Kyphoplasty in osteoporotic vertebral compression fractures--guidelines and technical considerations.
Kyphoplasty in osteoporotic vertebral compression fractures--guidelines and technical considerations.
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DOI：
10.1186/1749-799x-6-43
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发表时间：
2011-08-19
影响因子：
2.6
通讯作者：
Olerud C
中科院分区：
文献类型：
--
作者：
Robinson Y;Heyde CE;Försth P;Olerud C
骨质疏松性椎体压缩性骨折是对老年人的威胁，由于疼痛和畸形导致生活质量下降。起初，保守治疗仍是首选方法。在导致畸形、烧结和持续疼痛的情况下，目前广泛使用椎体骨水泥增强技术。通过不同类型的截骨术对畸形进行开放矫正，解决了矢状面平衡问题，但发病率很高。除了传统的椎体骨水泥增强技术外，球囊椎体后凸成形术已成为治疗疼痛性胸腰椎压缩性骨折的常用工具。与标准椎体成形术相比，它显示出疼痛减轻和并发症发生率降低。有趣的是，两项安慰剂对照椎体成形术研究的结果质疑了骨水泥强化的价值，如果与假手术相比。尽管目前有一项随机对照试验对椎体后凸成形术有有利的数据，但由于缺乏假手术组，安慰剂效应尚未得到解决。从技术上讲，椎体后凸成形术可以通过经椎弓根或椎弓根外入路进行。聚甲基丙烯酸甲酯（PMMA）-骨水泥应受到青睐，因为磷酸钙骨水泥显示出较差的生物力学性能和减少疼痛的效果，特别是在不太稳定的爆裂骨折。椎体后凸成形术的常见并发症是骨水泥渗漏和相邻节段骨折。罕见的并发症是PMMA单体毒性反应、骨水泥栓塞和感染。
Osteoporotic vertebral compression fractures are a menace to the elderly generation causing diminished quality of life due to pain and deformity. At first, conservative treatment still is the method of choice. In case of resulting deformity, sintering and persistent pain vertebral cement augmentation techniques today are widely used. Open correction of resulting deformity by different types of osteotomies addresses sagittal balance, but has comparably high morbidity. Besides conventional vertebral cement augmentation techniques balloon kyphoplasty has become a popular tool to address painful thoracic and lumbar compression fractures. It showed improved pain reduction and lower complication rates compared to standard vertebroplasty. Interestingly the results of two placebo-controlled vertebroplasty studies question the value of cement augmentation, if compared to a sham operation. Even though there exists now favourable data for kyphoplasty from one randomised controlled trial, the absence of a sham group leaves the placebo effect unaddressed. Technically kyphoplasty can be performed with a transpedicular or extrapedicular access. Polymethyl methacrylate (PMMA)-cement should be favoured, since calcium phosphate cement showed inferior biomechanical properties and less effect on pain reduction especially in less stable burst fractures. Common complications of kyphoplasty are cement leakage and adjacent segment fractures. Rare complications are toxic PMMA-monomer reactions, cement embolisation, and infection.