Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA.
AJR Am J Roentgenol. 2011 Jul;197(1):184-8. doi: 10.2214/AJR.10.5902.
The purpose of this study was to describe the radiologic pattern of sacral fractures after lumbosacral fusion and to identify clinical characteristics relevant to the radiologic diagnosis.
A search of CT, nuclear medicine, and MRI radiology reports over a 5-year period at our institution revealed a total of 23 patients with sacral fractures after lumbosacral fusion. Two radiologists reviewed all of the images to determine the sacral fracture pattern. The clinical records of these patients were reviewed for interval after surgery, fusion length, hardware, approach, preoperative diagnosis, symptoms, treatment, and risk factors.
All 23 sacral fractures were horizontal through the sacral body, involved the screw holes, and exited through the posterosuperior sacral alae. The fractures occurred within 3 months of fusion in 19 of 23 patients. All 23 patients had symptoms at the time of fracture. Seventeen of 23 fusions were long (more than four vertebrae). Four of 23 patients had osteoporosis. Eleven of 23 fractures healed without surgery, and 12 were managed with transiliac fixation.
Sacral fractures after lumbosacral fusion have a characteristic transverse pattern through the sacral screw holes that differs from the configuration of more common sacral insufficiency fractures. Most of these fractures occur within 3 months after surgery, and many of the patients need additional surgical fixation. Because few of the patients had osteoporosis and most underwent long fusion, the fractures might have been caused by hardware-related stress raisers in the sacrum.
本研究旨在描述腰骶融合术后骶骨骨折的影像学表现，并确定与影像学诊断相关的临床特征。
在我院对过去 5 年的 CT、核医学和 MRI 放射学报告进行检索，共发现 23 例腰骶融合术后骶骨骨折患者。两名放射科医生对所有图像进行了评估，以确定骶骨骨折的模式。对这些患者的临床记录进行了回顾，以了解手术间隔、融合长度、内固定物、入路、术前诊断、症状、治疗和危险因素。
所有 23 例骶骨骨折均为横断穿过骶骨体，累及螺钉孔，并从骶骨后上翼穿出。23 例患者中有 19 例在融合后 3 个月内发生骨折。所有 23 例患者在骨折时均有症状。23 例融合中有 17 例较长（超过 4 个椎体）。4 例患者有骨质疏松症。23 例骨折中有 11 例未经手术愈合，12 例采用经髂骨固定。
腰骶融合术后的骶骨骨折具有穿过骶骨螺钉孔的特征性横断模式，与更常见的骶骨不全骨折的形态不同。大多数骨折发生在术后 3 个月内，许多患者需要额外的手术固定。由于很少有患者有骨质疏松症，而且大多数患者都进行了长融合，这些骨折可能是由骶骨内固定物引起的应力集中所致。
