Vergleich von konservativer Therapie vs. CT-gesteuerter Ballon -sakroplastie bei der Behandlung von Insuffizienz frakturen des Os sacrum

R. Andresen; S. Radmer; C. W. Lüdtke; P. Kamusella; M. Görmez; C. Wissgott; H.-C. Schober

doi:10.1055/s-0037-1622046

Osteologie, Inhaltsverzeichnis

Osteologie 2015; 24(02): 92-98
DOI: 10.1055/s-0037-1622046

Original- und Übersichtsbeiträge

Schattauer GmbH

Vergleich von konservativer Therapie vs. CT-gesteuerter Ballon -sakroplastie bei der Behandlung von Insuffizienz frakturen des Os sacrum

Conservative therapy versus CT guided balloon sacroplasty in the treatment of insufficiency fractures of the sacrum

R. Andresen

¹Institut für Diagnostische und Interventionelle Radiologie/Neuroradiologie, Westküstenklinikum Heide, Akademisches Lehrkrankenhaus der Universitäten Kiel, Lübeck und Hamburg, Heide

,

S. Radmer

²Facharztpraxis für Orthopädie, Zentrum für Be-wegungsheilkunde, Berlin

,

C. W. Lüdtke

¹Institut für Diagnostische und Interventionelle Radiologie/Neuroradiologie, Westküstenklinikum Heide, Akademisches Lehrkrankenhaus der Universitäten Kiel, Lübeck und Hamburg, Heide

,

P. Kamusella

¹Institut für Diagnostische und Interventionelle Radiologie/Neuroradiologie, Westküstenklinikum Heide, Akademisches Lehrkrankenhaus der Universitäten Kiel, Lübeck und Hamburg, Heide

,

M. Görmez

³Klinik für Unfallchirurgie und Orthopädie, Westküstenklinikum Heide, Akademisches Lehr-krankenhaus der Universitäten Kiel, Lübeck und Hamburg, Heide

,

C. Wissgott

¹Institut für Diagnostische und Interventionelle Radiologie/Neuroradiologie, Westküstenklinikum Heide, Akademisches Lehrkrankenhaus der Universitäten Kiel, Lübeck und Hamburg, Heide

,

H.-C. Schober

⁴Klinik für Innere Medizin I, Klinikum Südstadt Rostock, Akademisches Lehrkrankenhaus der Universität Rostock, Rostock

› Institutsangaben

Abstract

Zusammenfassung

Ziel der Studie

Bei älteren osteoporotischen Patienten sind Insuffizienzfrakturen des Os sacrum relativ häufig und typischerweise mit invalidisierenden Schmerzen verbunden. In unserer Studie sollte das Outcome für die konservative Behandlung und die Ballon -sakroplastie retrospektiv überprüft werden. Material und Methoden: Bei 90 Patienten wur-de mittels MRT eine Os sacrum-Fraktur detek-tiert. Die konservative Behandlung beinhaltete Schmerztherapie und physio therapeutische Maßnahmen. Die Ballon sakroplastie erfolgte CT-gesteuert. Die Schmerzen wurden nach vi-sueller Analog skala (VAS) dokumentiert, die Patienten zufriedenheit wurde nach zwölf Mo-naten erfragt.

Ergebnisse

Bei dem Vergleich der Patienten in den konservativ behandelten Gruppen zeigt sich, dass Patienten mit einem Schmerzniveau bis 5 klinisch deutlich bessere Ergebnisse auf-weisen als Patienten mit Werten > 5. In der In-terventionsgruppe zeigte sich postinterventio-nell eine schnelle, signifikante und nachhaltige Schmerzreduktion. Nach zwölf Monaten fand sich eine hohe Patienten zufriedenheit.

Fazit

Der Erfolg der konservativen Therapie ist stark von der Schmerzausgangsintensität abhängig. Patienten mit VAS-Werten > 5 sollten aufgrund der schnellen und signifikanten Schmerzreduktion nach Zement augmentation einer Ballonsakroplastie zugeführt werden.

Summary

Objective

In elderly patients with reduced bone quality, insufficiency fractures of the sacrum are relatively common and are typically associated with intense, disabling pain. The standard therapy for sacral insufficiency fractures remains conservative today. Balloon sa-croplasty represents an alternative treatment option. Our study was designed to examine the outcome of the different treatment forms retrospectively.

Material and methods

In 90 patients with an average age of 80.3 years, a sacral fracture was detected by MRI. Depending on the pain intensity, the conservative treatment given involved bed rest, adjuvant analgesic therapy, as well as mobilisation with pain-adapted weight-bearing. The cement augmentation was performed by CT guided balloon sacroplasty. Pain was documented on a visual analogue scale (VAS) on the day of in-patient admission, after 3 days, on the day of discharge, and after 6 and 12 months. Additionally occurring complications were recorded, and the patients were asked to state how satisfied they were after 12 months.

Results

Conservatively treated patients with a pain level of up to 5 could be discharged from inpatient treatment earlier and were less reliant on analgesics and supporting aids in everyday life than patients with values > 5. Conservatively treated patients with VAS values >5 showed a significantly higher rate of complications and mortality, and the pain level was significantly higher. In particular, a higher incidence of newly occurring anterior pelvic ring fractures was observed over the course in this group of patients. In the inter-ventional group, an average pain value of 8.7 was observed prior to the intervention. There was a significant pain reduction on the second postoperative day (p < 0.001) with an average value of 2.5, and this was stable at 2.5 after 6 months and 2.4 after 12 months. A high patient satisfaction was found after 12 months.

Conclusion

The success of conservative therapy is strongly dependent upon the pain intensity at baseline, whereby patients with a high level of pain require longer periods of treatment and show much higher complication rates. On the basis of the rapid and significant reduction in pain after cement augmentation, patients with VAS values >5 should be treated by balloon sacroplasty.

Schlüsselwörter

Ballonsakroplastie - Insuffizienzfraktur - kon-servative Behandlung - Os sacrum-Fraktur - Schmerztherapie - Zementaugmentation

Keywords

Balloon sacroplasty - insufficiency fracture - conservative treatment - sacral fracture - pain therapy - cement augmentation

Volltext

Referenzen

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