Department of Internal Medicine,Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
J Natl Compr Canc Netw. 2010 Sep;8(9):1095-102. doi: 10.6004/jnccn.2010.0078.
Vertebral compression fractures are common in malignant disease and frequently cause severe back pain. However, management of that pain with conventional medical, radiotherapy, or surgical modalities is often inadequate. Vertebral augmentation techniques, such as vertebroplasty and kyphoplasty, are minimally invasive techniques in which methylmethacrylate bone cement is percutaneously injected into compressed vertebral bodies. Vertebral augmentation often improves mechanical stability of compressed vertebrae, provides pain relief, and may prevent progression of vertebral collapse. Kyphoplasty may provide increased chance for vertebral body height restoration, but the clinical importance of slight change in vertebral body height is unclear. Vertebral augmentation can be used in conjunction with other treatment modalities, and associated pain relief may improve patient tolerance of needed antitumor therapies, such as radiation therapy. Vertebral augmentation is generally very well tolerated, and complications associated with bone cement extravasation beyond the vertebral body have rarely been reported. Because it often provides good to excellent relief of otherwise intractable pain and is generally well tolerated, vertebral augmentation is becoming a first-line agent for management of painful vertebral compression fractures, especially in the setting of malignant disease.
椎体压缩性骨折在恶性疾病中很常见，常导致严重的背痛。然而，常规的医学、放射治疗或手术方式治疗这种疼痛往往效果不佳。椎体增强技术，如椎体成形术和后凸成形术，是一种微创技术，通过经皮将甲基丙烯酸甲酯骨水泥注入压缩的椎体中。椎体增强术通常可以提高受压椎体的机械稳定性，缓解疼痛，并可能防止椎体塌陷的进展。后凸成形术可能提供更大的机会恢复椎体高度，但椎体高度的微小变化的临床重要性尚不清楚。椎体增强术可与其他治疗方式联合使用，相关的疼痛缓解可能提高患者对所需抗肿瘤治疗（如放射治疗）的耐受性。椎体增强术通常耐受性良好，且骨水泥向椎体外渗漏的相关并发症很少见。因为它通常可以很好地缓解其他难以治疗的疼痛，并且耐受性良好，所以椎体增强术正在成为治疗疼痛性椎体压缩性骨折的一线药物，特别是在恶性疾病的情况下。
