Gjertsen O, Schellhorn T, Nakstad P H
Department of Neuroradiology, Division of Medical Services, Ullevål University Hospital, University of Oslo, Oslo, Norway.
Acta Radiol. 2008 Nov;49(9):1042-8. doi: 10.1080/02841850802350659.
Osteoporotic sacral insufficiency fractures are usually spontaneous or caused by discrete traumas. The fluoroscopic anatomy of the sacrum can be difficult to understand, and this is why sacroplasty is considered more challenging than ordinary vertebroplasties.
To demonstrate the planning of the procedure and the effectiveness of treatment with sacroplasty by means of three-dimensional computed tomography (3D CT) by combining multiplanar reconstructions (MPR) and volume-rendering technique (VRT).
Five elderly, osteoporotic patients with intense pelvic and hip pain underwent weeks of inconclusive clinical and radiological diagnostic efforts. Correct diagnosis was finally attained with magnetic resonance imaging (MRI) and CT. Plain radiographs rarely show fractures, and MR or CT examinations are necessary to demonstrate longitudinal fractures. The procedures were performed with digital biplane equipment using preoperative 3D CT planning procedures. Polymethyl methacrylate (PMMA) was injected to fill the fracture sites.
The fractures were successfully treated with sacroplasty using PMMA. A new technique, which involves placing the needles along the long axis of the sacrum, was optimized to the individual patients' fractures and sacral anatomy by meticulous planning on a workstation with 3D CT data sets. It was technically successful in all five cases. Four of the five patients had sustained pain relief.
Sacral insufficiency fractures are not uncommon and should be considered in the elderly population with low back pain. Sacroplasty using the optimized "long-axis technique" gave almost immediate pain relief for all five patients in our study material. No complications were observed.
骨质疏松性骶骨不全骨折通常是自发性的或由离散创伤引起。骶骨的荧光透视解剖结构可能难以理解，这就是为什么骶骨成形术被认为比普通椎体成形术更具挑战性的原因。
通过结合多平面重建（MPR）和容积再现技术（VRT）的三维计算机断层扫描（3D CT）来展示该手术的规划以及骶骨成形术的治疗效果。
五名患有严重骨盆和髋部疼痛的老年骨质疏松患者经过数周的临床和放射学诊断仍未确诊。最终通过磁共振成像（MRI）和CT得以正确诊断。普通X线片很少能显示骨折，而MR或CT检查对于显示纵向骨折是必要的。手术使用数字双平面设备并采用术前3D CT规划程序进行。注入聚甲基丙烯酸甲酯（PMMA）以填充骨折部位。
使用PMMA的骶骨成形术成功治疗了骨折。一种沿着骶骨长轴放置针的新技术，通过在具有3D CT数据集的工作站上进行细致规划，针对个体患者的骨折和骶骨解剖结构进行了优化。在所有五例中技术上均获成功。五名患者中有四名疼痛持续缓解。
骶骨不全骨折并不罕见，在患有腰痛的老年人群中应予以考虑。在我们的研究材料中，使用优化的“长轴技术”进行骶骨成形术使所有五名患者几乎立即缓解了疼痛。未观察到并发症。
