Gotis-Graham I, McGuigan L, Diamond T, Portek I, Quinn R, Sturgess A, Tulloch R
St George Hospital, Kogarah, Australia.
J Bone Joint Surg Br. 1994 Nov;76(6):882-6.
Sacral insufficiency fractures are not uncommon in elderly patients. We have diagnosed 20 cases in a five-year period, and have reviewed the clinical records, radiographs, CT and bone scans. We also assessed the degree of osteoporosis by measuring bone density using dual-energy X-ray absorptiometry and bone histomorphometry, and monitored the patients' functional outcome. Bone scans were positive in all 20 patients, CT showed a fracture or sclerosis in 7 of 12 patients and was useful in excluding malignancy. Plain radiographs were the least helpful, showing sclerosis in only 4 of the 20 patients. Involutional osteoporosis with a reduced bone formation rate was the most common underlying cause. Seventeen patients had complete resolution of pain within nine months, and no patient lost independence in daily activities. Increased awareness of these fractures may help to avoid unnecessary investigation and treatment. Bedrest and analgesia followed by rehabilitation provide good relief of symptoms.
骶骨不全骨折在老年患者中并不少见。我们在五年内诊断出20例，并回顾了临床记录、X线片、CT和骨扫描。我们还通过双能X线吸收法和骨组织形态计量学测量骨密度来评估骨质疏松程度，并监测患者的功能转归。20例患者的骨扫描均为阳性，12例患者中的7例CT显示有骨折或骨质硬化，CT有助于排除恶性肿瘤。平片的帮助最小，20例患者中只有4例显示有骨质硬化。骨形成率降低的老年性骨质疏松是最常见的潜在病因。17例患者在九个月内疼痛完全缓解，没有患者在日常生活中失去自理能力。提高对这些骨折的认识可能有助于避免不必要的检查和治疗。卧床休息、止痛，随后进行康复治疗能有效缓解症状。
