Röllinghoff M, Zarghooni K, Dargel J, Schlegel U J, Siewe J, Eysel P, Sobottke R
Department of Orthopedic and Trauma Surgery, University of Cologne, Cologne, Germany.
Minerva Chir. 2010 Aug;65(4):429-37.
Vertebroplasty (VP) and kyphoplasty (KP) are minimally invasive vertebral augmentation procedures for the treatment of fresh vertebral compression fractures (VCFs) associated with osteoporosis, trauma, malignant conditions, hemangiomas, and osteonecrosis. During these procedures, bone cement (e.g., polymethylmethacrylate) is percutaneously injected into the vertebral body. Systematic reviews of both procedures have shown significantly improved back pain and quality of life compared to conservative therapy. Direct comparison between VP and KP is not possible because of the lack of prospective randomized data comparing the two procedures. Both appear to improve patient functional status in most studies, although it is difficult to pool the available data because of differing measurement scales. With increasing popularity of both techniques, particularly over the past ten years, a rising number of publications have detailed potential complications secondary to cement extravasation, from compression of neural elements to venous embolism. Overall complication rates for both procedures are low. Systematic reviews have found significantly higher rates of cement leakage after VP (40%) versus KP (8%), with 3% of VP leaks being symptomatic. The evidence for increased risk of adjacent level fracture after these procedures compared to conservative treatment is inconclusive. When performed by a well-trained practitioner in appropriately selected patients, vertebroplasty and kyphoplasty are both safe and effective treatments for fresh vertebral compression fractures. Results from ongoing randomized controlled trials will provide further detailed information about both procedures in the future.
椎体成形术（VP）和后凸成形术（KP）是用于治疗与骨质疏松症、创伤、恶性疾病、血管瘤和骨坏死相关的新鲜椎体压缩骨折（VCF）的微创椎体强化手术。在这些手术过程中，骨水泥（如聚甲基丙烯酸甲酯）经皮注入椎体。对这两种手术的系统评价表明，与保守治疗相比，背痛和生活质量有显著改善。由于缺乏比较这两种手术的前瞻性随机数据，无法对VP和KP进行直接比较。在大多数研究中，两者似乎都能改善患者的功能状态，尽管由于测量尺度不同，难以汇总现有数据。随着这两种技术越来越普及，特别是在过去十年中，越来越多的出版物详细描述了骨水泥渗漏继发的潜在并发症，从神经受压到静脉栓塞。两种手术的总体并发症发生率都很低。系统评价发现，VP后骨水泥渗漏率（40%）显著高于KP（8%），VP渗漏中有3%出现症状。与保守治疗相比，这些手术后相邻节段骨折风险增加的证据尚无定论。当由训练有素的医生对适当选择的患者进行手术时，椎体成形术和后凸成形术都是治疗新鲜椎体压缩骨折的安全有效的方法。正在进行的随机对照试验的结果将在未来提供有关这两种手术的进一步详细信息。
