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[骨质疏松性椎体骨折。椎体后凸成形术和椎体成形术与保守治疗的对比]

[Vertebral fractures due to osteoporosis. Kyphoplasty and vertebroplasty vs conservative treatment].

作者信息

Müller C W, Gösling T, Mameghani A, Stier R, Klein M, Hüfner T, Krettek C

机构信息

Abteilung Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Deutschland.

出版信息

Orthopade. 2010 Apr;39(4):417-24. doi: 10.1007/s00132-009-1576-6.

Abstract

Vertebral compression fractures are among the most common forms of manifestations of osteoporosis. Conservative treatment comprises adequate analgesia, osteoporosis medication and individualized physiotherapy or braces. Nevertheless, vertebral compression fractures frequently lead to persisting pain and decrease daily activity and quality of life. In these cases, kyphoplasty and vertebroplasty can be efficient treatment options. Vertebroplasty is a minimally invasive procedure, in which bone cement is filled into the vertebral body under fluoroscopic control. In most cases, this internal stabilization leads to a rapid reduction in pain. Kyphoplasty additionally aims to correct the kyphotic deformation of the broken vertebra via introducing and inflating a balloon catheter. There is broad clinical experience with both procedures. For kyphoplasty, randomized controlled trials showed significant improvements in pain and quality of life in patients undergoing kyphoplasty. However, cement leakages lead to rare but severe complications such as pulmonary embolism and nerve palsies.

摘要

椎体压缩骨折是骨质疏松症最常见的表现形式之一。保守治疗包括充分镇痛、骨质疏松症药物治疗以及个体化物理治疗或支具治疗。然而,椎体压缩骨折常导致持续性疼痛,并降低日常活动和生活质量。在这些情况下,椎体后凸成形术和椎体成形术可能是有效的治疗选择。椎体成形术是一种微创手术,在荧光镜控制下将骨水泥注入椎体。在大多数情况下,这种内固定可迅速减轻疼痛。椎体后凸成形术还旨在通过插入并充盈球囊导管来纠正骨折椎体的后凸畸形。这两种手术都有广泛的临床经验。对于椎体后凸成形术,随机对照试验表明,接受该手术的患者在疼痛和生活质量方面有显著改善。然而,骨水泥渗漏会导致罕见但严重的并发症,如肺栓塞和神经麻痹。

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