Department of Orthopedic Surgery, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, The Netherlands.
J Vasc Interv Radiol. 2011 Jul;22(7):1017-23. doi: 10.1016/j.jvir.2011.02.036. Epub 2011 May 14.
To assess clinical outcome and technical feasibility of percutaneous vertebroplasty (PVP) in 34 patients with 37 osteoporotic vertebral compression fractures (OVCFs) with vertebral body collapse to less than one-third of the original height, termed very severe osteoporotic vertebral compression fractures (vsOVCFs).
A prospective follow-up study was conducted using a 0-10 pain intensity numerical rating scale and the Short Form-36 General Health Survey (SF-36) quality-of-life questionnaire, completed before PVP and 7 days (pain only), 1 month, 3 months, and 12 months after PVP. Cement leakage was analyzed on postoperative computed tomography (CT) scanning. The presence of new fractures was assessed at 6 weeks and 52 weeks and when suspected clinically.
Decrease in average and worst back pain was 2.5 points and 3.0 points after 7 days, and 2.5 points and 2.9 points after 12 months. The physical and mental SF-36 summary scores were significantly increased. Incidence of cement leakage in vsOVCFs was 91.9%, which was substantially higher compared with non-vsOVCFs (n = 40) treated in the same patients (64.1%; odds ratio [OR] 6.4, 95% confidence interval [CI] 1.7-24.5, P = .004). Mean leakage volume per treated vertebra was more than twice as high (0.80 mL vs 0.32 mL; P < .001). Seventeen new OVCFs in 11 patients (32.4%) were identified. Only one (2.9%) minor complication occurred, confirming the feasibility of PVP in vsOVCFs.
Patients with painful vsOVCFs can be treated with, and benefit from, PVP. Although technically more demanding and with a higher procedural risk (ie, more frequent necessity of placement of a second needle, higher leakage incidence, and greater leakage volumes), PVP is technically feasible and should not be withheld from these patients.
评估经皮椎体成形术（PVP）在 34 例 37 个椎体骨压缩骨折（OVCF）患者中的临床疗效和技术可行性，这些患者的椎体塌陷程度不到原有高度的 1/3，称为严重骨质疏松性椎体压缩骨折（vsOVCF）。
前瞻性随访研究采用 0-10 疼痛强度数字评分和健康调查简表 36 项（SF-36）生活质量问卷，分别在 PVP 前、PVP 后 7 天（仅疼痛）、1 个月、3 个月和 12 个月进行评估。术后行 CT 扫描分析骨水泥渗漏情况。6 周和 52 周时及临床怀疑有新骨折时行 X 线检查评估新骨折发生情况。
7 天后平均和最差背痛分别下降 2.5 分和 3.0 分，12 个月后分别下降 2.5 分和 2.9 分。SF-36 躯体和精神健康综合评分显著提高。vsOVCFs 患者骨水泥渗漏发生率为 91.9%，显著高于同期非 vsOVCFs（n=40）患者（64.1%；优势比[OR]6.4，95%置信区间[CI]1.7-24.5，P=0.004）。每治疗椎体的平均渗漏量高出 2 倍以上（0.80 mL 比 0.32 mL；P<0.001）。11 例患者（32.4%）中发现 17 个新的 OVCF。仅 1 例（2.9%）发生轻微并发症，证实 vsOVCFs 行 PVP 是可行的。
患有疼痛性 vsOVCFs 的患者可以接受 PVP 治疗，并从中获益。尽管技术上要求更高，手术风险更大（即更频繁地需要放置第二根针、更高的渗漏发生率和更大的渗漏量），但 PVP 在技术上是可行的，不应拒绝为这些患者实施该手术。
