没有骶骨吗?骶骨损伤骨折的识别和治疗

IF 0.1 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Nicholaus Monsma, Rebecca Le, Robert Brooks, Evan Basha, Garrett Schneider
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引用次数: 0

摘要

骶骨闭锁不全骨折是一种被忽视的背痛病因,也很难通过影像学诊断。包括磁共振成像和闪烁成像在内的先进成像技术是诊断的有用方法,因为这些骨折在平片上经常被漏诊。治疗通常采用保守疗法,以避免手术固定,而手术固定因其发病率高而很少采用。放射科医生还可以通过骶骨成形术缓解症状,这是一种微创、经皮、图像引导的手术,于 2002 年首次被描述。骨盆发育不全骨折最常见的部位包括骶骨髂骨和耻骨联合骨旁区域。蝶形或 "H "形形态是这种骨折在闪烁扫描中的典型表现,在后方最易观察到。磁共振成像被认为是诊断闭合不全骨折的金标准,其特征是低 T1 带状信号强度和相应的高 T2/T2 短陶反转恢复(STIR)信号强度。此类骨折可通过骶骨成形术进行治疗,即通过一个或多个套管针小心注射聚甲基丙烯酸甲酯骨水泥。在手术过程中,了解骶骨解剖至关重要,以免侵犯特定的骶骨区或穿越任何神经孔。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Is Nothing Sacrum? Identification and Treatment of Sacral Insufficiency Fractures
Sacral insufficiency fractures are an overlooked etiology of back pain that can also be difficult to diagnose radiographically. Advanced imaging, including MR and scintigraphy, are useful modalities for diagnosis, as these fractures are frequently missed on plain films. Management is often conservative to avoid surgical fixation, a rarely performed surgery due to its high morbidity. Radiologists are also able to provide symptomatic relief via sacroplasty, a minimally invasive, percutaneous, image-guided procedure first described in 2002. The most common sites of pelvic insufficiency fractures include the sacral ala and parasymphyseal region of the os pubis. The butterfly or “H-shaped” pattern is a classic sign of this fracture on scintigraphy, best appreciated posteriorly. MR is considered the gold standard in diagnosing insufficiency fractures and is characterized by low T1 band-like signal intensity with corresponding high T2/T2 short-tau inversion recovery (STIR) signal intensity. Such fractures can be treated via sacroplasty by carefully injecting polymethylmethacrylate bone cement via one or more trocar needles. Knowledge of sacral anatomy is critical during the procedure to not violate specific sacral zones or traverse any of the neural foramina.
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