Sellei Richard Martin, Kobbe Philipp
Klinik für Unfallchirurgie und Orthopädische Chirurgie, Sana Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach am Main, Deutschland.
Klinik für Unfallchirurgie und Wiederherstellungschirurgie, Universitätsklinik der RWTH Aachen, Pauwelsstrasse 30, Aachen, 52074, Deutschland.
Orthopade. 2019 Oct;48(10):837-843. doi: 10.1007/s00132-019-03773-y.
In trauma care of fragility fractures of the spine, degenerative stenosis is often seen as an accompanying pathology. This may lead to a possible compression of neurogenic structures. The stenosis of the spinal canal can manifest itself with clinically significant complaints before the fracture occurs. This coexistence may have an impact on the injury itself or may provoke a complicated treatment of the fracture.
The aim of this work is to differentiate these pathophysiologies and their merger in terms of clinical diagnostics and treatment options.
The differential diagnosis is difficult and is often inadequately appreciated in everyday clinical life. The etiology and pathophysiology of both entities show, in several aspects, a congruence that enables joint treatment. If the indication is set for the decompression of a stenosing fracture, a pre-existing relevant stenosis can be addressed in the same session. Conversely, significant degenerative stenosis accompanying a fracture may lead to the indication of decompression.
在脊柱脆性骨折的创伤护理中，退行性狭窄常被视为一种伴随病变。这可能导致神经源性结构受到潜在压迫。椎管狭窄可能在骨折发生前就出现具有临床意义的症状。这种共存情况可能会对损伤本身产生影响，或引发骨折的复杂治疗。
这项工作的目的是在临床诊断和治疗选择方面区分这些病理生理学及其合并情况。
鉴别诊断困难，在日常临床实践中常常未得到充分认识。这两种情况的病因和病理生理学在几个方面存在一致性，使得可以进行联合治疗。如果决定对狭窄性骨折进行减压，那么同时可以处理已存在的相关狭窄。相反，骨折伴有的明显退行性狭窄可能导致减压的指征。
