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Unilaterale trianguläre lumbopelvine Stabilisierung

Indikationen und Technik

Unilateral triangular lumbopelvic stabilization

Indications and techniques

Der Unfallchirurg volume 116, pages 985–990 (2013)Cite this article

Zusammenfassung

Die operative Versorgung instabiler Sakrumfrakturen wird als Standard erachtet. Die Verwendung von iliosakralen Schrauben führt zu Redislokationsraten in bis zu 15 %. Vertikale Sakrumfrakturen mit Beteiligung des kranialen S1-Facettengelenks (Isler Typ 2 und 3) führen zu einer multidirektionalen Instabilität. Eine lumbopelvine trianguläre Stabilisierung des hinteren Beckenrings überträgt die axialen Kräfte der Wirbelsäule unter Umgehung der sakroiliakalen Gelenke auf das Os ilium durch Kombination einer lumbalen pedikulären Verankerung mit einer Iliumschraubenverankerung, welche von der Spina iliaca posterior superior zur Spina iliaca anterior inferior verläuft und mit einer horizontal stabilisierenden sakroiliakalen Schraube kombiniert wird. Diese Versorgung ist belastungsstabil und erlaubt eine frühzeitige Mobilisation des Patienten. Sie ist jedoch ein komplexer chirurgischer Eingriff und erfordert eine gute Vorbereitung und operative Logistik. Insbesondere lokale Komplikationen werden beschrieben. Vorbestehende Weichteilschädigungen (Morell-Lavallée) erhöhen das Risiko von Infekten. Prominente Schraubenköpfe der Iliumschraube führen zu lokalen Problemen und sollten durch konsequentes knöchernes Versenken vermieden werden.

Abstract

Operative fixation has become treatment of choice for unstable sacral fractures. Osteosynthesis for these fractures results in loss of reduction in up to 15%. Vertical sacral fractures involving the S1 facet joint (Isler 2 and 3) may lead to multidirectional instability. Multidirectional instability of the posterior pelvic ring and lumbopelvic junction may be stabilized and forces balanced by a so-called lumbopelvic triangular fixation. Lumbopelvic triangular fixation combines vertical fixation between the lumbar vertebral pedicle and the ilium, with horizontal fixation, as an iliosacral screw or a transiliacal plate osteosynthesis. The iliac screw is directed from the posterior superior iliac spine (PSIS) to the anterior inferior iliac spine (AIIS). Thereby, lumbopelvic fixation decreases the load to the sacrum and SI joint and transfers axial loads from the lumbar spine directly onto the ilium. Triangular lumbopelvic fixation allows early full weight bearing and therefore reduces prolonged immobilization. The placement of iliac screws may be a complex surgical procedure. Thus, the technique requires thorough surgical preparation and operative logistics. Wound-related complications may occur. Preexisting Morell–Lavalée lesions increase the risk for infection. Prominent implants cause local irritation and pain. Hardware prominence and pain are markedly reduced with screw head recession into the PSIS.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. M.F. Hoffmann, M. Dudda und T.A. Schildhauer geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Affiliations

  1. Chirurgische Universitätsklinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland

    M.F. Hoffmann, M. Dudda & T.A. Schildhauer

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  1. M.F. Hoffmann
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  2. M. Dudda
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  3. T.A. Schildhauer
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Correspondence to M.F. Hoffmann.

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Hoffmann, M., Dudda, M. & Schildhauer, T. Unilaterale trianguläre lumbopelvine Stabilisierung. Unfallchirurg 116, 985–990 (2013). https://doi.org/10.1007/s00113-012-2337-2

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  • DOI: https://doi.org/10.1007/s00113-012-2337-2

Schlüsselwörter

  • Sakrumfraktur
  • Becken
  • Fraktur
  • Osteosynthese
  • Pedikelschraubenfixation

Keywords

  • Sacrum
  • Pelvis
  • Fracture fixation, internal
  • Osteosynthesis
  • Pedicle screw fixation