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Perkutane interne Fixation bei Beckenfrakturen

Percutaneous internal fixation of pelvic fractures. German version

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Zusammenfassung

Hintergrund

Für die perkutane interne Fixation von Beckenfrakturen, die sich zunehmender Beliebtheit erfreut, werden verschiedene neue Techniken beschrieben.

Ziel der Arbeit

Im vorliegenden Beitrag werden die bildgebende Diagnostik, Indikation, Planung, apparative Ausstattung, chirurgische Technik und Komplikationen dieser Verfahren dargestellt.

Methoden

Neben einem Überblick über die Literatur werden die Techniken für die anteriore und posteriore Beckenstabilisierung erörtert.

Ergebnisse

Hochwertige präoperative Computertomographie(CT)-Aufnahmen sind für dieses Verfahren essenziell. Der anteriore Fixateur interne („InFix“) ist eine wirkungsvolle Technik zur Stabilisierung des vorderen Beckenrings und sollte gewöhnlich zusammen mit einer posterioren Fixation eingesetzt werden. Bei guter Technik lassen sich neurovaskuläre Verletzungen vermeiden, welche eine äußerst folgenreiche Komplikation darstellen können. Die „retrograde anterior column screw“ (RACS, retrograde anteriore Hüftbeinschraube) ist ein Verfahren, das bei den meisten Patienten angewendet werden kann; bei kleineren Patienten sind aber möglicherweise kleinere Schraubendurchmesser erforderlich. Die Insertion der Schraube erfolgt bei Frauen weiter lateral als bei Männern. Iliosakralschrauben (ISS) stellen eine wirkungsvolle Methode der posterioren Stabilisierung dar und können unter Verwendung der 2‑D- oder der 3‑D-Durchleuchtung, der Computer- oder CT-Navigation platziert werden.

Schlussfolgerung

Die perkutane Fixation von Beckenfrakturen erfordert eine Bildgebung hoher Qualität und kann durch Computernavigation unterstützt werden. Die sicheren Verfahren sind reproduzierbar; allerdings können nicht alle Patienten und Frakturmuster mit diesen Verfahren behandelt werden.

Abstract

Background

Percutaneous internal fixation of pelvic fractures is increasing in popularity with multiple new techniques reported.

Objectives

The purpose of this article is to outline the imaging, indication, planning, equipment, surgical technique and complications of these methods.

Methods

A review of the literature is provided and the techniques for anterior and posterior pelvic stabilization are discussed.

Results

High-quality preoperative CT scans are essential in planning for this technique. The anterior internal fixator (“InFix”) is an effective method for stabilizing the anterior ring and should be usually used in conjunction with posterior fixation. Good technique avoids neurovascular injury, which can be a devastating complication. The retrograde anterior column screw (RACS) is a technique that can be used in most patients, although in smaller patients smaller screw diameters may be needed. The entry point for the screw is more lateral in women than men. Iliosacral screws (ISS) are an effective method of posterior stabilization and can be placed using 2D or 3D fluoroscopy, computer navigation or CT navigation.

Conclusion

Percutaneous fixation of pelvic fractures requires high-quality imaging and can be aided by computer navigation. Safe techniques are reproducible; however, not all patients and fracture patterns can be treated using these techniques.

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Authors and Affiliations

  1. Pelvic Reconstruction and Trauma Fellow, Royal Melbourne Hospital, Victoria, Australia

    A. J. Stevenson & A. T. Bucknill MBBS, MSc (Dist), FRCS, FRACS

  2. Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Ludwigshafen, Deutschland

    B. Swartman

  3. Head of Orthopaedic Surgery, The University of Melbourne, Royal Melbourne Hospital, 3050, Victoria, Australia

    A. T. Bucknill MBBS, MSc (Dist), FRCS, FRACS

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  1. A. J. Stevenson
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Correspondence to A. T. Bucknill MBBS, MSc (Dist), FRCS, FRACS.

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A. J. Stevenson, B. Swartman und A. T. Bucknill geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Die englische Version dieses Beitrags ist unter doi: 10.1007/s00113-016-0225-x zu finden.

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Stevenson, A.J., Swartman, B. & Bucknill, A.T. Perkutane interne Fixation bei Beckenfrakturen. Unfallchirurg 119, 825–834 (2016). https://doi.org/10.1007/s00113-016-0242-9

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