primary neurological deficits (35%) only 4 showed complete neurological recovery. Chronic low back pain was rarely observed (n=8, 7%) and only in type C injuries.

The low incidence of chronic low back pain justifies conservative treatment of minimally (<1 cm) displaced sacral fractures. Long-term outcome is largely determined by neurological deficits, which persist in 30% of all patients with sacral fractures.

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  1. Klinik für Unfallchirurgie, Universitätsspital, Zürich, Schweiz

    K. Eid, M. Keel, A. Keller, W. Ertel & O. Trentz

  2. Klinik für Unfallchirurgie, Universitätsspital, Rämistraße 100, CH-8091, Zürich, Schweiz

    K. Eid

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  1. K. Eid
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Correspondence to K. Eid.

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Eid, K., Keel, M., Keller, A. et al. Einfluss der Sakrumfraktur auf das funktionelle Langzeitergebnis von Beckenringverletzungen. Unfallchirurg 108, 35–42 (2005). https://doi.org/10.1007/s00113-004-0864-1

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