Dasgupta B, Shah N, Brown H, Gordon T E, Tanqueray A B, Mellor J A
Southend Health Care Trust, Prittlewell Chase, Westcliff-on-Sea, Essex.
Br J Rheumatol. 1998 Jul;37(7):789-93. doi: 10.1093/rheumatology/37.7.789.
We describe 10 cases of sacral fractures diagnosed within the rheumatology department at Southend Hospital over the last 5 yr. All presented with sudden-onset low back pain. The majority were elderly, frail, with chronic inflammatory disease (six with rheumatoid arthritis, one with polymyalgia rheumatica, one with vasculitis) and had received steroids. Diagnosis was delayed by the inability of plain radiographs to show these fractures and was ultimately demonstrated by technetium scintigraphy/computed tomography scan. We feel that this diagnosis should be considered in elderly patients with rheumatoid arthritis or other risk factors for osteoporosis who present with low back pain and sacral tenderness. Further clues may be parasymphyseal tenderness (suggesting associated pubic ramus fracture), elevated alkaline phosphatase and plain radiograph showing pubic ramus fractures or parasymphyseal sclerosis. Patients with this complication generally have a poor prognosis and two of our patients have died. Seven required in-patient stay (mean 20 days; range 14-41). The mortality, morbidity and costs incurred in management may be comparable to those of femoral neck fractures.
我们描述了过去5年在绍森德医院风湿病科确诊的10例骶骨骨折病例。所有患者均突发腰痛。大多数患者为老年体弱，患有慢性炎症性疾病（6例类风湿关节炎、1例风湿性多肌痛、1例血管炎）且曾接受过类固醇治疗。由于普通X线片无法显示这些骨折，诊断被延迟，最终通过锝骨闪烁显像/计算机断层扫描得以证实。我们认为，对于患有类风湿关节炎或其他骨质疏松风险因素且出现腰痛和骶骨压痛的老年患者，应考虑这一诊断。进一步的线索可能是耻骨联合旁压痛（提示合并耻骨支骨折）、碱性磷酸酶升高以及普通X线片显示耻骨支骨折或耻骨联合旁硬化。出现这种并发症的患者通常预后较差，我们的两名患者已经死亡。7例患者需要住院治疗（平均20天；范围14 - 41天）。管理过程中产生的死亡率、发病率和费用可能与股骨颈骨折相当。
