Garfin S R, Yuan H A, Reiley M A
University of California, San Diego, California, USA.
Spine (Phila Pa 1976). 2001 Jul 15;26(14):1511-5. doi: 10.1097/00007632-200107150-00002.
Literature review.
To describe new treatments for painful osteoporotic compression fractures in light of available scientific literature and clinical experience.
Painful vertebral osteoporotic compression fractures lead to significant morbidity and mortality. This relates to pulmonary dysfunction, eating disorders (nutritional deficits), pain, loss of independence, and mental status change (related to pain and medications). Medications to treat osteoporosis (primarily antiresorptive) do not effectively treat the pain or the fracture, and require over 1 year to reduce the degree of osteoporosis. Kyphoplasty and vertebroplasty are new techniques that help decrease the pain and improve function in fractured vertebrae.
This is a descriptive review of the background leading to vertebroplasty and kyphoplasty, a description of the techniques, a review of the literature, as well as current ongoing studies evaluating kyphoplasty.
Both techniques have had a very high acceptance and use rate. There is 95% improvement in pain and significant improvement in function following treatment by either of these percutaneous techniques. Kyphoplasty improves height of the fractured vertebra, and improves kyphosis by over 50%, if performed within 3 months from the onset of the fracture (onset of pain). There is some height improvement, though not as marked, along with 95% clinical improvement, if the procedure is performed after 3 months. Complications occur with both and relate to cement leakage in both, and cement emboli with vertebroplasty.
Kyphoplasty and vertebroplasty are safe and effective, and have a useful role in the treatment of painful osteoporotic vertebral compression fractures that do not respond to conventional treatments. Kyphoplasty offers the additional advantage of realigning the spinal column and regaining height of the fractured vertebra, which may help decrease the pulmonary, GI, and early morbidity consequences related to these fractures. Both procedures are technically demanding.
文献综述。
根据现有科学文献和临床经验，描述疼痛性骨质疏松性压缩骨折的新治疗方法。
疼痛性椎体骨质疏松性压缩骨折会导致显著的发病率和死亡率。这与肺功能障碍、饮食失调（营养缺乏）、疼痛、失去独立性以及精神状态改变（与疼痛和药物有关）有关。治疗骨质疏松症的药物（主要是抗吸收药物）不能有效治疗疼痛或骨折，且需要超过1年的时间来降低骨质疏松程度。椎体后凸成形术和椎体成形术是有助于减轻骨折椎体疼痛并改善功能的新技术。
这是一篇对导致椎体成形术和椎体后凸成形术的背景的描述性综述、技术描述、文献综述以及当前正在进行的评估椎体后凸成形术的研究。
这两种技术的接受度和使用率都非常高。通过这两种经皮技术中的任何一种进行治疗后，疼痛改善率达到95%，功能也有显著改善。椎体后凸成形术能改善骨折椎体的高度，如果在骨折发生（疼痛开始）后3个月内进行，还能使后凸畸形改善超过50%。如果在3个月后进行该手术，虽然高度也有一定改善，但不如前者明显，不过临床改善率仍为95%。两种手术都有并发症，都与骨水泥渗漏有关，椎体成形术还与骨水泥栓塞有关。
椎体后凸成形术和椎体成形术安全有效，在治疗对传统治疗无反应的疼痛性骨质疏松性椎体压缩骨折方面具有重要作用。椎体后凸成形术还具有使脊柱重新排列并恢复骨折椎体高度的额外优势，这可能有助于减少与这些骨折相关的肺部、胃肠道及早期发病后果。这两种手术在技术上都要求较高。
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