Versorgung von Sakruminsuffizienzfrakturen

Zusammenfassung

Sakruminsuffizienzfrakturen zeigen eine kontinuierlich ansteigende Inzidenz. Ihre Behandlung ist in der Mehrzahl der Fälle konservativ, jedoch können anhaltende Schmerzen und Mobilitätseinschränkungen eine Indikation zur Operation darstellen. Mit Hilfe der OF-Pelvis Klassifikation lassen sich die Frakturen relativ einfach nach ihrem Schweregrad einteilen. Der OF-Pelvis Score dient zur Therapieentscheidung und kann auch zur Verlaufsbeobachtung eingesetzt werden. Die chirurgische Therapie ist regelhaft minimal-invasiv und reicht von der Sakroplastie, über iliosakrale Verschraubungen bis hin zur lumbopelvinen Stabilisation.

Abstract

Sacral insufficiency fractures show a continuously increasing incidence. Although their treatment is mainly conservative, ongoing pain and impaired mobilization can justify surgical treatment. With the help of the OF-Pelvis classification the fractures can be grouped easily according to their degree of instability. The OF-Pelvis score can be used for therapeutic decision making and to monitor the course. The surgical therapy is predominantly minimal-invasive and ranges from Sacroplasty to iliosacral screw fixation to lumbo-pelvic stabilization.

Schlüsselwörter

Sakruminsuffizienzfraktur - Osteoporose - Becken - Klassifikation - Chirurgie

Keywords

sacral insufficiency fractures - osteoporosis - pelvis - classification - surgery

• Literatur

• 1 Rupp M, Walter N, Pfeifer C. et al. Inzidenz von Frakturen in der Erwachsenenpopulation in Deutschland. Eine Analyse von 2009 bis 2019. Dtsch Arztebl Int 2021; 118: 665-669
• 2 Wagner D, Kamer L, Sawaguchi T. et al. Sacral Bone Mass Distribution Assessed by Averaged Three-Dimensional CT Models: Implications for Pathogenesis and Treatment of Fragility Fractures of the Sacrum. J Bone Joint Surg Am 2016; 98: 584-590
• 3 de Peretti F, Argenson C, Bourgeon A. et al. Anatomic and experimental basis for the insertion of a screw at the first sacral vertebra. Surg Radiol Anat 1991; 13: 133-213
• 4 Mendel T, Ullrich BW, Hofmann GO. et al. Progressive instability of bilateral sacral fragility fractures in osteoporotic bone: a retrospective analysis of X-ray, CT, and MRI datasets from 78 cases. Eur J Trauma Emerg Surg 2021; 47: 11-19
• 5 Oberkircher L, Ruchholtz S, Rommens PM. et al. Osteoporotic Pelvic Fractures. Dtsch Arztebl Int 2018; 115: 70-80
• 6 Nanninga GL, de Leur K, Panneman MJ. et al. Increasing rates of pelvic fractures among older adults: the Netherlands, 1986–2011. Age and ageing 2014; 43: 648-53
• 7 Andrich S, Haastert B, Neuhaus E. et al. Epidemiology of pelvic fractures in Germany: 8. Considerably high incidence rates among older people. PLoS One 2015; 10: e0139078
• 8 Otero B, Ñiguez I, Colomé C. et al. Osteoporotic fractures prevalence in postmenopausal women. Maturitas 2017; 100: 155
• 9 Benzinger P, Riem S, Bauer J. et al. Risk of institutionalization following fragility fractures in older people. Osteoporos Int 2019; 30: 1363-1370
• 10 Schousboe JT. Mortality after osteoporotic fractures: What proportion is caused by fracture and is preventable?. J Bone Miner Res 2017; 32: 1783-1788
• 11 Scheyerer MJ, Osterhoff G, Wehrle S. et al. Detection of posterior pelvic injuries in fractures of the pubic rami. Injury 2012; 43: 1326-1329
• 12 Tile M. Pelvic ring fractures: should they be fixed?. J Bone Joint Surg Br 1988; 70: 1-12
• 13 AO Foundation. AO Spine Sacral Injury Classification System. Accessed November 13, 2024 at: https://www.aofoundation.org/spine/clinical-library-and-tools/aospine-classification-systems
• 14 Rommens PM, Hofmann A. Comprehensive classification of fragility fractures of the pelvic ring: Recommendations for surgical treatment. Injury 2013; 44: 1733-1744
• 15 Wagner D, Ossendorf C, Gruszka D. et al. Fragility fractures of the sacrum: how to identify and when to treat surgically?. European Journal of Trauma and Emergency Surgery 2015; 41: 349-362
• 16 Krappinger D, Kaser V, Merkel A. et al. An alphanumeric classification of osteoporotic pelvic ring injuries. Arch Orthop Trauma Surg 2021; 141: 861-869
• 17 Ullrich BW, Schnake KJ, Spiegl UJA. et al. OF-Pelvis classification of osteoporotic sacral and pelvic ring fractures. BMC Musculoskelet Disord 2021; 22: 992
• 18 Schnake KJ, Blattert TR, Hahn P. et al. Classification of osteoporotic thoracolumbar spine fractures: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU). Global Spine Journal 2018; 8: 46S-9
• 19 Spiegl UJA, Schnake KJ, Scheyerer MJ. et al. Entwicklung und Evaluation des OF-Pelvis-Scores bei osteoporotischen Beckenringfrakturen – retrospektive Beurteilung der Therapieempfehlung anhand von 107 Patienten. Z Orthop Unfall 2024; DOI: 10.1055/a-2385–1747. Online ahead of print.
• 20 Subramaniam S, Aalberg JJ, Soriano RP. et al. New 5-factor modified frailty index using American College of Surgeons NSQIP data. Journal of the American College of Surgeons 2018; 226: 173-181
• 21 Spiegl UJA, Schnake KJ, Ullrich B. et al. Current Minimally Invasive Surgical Concepts for Sacral Insufficiency Fractures. Z Orthop Unfall 2023; 161: 143-153
• 22 Gericke L, Fritz A, Osterhoff G. et al. Percutaneous operative treatment of fragility fractures of the pelvis may not increase the general rate of complications compared to non-operative treatment. Eur J Trauma Emerg Surg 2022; 48: 3729-3735
• 23 Mendel T, Noser H, Kuervers J. et al. The influence of sacral morphology on the existence of secure S1 and S2 transverse bone corridors for iliosacroiliac screw fixation. Injury 2013; 44: 1773-1779
• 24 Höch A, Pieroh P, Henkelmann R. et al. In-screw polymethylmethacrylate-augmented sacroiliac screw for the treatment of fragility fractures of the pelvis: a prospective, observational study with 1-year follow-up. BMC Surg 2017; 17: 132
• 25 Andresen R, Radmer S, Andresen JR. et al. Clinical Improvement and Cost-effectiveness of CT-guided Radiofrequency Sacroplasty (RFS) and Cement Sacroplasty (CSP) - a Prospective Randomised Comparison of Methods. Z Orthop Unfall 2019; 157: 524-533
• 26 Rovere G, De Mauro D, Smakaj A. et al. Triangular osteosynthesis and lumbopelvic fixation as a valid surgical treatment in posterior pelvic ring lesions: a systematic review. Front Surg 2024; 11: 1266393
• 27 Pieroh P, Höch A, Hohmann T. et al. Fragility fractures of the pelvis classification: a multicenter assessment of the intra-rater and inter-rater reliabilities and percentage of agreement. JBJS 2019; 101: 987-994