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Minimal-invasive Stabilisierung bei Frakturen des Sakrums

Minimally invasive stabilization of sacral fractures

Der Unfallchirurg volume 123, pages 774–782 (2020)Cite this article

Zusammenfassung

Hintergrund

Sakrumfrakturen treten sowohl als Insuffizienzfrakturen als auch als traumatische Frakturen auf. Während bei den mechanisch stabilen Insuffizienzfrakturen insbesondere die Schmerzreduktion das therapeutische Ziel ist, bedürfen die instabilen Insuffizienzfrakturen und instabilen Frakturen nach Hochenergietraumata insbesondere auch der mechanischen Stabilisierung. Verschiedene operative Möglichkeiten stehen hierfür zur Verfügung, wobei minimal-invasive Techniken zunehmend favorisiert werden.

Ziel der Arbeit

Darstellung der klinischen Herausforderungen und Möglichkeiten in der minimal-invasiven operativen Therapie von Sakrumfrakturen.

Material und Methoden

Erläuterung aktueller Studienergebnisse sowie des eigenen therapeutischen Vorgehens.

Ergebnisse

Die wesentlichen Verfahren zur minimal-invasiven operativen Behandlung von Sakrumfrakturen werden dargestellt: sakroiliakale Schraubenosteosynthese, lumbopelvine Stabilisierung und Sakroplastie. Die Auswahl des operativen Verfahrens sollte individuell erfolgen. Während die sakroiliakale Schraubenosteosynthese der internationale Goldstandard ist, haben diverse Autoren auch minimal-invasive Techniken der lumbopelvinen Stabilisierung publiziert. Letztere ermöglicht eine höhere mechanische Stabilität. Die Sakroplastie ist lediglich als therapeutische Alternative bei Insuffizienzfrakturen zu betrachten. Vergleichende Daten der genannten Techniken sind nicht vorhanden.

Schlussfolgerung

Alle Verfahren haben ihren Stellenwert. Allerdings differiert die zu erreichende mechanische Stabilisierung deutlich. Daher sollte individuell eine exakte Analyse erfolgen, was hinsichtlich Reposition und Retention notwendig ist und erreicht werden soll.

Abstract

Background

Sacral fractures can be of traumatic origin and can also occur as insufficiency fractures. While the therapeutic target of mechanically stable insufficiency fractures is mainly pain relief, mechanically unstable insufficiency fractures and traumatic sacral fractures following high-energy trauma require biomechanical stabilization. Various surgical strategies are available for this, whereby minimally invasive techniques are now preferred whenever possible.

Objective

This article presents the clinical challenges and options for minimally invasive treatment of sacral fractures.

Material and methods

Selected important study data are discussed and our own treatment approach is presented.

Results

The most important minimally invasive techniques for operative treatment of sacral fractures are presented: sacroiliac screw osteosynthesis, lumbopelvic stabilization and sacroplasty. The selection of the surgical technique should be made on an individual basis. While sacroiliac screw osteosynthesis is the international gold standard, diverse authors have also published minimally invasive techniques for lumbopelvic stabilization. The latter enables a higher mechanical stability. In contrast, sacroplasty should only be used as an alternative treatment in insufficiency fractures. Comparative studies of the described techniques are still missing.

Conclusion

All surgical options have their indications. Nevertheless, the biomechanical stability which can be achieved differs widely. Therefore, an exact analysis should be carried out of what is necessary with respect to reduction and retention and what should be achieved when treating sacral fractures.

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Affiliations

  1. Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    S. Decker, C. Krettek & T. Stübig

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  1. S. Decker
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  2. C. Krettek
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  3. T. Stübig
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Corresponding author

Correspondence to S. Decker.

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Interessenkonflikt

S. Decker, C. Krettek und T. Stübig geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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C. Müller, Hamburg

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Decker, S., Krettek, C. & Stübig, T. Minimal-invasive Stabilisierung bei Frakturen des Sakrums. Unfallchirurg 123, 774–782 (2020). https://doi.org/10.1007/s00113-020-00853-z

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  • DOI: https://doi.org/10.1007/s00113-020-00853-z

Schlüsselwörter

  • Insuffizienzfrakturen
  • Trauma
  • Frakturfixierung
  • Hinterer Beckenring
  • Spinopelvine Dissoziation

Keywords

  • Insufficiency fractures
  • Trauma
  • Fracture fixation
  • Posterior pelvic ring
  • Spinopelvic dissociation