椎体后凸成形术——一种用于重新定位和稳定椎体的新型微创治疗方法

[Kyphoplasty - a new minimally invasive treatment for repositioning and stabilising vertebral bodies].

作者信息

Weisskopf M, Herlein S, Birnbaum K, Siebert C, Stanzel S, Wirtz D C

机构信息

Orthopädische Universitätsklinik, Klinikum der Rheinisch Westfälischen Technischen Hochschule Aachen, Germany.

出版信息

Z Orthop Ihre Grenzgeb. 2003 Jul-Aug;141(4):406-11. doi: 10.1055/s-2003-41564.

DOI:10.1055/s-2003-41564

PMID:12928997

Abstract

AIM OF THE STUDY

Osteoporotic vertebral fractures are an ailment of the aging population of increasing incidence and high socioeconomic impact. Intractable pain causing significant morbidity leads to long-term hospitalisation. Kyphoplasty offers a new minimal invasive operative stabilisation procedure for these vertebral compression fractures. This study is conducted to investigate whether this procedure significantly reduces both pain and the duration of hospital stay in comparison to conservative treatment modalities.

METHOD

From January until July 2002 a total of 22 patients had undergone kyphoplasty in 37 vertebral bodies. Osteoporotic vertebral fractures were treated in 18 cases, while in another 4 cases prophylactic stabilisation for osteolytic lesions was performed. Both the duration of hospital stay and the reduction of pain symptoms were determined and compared to a conservatively treated control group of 20 patients suffering from 35 fractured vertebral bodies. Pre- and postoperative endplate angles were measured to assess the restoration of the sagittal alignment. The effects on pain symptoms were measured on a self-reported Visual Analogue Score Scale.

RESULTS

The mean pain relief for the patients undergoing kyphoplasty was 82 %, which was significantly higher (p < 0.0001) compared to the group of the conservatively treated patients (42 %). Reduction of the kyphotic deformity was achieved in 4 cases (average 8.5 degrees ). The average in-patient treatment duration for the surgical treated patients was 10 days as opposed to a significantly longer mean hospitalisation of 20 days (p = 0.003). Cement extravasation was observed in 5 out of 37 treated vertebral bodies without clinical sequelae.

CONCLUSION

Kyphoplasty is a safe minimal invasive procedure for the stabilisation of osteoporotic vertebral fractures leading to a statistically significant reduction both of pain status and duration of hospitalisation.

摘要

研究目的

骨质疏松性椎体骨折是一种在老年人群中发病率不断上升且具有较高社会经济影响的疾病。导致严重发病的顽固性疼痛会导致长期住院。椎体后凸成形术为这些椎体压缩骨折提供了一种新的微创手术稳定方法。本研究旨在调查与保守治疗方式相比，该手术是否能显著减轻疼痛并缩短住院时间。

方法

2002年1月至7月，共有22例患者接受了37个椎体的椎体后凸成形术。其中18例为骨质疏松性椎体骨折，另外4例为溶骨性病变的预防性稳定治疗。确定了住院时间和疼痛症状的减轻情况，并与20例患有35个骨折椎体的保守治疗对照组进行比较。测量术前和术后终板角度以评估矢状位对线的恢复情况。疼痛症状的影响通过自我报告的视觉模拟评分量表进行测量。

结果

接受椎体后凸成形术的患者平均疼痛缓解率为82%，与保守治疗患者组（42%）相比显著更高（p < 0.0001）。4例患者实现了后凸畸形的减轻（平均8.5度）。手术治疗患者的平均住院治疗时间为10天，而保守治疗患者的平均住院时间明显更长，为20天（p = 0.003）。在37个接受治疗的椎体中有5个观察到骨水泥渗漏，但无临床后遗症。