Koch C A, Layton K F, Kallmes D F
Mayo Clinic College of Medicine, Rochester, MI 55905, USA.
AJNR Am J Neuroradiol. 2007 Mar;28(3):563-6.
The purpose of this study was to determine the efficacy and rate of complications in patients undergoing percutaneous vertebroplasty (PVP) for vertebral compression fractures as a result of secondary osteoporosis caused by long-term corticosteroid use compared with patients with primary osteoporosis treated with PVP.
A retrospective review of all patients undergoing PVP was conducted to identify patients who also received long-term corticosteroid therapy. Outcomes including pain, periprocedural complications, and frequency of new fractures in patients receiving corticosteroids were compared with control patients undergoing PVP for primary osteoporosis.
Sixty-eight patients receiving long-term corticosteroid therapy underwent 79 PVP procedures. Patients treated with corticosteroids undergoing PVP were significantly younger and more likely to be male compared with control subjects. Patients receiving long-term corticosteroid treatment experienced significant pain relief immediately postprocedure and at 1 week, 1 month, 6 months, 1 year and 2 years postprocedure (P < .0001 at all time points). Patients receiving corticosteroids experienced similar decreases in pain from baseline compared with control subjects at all follow-up time points (P > .05). The complication rate for patients receiving corticosteroids was 4.4% compared with 3.4% for control subjects (P = .60). Patients on long-term corticosteroid treatment did not have an increased risk of new fractures after PVP compared with control subjects (P = .68).
Percutaneous vertebroplasty performed for vertebral compression fractures as a result of long-term corticosteroid therapy is as safe and effective in relieving pain as PVP performed in patients with vertebral compression fractures as a result of primary osteoporosis.
本研究的目的是确定因长期使用皮质类固醇导致继发性骨质疏松而接受经皮椎体成形术(PVP)的患者与接受PVP治疗的原发性骨质疏松患者的疗效及并发症发生率。
对所有接受PVP的患者进行回顾性研究,以确定同时接受长期皮质类固醇治疗的患者。将接受皮质类固醇治疗患者的疼痛、围手术期并发症及新发骨折频率等结果与接受PVP治疗的原发性骨质疏松对照患者进行比较。
68例接受长期皮质类固醇治疗的患者接受了79次PVP手术。与对照组相比,接受皮质类固醇治疗并接受PVP的患者明显更年轻,且男性比例更高。接受长期皮质类固醇治疗的患者在术后即刻、术后1周、1个月、6个月、1年和2年时疼痛均有显著缓解(所有时间点P <.0001)。在所有随访时间点,接受皮质类固醇治疗的患者与对照患者相比,疼痛较基线水平的下降幅度相似(P >.05)。接受皮质类固醇治疗患者的并发症发生率为4.4%,而对照患者为3.4%(P =.60)。与对照患者相比,长期接受皮质类固醇治疗的患者在PVP术后发生新发骨折的风险并未增加(P =.68)。
因长期皮质类固醇治疗导致椎体压缩骨折而进行的经皮椎体成形术在缓解疼痛方面与因原发性骨质疏松导致椎体压缩骨折患者接受的PVP一样安全有效。