Andresen Julian Ramin, Prokop Axel, Wollny Mathias, Radmer Sebastian, Schober Hans-Christof, Andresen Reimer
Fakultät für Medizin, Sigmund-Freud-Privatuniversität, Freudplatz 3, 1020, Wien, Österreich.
Klinik für Unfallchirurgie, Klinikum Sindelfingen-Böblingen, Akademisches Lehrkrankenhaus der Universität Tübingen, Sindelfingen, Deutschland.
Unfallchirurg. 2021 Jul;124(7):588-597. doi: 10.1007/s00113-020-00932-1. Epub 2020 Dec 10.
Insufficiency fractures of the sacrum are being detected increasingly more frequently, whereby their incidence will no doubt increase further as a result of the rise in life expectancy.
The clinical appearance of sacral insufficiency fractures, the treatment approach taking into account the clinical outcomes and the DRG proceeds are discussed on the basis of clinical examples.
Three female patients (average age 78.3 years) with sacral insufficiency fractures were admitted for inpatient treatment due to increasing disabling pain. Taking into account the clinical symptoms and the recommendation of an interdisciplinary case conference, one patient was treated conservatively with short-term bed rest, accompanying analgesic medication and pain-adapted exercise measures. The second patient underwent computed tomography (CT)-guided balloon sacroplasty. Transsacroiliac screw fixation was performed on the third patient. Pain was documented over the course on a visual analogue scale (VAS) and the degree of independence on the Barthel scale. The fractures were classified according to Denis et al. and the classification of the FFP according to Rommens and Hofmann. The DRG revenue for the 2020 accounting period was then presented for each case.
Patient No. 1: conservative therapy, unilateral Denis 1 fracture zone, corresponding to an FFP type IIa, baseline pain 7 score points, at discharge 4 score points, the Barthel scale increased from 55 to 75 points. After 6 days hospitalization, transferred to rehab. The DRG proceeds were € 3817.95. Patient No. 2: balloon sacroplasty, bilateral Denis 1-2 fracture zone, corresponding to an FFP type IIa, baseline pain 9 score points, at discharge 2 score points, the Barthel scale increased from 35 to 95 points. After 4 days hospitalization, discharged to outpatient follow-up treatment. The DRG proceeds were € 7409.44. Patient No. 3: osteosynthesis, bilateral Denis 1 fracture zone, corresponding to an FFP type IIa, baseline pain 7 score points, at discharge 2 score points, the Barthel scale increased from 40 to 90 points. After 5 days hospitalization, transferred to rehab. The DRG proceeds were € 6714.30.
The sacral insufficiency fracture is a strong indicator for the presence of manifest osteoporosis. Fracture risk factors are the female sex, advanced age, the presence of osteoporosis and vitamin D deficiency. Conservative therapy is the first step of the treatment cascade; however, in patients with persistent, disabling pain and no potential for mobilization, sacroplasty or osteosynthesis should be performed at an early stage. In patients treated with coordinated therapy processes and without clinical complications, all three treatment options are economically sufficient.
骶骨不全骨折的检出频率越来越高，随着预期寿命的增加，其发病率无疑还会进一步上升。
基于临床实例，探讨骶骨不全骨折的临床表现、考虑临床结果的治疗方法以及疾病诊断相关分组（DRG）费用。
三名患有骶骨不全骨折的女性患者（平均年龄78.3岁）因疼痛加剧导致功能障碍而入院接受住院治疗。根据临床症状并参考多学科病例讨论会的建议，一名患者接受了保守治疗，包括短期卧床休息、辅助镇痛药物以及根据疼痛情况调整的运动措施。第二名患者接受了计算机断层扫描（CT）引导下的球囊骶骨成形术。第三名患者接受了经骶髂螺钉固定术。通过视觉模拟评分法（VAS）记录整个病程中的疼痛情况，并通过Barthel量表记录独立程度。根据Denis等人的方法对骨折进行分类，并根据Rommens和Hofmann的方法对FFP进行分类。然后列出每个病例在2020会计期间的DRG收入。
1号患者：保守治疗，单侧Denis 1骨折区，对应FFP IIa型，基线疼痛评分为7分，出院时为4分，Barthel量表评分从55分提高到75分。住院6天后，转至康复机构。DRG费用为3817.95欧元。2号患者：球囊骶骨成形术，双侧Denis 1 - 2骨折区，对应FFP IIa型，基线疼痛评分为9分，出院时为2分，Barthel量表评分从35分提高到95分。住院4天后，出院接受门诊随访治疗。DRG费用为7409.44欧元。3号患者：内固定术，双侧Denis 1骨折区，对应FFP IIa型，基线疼痛评分为7分，出院时为2分，Barthel量表评分从40分提高到90分。住院5天后，转至康复机构。DRG费用为6714.30欧元。
骶骨不全骨折是明显骨质疏松症存在的有力指标。骨折的危险因素包括女性、高龄、骨质疏松症和维生素D缺乏。保守治疗是治疗流程的第一步；然而，对于持续存在功能障碍性疼痛且无法活动的患者，应尽早进行骶骨成形术或内固定术。在接受协调治疗且无临床并发症的患者中，所有三种治疗选择在经济上都是可行的。
