Balloon kyphoplasty versus vertebroplasty for treatment of osteoporotic vertebral compression fracture: a prospective, comparative, and randomized clinical study
Balloon kyphoplasty versus vertebroplasty for treatment of osteoporotic vertebral compression fracture: a prospective, comparative, and randomized clinical study
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DOI：
10.1007/s00198-009-0952-8
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发表时间：
2010-02-01
影响因子：
4
通讯作者：
Lin, T. B.
中科院分区：
文献类型：
--
作者：
Liu, J. T.;Liao, W. J.;Lin, T. B.
骨痛和脊柱轴向畸形是老年人椎体压缩性骨折（VCF）的主要问题。疼痛可以通过椎体成形术或椎体后凸成形术缓解，其中压缩的椎体填充有替代物。我们将100例胸腰椎（T-L）交界处椎体压缩性骨折患者随机分为两组：椎体成形术和椎体后凸成形术;我们使用聚甲基丙烯酸甲酯（PMMA）作为骨填充物。采用视觉模拟量表（VAS）评分评估治疗前后的疼痛，并通过重建的计算机断层扫描图像测量椎体高度和后凸楔角。椎体后凸成形术组使用的PMMA多于椎体成形术组（5.56 +/- 0.62 vs. 4.91 +/- 0.65 mL，p < 0.001）。T-L脊柱的椎体高度和后凸楔角也得到改善（p < 0.001）。治疗组间VAS疼痛评分无显著差异。随访时间为6个月。椎体后凸成形术组中有2例患者发生相邻节段骨折。在临床结局方面，治疗组之间几乎没有差异。因此，由于后凸球囊手术的成本较高，我们建议椎体成形术超过椎体后凸成形术用于治疗膨胀性VCFs.Spinal轴向畸形是患有膨胀性椎体压缩骨折的老年患者的主要问题。椎体成形术或椎体后凸成形术可缓解疼痛。我们研究了这些手术的影像学和临床结果，将100例胸腰交界处VCF患者随机分为两组：椎体成形术或椎体后凸成形术（各50例）。我们用聚甲基丙烯酸甲酯作为骨填充物。通过视觉模拟量表评分评估治疗前后的疼痛，并通过重建的计算机断层扫描图像测量椎体高度和后凸楔角，椎体后凸成形术组比椎体成形术组使用更多的PMMA（5.56 +/- 0.62 vs. 4.91 +/- 0.65 mL，p < 0.001）。T-L脊柱的椎体高度和后凸楔角也得到改善（p < 0.001）。治疗组间VAS疼痛评分无显著差异。随访时间为6个月。椎体后凸成形术组中有2例患者发生相邻节段骨折。就临床结局而言，两个治疗组之间几乎没有差异。因此，由于后凸球囊手术的成本较高，我们建议椎体成形术而不是椎体后凸成形术治疗椎体后凸性VCF。
Bone pain and spinal axial deformity are major concerns in aged patients suffering from osteoporotic vertebral compression fracture (VCF). Pain can be relieved by vertebroplasty or kyphoplasty procedures, in which the compressed vertebral body is filled with substitutes. We randomly assigned 100 patients with osteoporotic compression fracture at the thoraco-lumbar (T-L) junction into two groups: vertebroplasty and kyphoplasty; we used polymethylmethacrylate (PMMA) as the bone filler. Pain before and after treatment was assessed with visual analog scale (VAS) scores and vertebral body height and kyphotic wedge angle were measured from reconstructed computed tomography images. More PMMA was used in the kyphoplasty group than in the vertebroplasty group (5.56 +/- 0.62 vs. 4.91 +/- 0.65 mL, p < 0.001). Vertebral body height and kyphotic wedge angle of the T-L spine were also improved (p < 0.001). VAS pain scores did not differ significantly between the treatment groups. The duration of follow-up was 6 months. Two patients in the kyphoplasty group had an adjacent segment fracture. In terms of clinical outcome there was little difference between the treatment groups. Thus, owing to the higher cost of the kyphotic balloon procedure, we recommend vertebroplasty over kyphoplasty for the treatment of osteoporotic VCFs.Spinal axial deformities are major concerns in aged patients suffering from osteoporotic vertebral compression fracture. Pain may be relieved by vertebroplasty or kyphoplasty. We investigated the radiological and clinical outcomes of these procedures.One hundred cases of VCF at the thoraco-lumbar junction were randomly assigned into two groups: vertebroplasty or kyphoplasty (50 cases each). We used polymethylmethacrylate as the bone filler. Pain before and after treatment was assessed with visual analog scale scores and vertebral body height and kyphotic wedge angle were measured from reconstructed computed tomography images.More PMMA was used in the kyphoplasty group than in the vertebroplasty group (5.56 +/- 0.62 vs. 4.91 +/- 0.65 mL, p < 0.001). Vertebral body height and kyphotic wedge angle of the T-L spine were also improved (p < 0.001). VAS pain scores did not differ significantly between the treatment groups. The duration of follow-up was 6 months. Two patients in the kyphoplasty group had an adjacent segment fracture.In terms of clinical outcome there was little difference between the treatment groups. Thus, with the higher cost of the kyphotic balloon procedure, we recommend vertebroplasty over kyphoplasty for the treatment of osteoporotic VCFs.