Melton L Joseph, Kallmes David F
Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, 200 First Street Southwest, Rochester, MN 55905, USA.
Acad Radiol. 2006 May;13(5):538-45. doi: 10.1016/j.acra.2006.01.005.
To put vertebral augmentation (eg, vertebroplasty) into perspective, the etiology and outcomes of vertebral fractures are reviewed. There is considerable debate about which criteria should be used to define a vertebral fracture because there is no consistent relation between symptoms and the degree of vertebral deformity. However, it is the more significant vertebral body deformities that are most closely associated with frequent or severe back pain, and the referrals for vertebral augmentation come mainly from this subset of patients. In addition to their vertebral fractures, these patients typically have osteoporosis or elevated bone turnover, and they are at greatly increased risk of subsequent fractures as a result of falling or, more often, excessive spinal loads from activities of everyday living. Additional risk factors for new vertebral fractures include the number and severity of vertebral deformities at baseline. Moreover, new fractures are most likely in nearby vertebrae, and they occur more frequently in the mid-thoracic or thoracolumbar regions of the spine. Interestingly, these are also the characteristics of the subsequent fractures of contiguous vertebrae considered by some to represent a complication of vertebral augmentation, yet they characterize vertebral fracture risk even in untreated patients. Vertebral fractures are very common among older men and postmenopausal women; they are associated with substantial morbidity and mortality; and they may have a devastating impact on the patient's quality of life. Vertebral augmentation may be able to help many of these patients, although opportunities exist to optimize management strategies with respect to the other factors that influence long-term outcomes in this patient population.
为正确看待椎体强化术（如椎体成形术），本文回顾了椎体骨折的病因及治疗结果。关于应采用哪些标准来定义椎体骨折存在诸多争议，因为症状与椎体畸形程度之间并无一致关联。然而，较为显著的椎体畸形与频繁或严重的背痛联系最为紧密，椎体强化术的转诊主要来自这类患者群体。除了椎体骨折外，这些患者通常还患有骨质疏松症或骨转换率升高，由于跌倒，或者更常见的是日常生活活动中脊柱负荷过大，他们随后发生骨折的风险大幅增加。新发椎体骨折的其他风险因素包括基线时椎体畸形的数量和严重程度。此外，新发骨折最有可能发生在邻近椎体，且在脊柱的中胸段或胸腰段更为频繁。有趣的是，这些也是一些人认为代表椎体强化术并发症的相邻椎体后续骨折的特征，但即使在未经治疗的患者中，它们也是椎体骨折风险的特征。椎体骨折在老年男性和绝经后女性中非常常见；它们与较高的发病率和死亡率相关；并且可能对患者的生活质量产生毁灭性影响。椎体强化术或许能够帮助许多此类患者，尽管在优化针对影响该患者群体长期预后的其他因素的管理策略方面仍有机会。
