Kim Tae-Kyun, Kim Kyung-Hoon, Kim Cheul-Hong, Shin Sang-Wook, Kwon Jae-Young, Kim Hae-Kyu, Baik Seong-Wan
Department of Anesthesia and Pain Medicine, College of Medicine, Pusan National University, Busan, Korea.
J Korean Med Sci. 2005 Dec;20(6):1023-8. doi: 10.3346/jkms.2005.20.6.1023.
It is surprising that about 24% of patients with benign osteoporotic vertebral fracture die within a year from respiratory infection and urinary tract infection because of coughing and voiding difficulties, depending on the sites of compression fractures. We reviewed 500 patients on whom percutaneous vertebroplasty (PVP) was performed, at 612 levels in terms of patient selection, operation technique, medication, and clinical outcomes during the follow-up course for 2 yr study period. To confirm the most painful level among the multiple fracture sites, physical examination after facet joint block under the fluoroscope was the most reliable method. The mean total lumbar spine fracture threshold of bone mineral density was 0.81+/-0.05 g/cm2. The mean changes of numeric rating scale scores, Oswestry Disability Index except sex life, and Karnofsky performance status were -72.00, -83.50 and +60.62% in the osteoporosis group and -51.89, -45.02, and 69.03% in the tumor group. Complications related to the procedure were lateral spinal cord damage, transient paresthesia and transient hypotension. PVP with facet joint block is a profitable method for the vertebral compression fracture because of low risk and short duration of procedure with a high chance to result in pain relief and early mobilization.
令人惊讶的是,约24%的良性骨质疏松性椎体骨折患者会在一年内因咳嗽和排尿困难导致的呼吸道感染和尿路感染而死亡,这取决于压缩性骨折的部位。我们回顾了500例行经皮椎体成形术(PVP)的患者,在为期2年的研究随访过程中,从患者选择、手术技术、药物治疗及临床结果等方面对612个椎体水平进行了分析。为确定多个骨折部位中最疼痛的椎体水平,在透视引导下进行小关节阻滞术后的体格检查是最可靠的方法。腰椎椎体骨密度骨折阈值的平均值为0.81±0.05g/cm²。骨质疏松组数字评分量表分数、除性生活外的Oswestry功能障碍指数以及卡氏功能状态评分的平均变化分别为-72.00、-83.50和+60.62%,肿瘤组分别为-51.89、-45.02和69.03%。与该手术相关的并发症有脊髓侧方损伤、短暂性感觉异常和短暂性低血压。因风险低、手术时间短、缓解疼痛及早期活动机会大,PVP联合小关节阻滞是治疗椎体压缩性骨折的有效方法。