Ishiguro Shigeo, Kasai Yuichi, Sudo Akihiro, Iida Koji, Uchida Atsumasa
Department of Orthopaedic Surgery, Oyamada Memorial Spa Hospital, Yokkaichi, Mie, Japan.
J Orthop Surg (Hong Kong). 2010 Dec;18(3):346-51. doi: 10.1177/230949901001800318.
To compare percutaneous transpedicular vertebroplasty using calcium phosphate cement (CPC) versus conservative treatment for osteoporotic vertebral fractures.
Eight men and 28 women aged 61 to 99 (mean, 80) years with osteoporotic vertebral fractures underwent percutaneous transpedicular vertebroplasty using CPC. During the same period, 6 men and 32 women aged 53 to 93 (mean, 77) years underwent conservative treatment. The indication for vertebroplasty was a painful unstable fracture, with mobility of the vertebral body shown on flexion and extension lateral radiographs. Fractures without mobility despite deformity were treated conservatively.
In the vertebroplasty group, all patients benefited from reduced back pain immediately after surgery, and pain relief was maintained at the latest follow-up. However, correction loss continued until one month after the operation. The mean visual analogue score for pain decreased significantly from preoperation to one day after surgery (9.3 vs. 6.2, p=0.02), and further decreased to 2.8 (p = 0.04) on day 3 or 4 when ambulation began, and to 1.5 at the one month follow-up and 1.4 at the final follow-up (mean, 14 months). The mean duration of analgesic treatment was significantly shorter in the vertebroplasty than conservatively treated group (10.2 vs. 63.5 days). All patients in the vertebroplasty group achieved bone union, with no adjacent vertebral fractures. However, in patients having conservative treatment, there were 2 adjacent vertebral fractures and 4 pseudarthroses, and the collapse continued for several months.
Percutaneous transpedicular vertebroplasty using CPC achieves immediate pain relief and reduces the risk of vertebral body collapse and pseudarthrosis among elderly patients with osteoporotic vertebral compression fractures.
比较使用磷酸钙骨水泥（CPC）的经皮椎弓根椎体成形术与骨质疏松性椎体骨折的保守治疗。
8名男性和28名年龄在61至99岁（平均80岁）的女性骨质疏松性椎体骨折患者接受了使用CPC的经皮椎弓根椎体成形术。同期，6名男性和32名年龄在53至93岁（平均77岁）的女性接受了保守治疗。椎体成形术的指征为疼痛性不稳定骨折，屈伸位侧位X线片显示椎体有活动度。尽管有畸形但无活动度的骨折采用保守治疗。
在椎体成形术组，所有患者术后立即背痛减轻，且在最近一次随访时疼痛缓解仍持续存在。然而，矫正丢失一直持续到术后1个月。疼痛的平均视觉模拟评分从术前到术后1天显著降低（9.3对6.2，p = 0.02），在开始行走的第3或4天进一步降至2.8（p = 0.04），在1个月随访时降至1.5，在最终随访（平均14个月）时降至1.4。椎体成形术组的平均镇痛治疗时间明显短于保守治疗组（10.2对63.5天）。椎体成形术组的所有患者均实现了骨愈合，无相邻椎体骨折。然而，在接受保守治疗的患者中，有2例相邻椎体骨折和4例假关节形成，且椎体塌陷持续了数月。
使用CPC的经皮椎弓根椎体成形术可立即缓解疼痛，并降低老年骨质疏松性椎体压缩骨折患者椎体塌陷和假关节形成的风险。
