Boszczyk B, Bierschneider M, Potulski M, Robert B, Vastmans J, Jaksche H
Abteilung für Neurochirurgie, Berufsgenossenschaftliche Unfallklinik Murnau, Germany.
Unfallchirurg. 2002 Oct;105(10):952-7. doi: 10.1007/s00113-002-0495-3.
Percutaneous vertebroplasty with polymethylmethacrylate allows minimally invasive stabilization of osteoporotic vertebral fractures. Fracture reduction is, however, not possible and the risk of uncontrolled epidural cement leakage with burst fractures is increased. Kyphoplasty, in contrast, allows a degree of fracture reduction and provides an extended spectrum of indications through open approaches, which enable spinal decompression and augmentation of incomplete burst fractures. METHODS. In kyphoplasty a contrast-filled balloon is inflated in the vertebra until a cavern is created. A degree of reposition may be achieved depending on fracture age. Augmentation is performed with high-viscosity polymethylmethacrylate under low pressure. In cases of neural compression, interlaminary spinal decompression and kyphoplasty through the posterior wall is performed. With anterior spinal procedures, kyphoplasty can be performed without extending the approach.
Vertebral augmentation was performed by percutaneous, interlaminary, and anterior approaches for incomplete burst fractures. Four representative cases are presented from a collective of 120 augmentations.
Percutaneous kyphoplasty, supplemented by open approaches, enables augmentation of osteoporotic incomplete burst fractures.
经皮聚甲基丙烯酸甲酯椎体成形术可实现骨质疏松性椎体骨折的微创稳定。然而，无法实现骨折复位，且爆裂骨折时硬膜外骨水泥渗漏失控的风险会增加。相比之下，后凸成形术允许一定程度的骨折复位，并通过开放手术提供更广泛的适应症，从而实现脊髓减压和不完全爆裂骨折的强化。方法：在后凸成形术中，将充满造影剂的球囊在椎体内膨胀，直到形成一个空洞。根据骨折时间可实现一定程度的复位。在低压下用高粘度聚甲基丙烯酸甲酯进行强化。在神经受压的情况下，通过后壁进行椎板间脊髓减压和后凸成形术。对于前路脊柱手术，可在不扩大手术入路的情况下进行后凸成形术。结果：通过经皮、椎板间和前路手术对不完全爆裂骨折进行椎体强化。从120例强化手术病例中选取了4个代表性病例进行展示。结论：经皮后凸成形术辅以开放手术，可实现骨质疏松性不完全爆裂骨折的强化。
