University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA.
Skeletal Radiol. 2010 Feb;39(2):117-30. doi: 10.1007/s00256-009-0722-x.
Insufficiency fractures of the pelvis, sacrum, spine, and long bones are painful, debilitating, and are common consequences of osteoporosis. Conventional treatment for these fractures varies from conservative therapy to surgery with plate and screw fixation. The former fails to address the underlying problem of fracture and frequently does not alleviate symptoms, while the latter is invasive and not always possible in older populations with low bone density and numerous co-morbidities. Osseous augmentation with polymethylmethacrylate (PMMA) has been used for over two decades to treat fractures related to osteoporosis, but has not been commonly used to treat fractures outside of the vertebral bodies. Osseous augmentation with PMMA is an image-guided procedure and various techniques have been utilized to treat fracture in different locations. We describe various techniques for image-guided osseous augmentation and treatment of insufficiency fractures with bothPMMA and allograft bone for fractures of the pelvis including sacrum, acetabulum, pubic symphysis, pubic rami ilium; appendicular skeleton including distal radius, proximal femur, and vertebral body. We also describe the potential risks and complications associated with percutaneous treatment of insufficiency fractures and techniques to avoid the pitfalls of the various procedures. We will present the process for patient follow-up and data regarding the pre- and postprocedure pain response in patients undergoing treatment for pelvic insufficiency fractures.
骨盆、骶骨、脊柱和长骨的骨不连是骨质疏松症的常见并发症，这些部位的骨折会引起疼痛和身体虚弱。这些骨折的常规治疗方法包括从保守治疗到使用钢板和螺钉固定的手术治疗。前者不能解决骨折的根本问题，而且经常不能缓解症状，而后者具有侵入性，并且对于骨密度低且合并多种疾病的老年人群来说并不总是可行的。聚甲基丙烯酸甲酯（PMMA）骨水泥填充术已被用于治疗与骨质疏松症相关的骨折超过二十年，但尚未广泛用于治疗椎体以外的骨折。PMMA 骨水泥填充术是一种影像学引导的治疗方法，已经采用了各种技术来治疗不同部位的骨折。我们描述了各种影像学引导的技术，以及使用 PMMA 和同种异体骨来治疗骨盆（包括骶骨、髋臼、耻骨联合、耻骨支、髂骨）和四肢（包括桡骨远端、股骨近端和椎体）的骨不连。我们还描述了与经皮治疗骨不连相关的潜在风险和并发症，以及避免各种程序陷阱的技术。我们将介绍患者随访的过程以及接受骨盆骨不连治疗的患者术前和术后疼痛反应的数据。
