Uppsala University Hospital, Institute for Surgical Sciences, Department of Orthopaedics, Uppsala, Sweden.
J Orthop Surg Res. 2011 Aug 19;6:43. doi: 10.1186/1749-799X-6-43.
Osteoporotic vertebral compression fractures are a menace to the elderly generation causing diminished quality of life due to pain and deformity. At first, conservative treatment still is the method of choice. In case of resulting deformity, sintering and persistent pain vertebral cement augmentation techniques today are widely used. Open correction of resulting deformity by different types of osteotomies addresses sagittal balance, but has comparably high morbidity. Besides conventional vertebral cement augmentation techniques balloon kyphoplasty has become a popular tool to address painful thoracic and lumbar compression fractures. It showed improved pain reduction and lower complication rates compared to standard vertebroplasty. Interestingly the results of two placebo-controlled vertebroplasty studies question the value of cement augmentation, if compared to a sham operation. Even though there exists now favourable data for kyphoplasty from one randomised controlled trial, the absence of a sham group leaves the placebo effect unaddressed. Technically kyphoplasty can be performed with a transpedicular or extrapedicular access. Polymethyl methacrylate (PMMA)-cement should be favoured, since calcium phosphate cement showed inferior biomechanical properties and less effect on pain reduction especially in less stable burst fractures. Common complications of kyphoplasty are cement leakage and adjacent segment fractures. Rare complications are toxic PMMA-monomer reactions, cement embolisation, and infection.
骨质疏松性椎体压缩骨折是老年人的一大威胁，会导致疼痛和畸形，降低生活质量。起初，保守治疗仍然是首选方法。如果出现畸形，目前广泛使用烧结和持续疼痛椎体骨水泥增强技术。通过不同类型的截骨术对畸形进行开放矫正可以解决矢状面平衡问题，但发病率相对较高。除了传统的椎体骨水泥增强技术外，球囊椎体后凸成形术已成为治疗胸腰椎压缩性骨折疼痛的一种流行工具。与标准椎体成形术相比，它显示出更好的止痛效果和更低的并发症发生率。有趣的是，两项安慰剂对照椎体成形术研究的结果对骨水泥增强的价值提出了质疑，如果与假手术相比。尽管目前有一项随机对照试验提供了有利于后凸成形术的有利数据，但缺乏假手术组使得安慰剂效应未得到解决。技术上，后凸成形术可以通过经皮或经皮外途径进行。应首选聚甲基丙烯酸甲酯（PMMA）-水泥，因为磷酸钙水泥的生物力学性能较差，对疼痛缓解的效果也较差，尤其是在不太稳定的爆裂性骨折中。后凸成形术的常见并发症是骨水泥渗漏和相邻节段骨折。罕见的并发症是有毒 PMMA 单体反应、水泥栓塞和感染。
