Radiologische Diagnostik von Stress- und Insuffizienzfrakturen des Sakrums

Zusammenfassung

Sakrumfrakturen, die ohne adäquates Trauma entstanden sind, werden in Insuffizienzfrakturen und Stressfrakturen eingeteilt. Während Insuffizienzfrakturen bei physiologischer Belastung meist auf dem Boden einer relevanten Osteoporose entstehen, beruhen Stressfrakturen auf einer mechanischen Überlastung. Der vordere Beckenring ist regelmäßig beteiligt. Aufgrund des fehlenden bzw. niederenergetischen Unfallhergangs wird die korrekte Diagnose oft verspätet gestellt. Demzufolge war es das Ziel der AG Osteoporotische Frakturen der Sektion Wirbelsäule der DGOU, die einzelnen bildgebenden Verfahren zur korrekten, schnellen und kosteneffektiven Diagnostik vorzustellen. Zur Diagnosesicherung sollte neben der konventionell radiologischen Diagnostik zeitnah eine Schnittbildgebung in die Wege geleitet werden. Mittels CT kann die Frakturmorphologie am besten beurteilt werden, wodurch potenzielle Instabilitätszeichen der Verletzung erkannt werden können. Die MRT kann aufgrund der hohen Sensitivität bei fehlendem Frakturnachweis im CT, bei jungen Patienten und unklaren Situationen zusätzliche wichtige Informationen liefern. Im Falle einer Kontraindikation für das MRT stellen nuklearmedizinische Untersuchungen eine gute Alternative dar.

Schlüsselwörter

Insuffizienzfraktur - Sakrum - Stressfraktur - MRT - CT

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