Masala Salvatore, Ciarrapico Anna Micaela, Konda Daniel, Vinicola Vincenzo, Mammucari Matteo, Simonetti Giovanni
Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiation Therapy, University Polyclinic of Tor Vergata, Viale Oxford 81, 00133 Rome, Italy.
Eur Spine J. 2008 Sep;17(9):1242-50. doi: 10.1007/s00586-008-0708-8. Epub 2008 Jul 18.
A retrospective study was conducted in 179 consecutive patients (48 males, 131 females; mean age: 72.0 +/- 8.59 years; range: 51-93) with single symptomatic acute amyelic osteoporotic vertebral fracture presenting between September 2004 and September 2005 to the Santa Lucia Foundation in Rome, Italy. Vertebral fractures usually become manifest due to pain which can be debilitating. Treatment depends on the presence or absence of spinal cord involvement. In the first case, surgical stabilization is mandatory. In the second case, treatment may be performed either by conservative medical therapy (CMT) or percutaneous vertebroplasty (PVT). The aim of this study was to evaluate the effectiveness, costs and cost-effectiveness of percutaneous vertebroplasty. After 2 weeks of analgesic therapy, 153 patients presented refractory pain and were offered treatment by PVT. A total of 58 patients accepted and underwent PVT (PVT group), while 95 refused and underwent conservative medical therapy (CMT group). Follow-up was performed by specialist consults, spine radiography and MRI and a self-assessment questionnaire evaluating pain using a Visual Analogue Scale (VAS) and function using an ambulation and an Activities of Daily Living (ADL) scale. A 12-month follow-up was obtained in 86 of 95 (90.5%) CMT group patients and 54 of 58 (93.1%) PVT group patients. Significant reduction of VAS and improvement of ambulation and ADL was observed in both groups at 1 week and 3 and 12 months (P < 0.05; Wilcoxon signed rank test), however, these results were significantly superior in the PVT group at 1 week and 3 months (P < 0.05; Mann-Whitney U test). Average cost per patient at 1 week and 3 and 12 months were respectively 755.49 +/- 661.96, 3791.95 +/- 3341.97 and 4299.55 +/- 3211.53 euros (CMT group) and 3311.35 +/- 0.32, 3745.30 +/- 3.59 and 4101.05 +/- 755.41 euros (PVT group). PVT resulted significantly more cost-effective than CMT with regards to the three scales at 1 week (P < 0.05; Mann-Whitney U test). At 3 months PVT was more cost-effective than CMT with regards to the three scales, however, the difference was significant only with regards to ambulation. No significant differences in cost-effectiveness where found between the two groups at 12 months. PVT should be considered the treatment of first choice in symptomatic acute amyelic osteoporotic vertebral fractures with refractory pain after a short period of analgesic therapy.
对2004年9月至2005年9月期间连续收治于意大利罗马圣卢西亚基金会的179例（48例男性，131例女性；平均年龄：72.0±8.59岁；范围：51 - 93岁）有症状的单发性急性骨质疏松性椎体骨折患者进行了一项回顾性研究。椎体骨折通常因疼痛而显现，疼痛可能使人衰弱。治疗取决于是否存在脊髓受累。在第一种情况下，手术稳定是必要的。在第二种情况下，治疗可通过保守药物治疗（CMT）或经皮椎体成形术（PVT）进行。本研究的目的是评估经皮椎体成形术的有效性、成本和成本效益。经过2周的镇痛治疗后，153例患者仍有顽固性疼痛，并被提供PVT治疗。共有58例患者接受并进行了PVT（PVT组），而95例患者拒绝并接受了保守药物治疗（CMT组）。通过专科会诊、脊柱X线摄影和MRI以及一份使用视觉模拟量表（VAS）评估疼痛并使用行走和日常生活活动（ADL）量表评估功能的自我评估问卷进行随访。CMT组95例患者中的86例（90.5%）和PVT组58例患者中的54例（93.1%）获得了12个月的随访。两组在1周、3个月和12个月时VAS均显著降低，行走和ADL均有改善（P<0.05；Wilcoxon符号秩检验），然而，这些结果在1周和3个月时PVT组显著优于CMT组（P<0.05；Mann-Whitney U检验）。CMT组患者在1周、3个月和12个月时的平均每位患者成本分别为755.49±661.96、3791.95±3341.97和4299.55±3211.53欧元，PVT组分别为3311.35±0.32、3745.30±3.59和4101.05±755.41欧元。在1周时，就三个量表而言，PVT的成本效益显著高于CMT（P<0.05；Mann-Whitney U检验）。在3个月时，就三个量表而言，PVT比CMT更具成本效益，然而，差异仅在行走方面显著。两组在12个月时的成本效益无显著差异。对于短期镇痛治疗后有顽固性疼痛的有症状急性骨质疏松性椎体骨折，PVT应被视为首选治疗方法。
