Acta chirurgiae orthopaedicae
et traumatologiae Čechoslovaca

Acta Chir Orthop Traumatol Cech. 2018; 85(2):85-88 | DOI: 10.55095/achot2018/013

"Baloon guided" augumentace iliosakrálních šroubů kostním cementem v léčení insuficientních zlomenin sakra - popis nové metody a předběžné výsledkyPůvodní práce

G. H. SANDMANN^1,3,*, U. STÖCKLE¹, T. FREUDE^1,2, F. M. STUBY¹

¹ BG Unfallklinik Tuebingen, Eberhard-Karls-Universitaet Tuebingen, Germany

² Salzburger Landeskliniken, Paracelsus Universitaet Salzburg, Austria

³ Sportklinik Ravensburg, Germany

PURPOSE OF THE STUDY:
Fragility fractures of the pelvic ring in the elderly population are a serious problem in orthopaedics. The treatment options range from conservative treatment to diverse operative options. We present a balloon guided new technique of implanting cement augmented screws aiming at improved implant anchorage and reduced cement leakage.

MATERIAL AND METHODS:
We describe a new technique of balloon- guided cement augmented iliosacral screws. After the balloon has been insufflated and contrast medium has been instillated for leakage detection, iliosacral screws can safely be placed with a relevant cement depot.

RESULTS:
All patients (n = 8) treated in this way were allowed to weight bear on both legs and mobilisation was tolerated the next day after surgery. In the post-operative controls including X-ray and CT scan we noticed no cement leakage. Pain level as measured by the visual analog scale was significantly reduced to pre- surgery (mean 7.6 pre-operatively, mean 2.5 post-operatively). In addition pain medication could be reduced gradually soon after surgery.

CONCLUSIONS:
The described procedure to address fragility fractures of the pelvic ring is a safe and easy to handle method. There are three advantages: First the osteoporotic S1 vertebral body can by stabilised by the amount of cement; second the cement leakage can be prevented by the balloon-compaction of the cancellous bone and the possibility to control the created cavity with contrast medium; third the bone - screw interface is much stronger compared to other procedures and is biomechanically superior against vertical shear stress. In contrast to sacroplasty, the cement application is guided by the previous use of a balloon.

Klíčová slova: pelvic ring, fragility fracture, osteoporosis, elderly

Zveřejněno: 1. duben 2018  Zobrazit citaci