Leni and Peter W. May Department of Orthopaedic Surgery, The Mount Sinai Medical Center, 5 East 98th St, 9th Floor, New York, NY 10029, USA.
Spine J. 2011 Aug;11(8):737-44. doi: 10.1016/j.spinee.2011.07.002. Epub 2011 Sep 8.
Vertebral compression fractures (VCFs) are a substantial health concern. Kyphoplasty (KP) and vertebroplasty (VP) are vertebral augmentation procedures (VAPs) used to treat VCFs.
To compare VP and KP patient demographics and evaluate inpatient and outpatient utilization trends.
Retrospective analysis of patient demographics, and inpatient and outpatient utilization trends, from California, New York, and Florida inpatient and ambulatory discharge databases.
Hospitalizations for VP and KP were identified from California, New York, and Florida inpatient and ambulatory discharge databases from 2005 to 2008. International Classification of Diseases, Ninth Revision diagnosis codes for pathologic, dorsal, and lumbar fracture of vertebrae were cross-referenced with ICD-9 procedure codes and Current Procedural Terminology codes to select the population. Patients younger than 40 years or those who underwent both procedures were excluded.
The final population contained 61,851 VAPs (35,805 KPs and 26,046 VPs). Kyphoplasty showed increased inpatient and outpatient utilization. Vertebroplasty utilization remained at a low level of 6/100,000 capita. Kyphoplasty patients had more comorbidities than VP patients. In Florida in 2008, radiologists performed most VPs (52.3%) and orthopedists performed the most KPs (35.45%). Postoperative complication rates were significantly different; 0.79% of KPs had cardiac complications versus 0.57% of VPs (p=.0073). Respiratory complications occurred in 0.83% of KPs and 0.49% of VPs (p<.0001).
Vertebral augmentation procedures have seen a continued increase in use from 2004 to 2008. Use of KP significantly outpaces the use of VP. Reasons for the increasing utilization of KP likely include financial incentives, the specialty performing KP, perceived safety, and effectiveness of vertebral height restoration. Conflicting evidence regarding which procedure is safer warrants further evaluation.
椎体压缩性骨折（VCFs）是一个严重的健康问题。后凸成形术（KP）和椎体成形术（VP）是用于治疗 VCFs 的椎体增强手术（VAPs）。
比较 VP 和 KP 患者的人口统计学特征，并评估住院和门诊利用趋势。
对加利福尼亚州、纽约州和佛罗里达州住院和门诊出院数据库中的患者人口统计学特征以及住院和门诊利用趋势进行回顾性分析。
从加利福尼亚州、纽约州和佛罗里达州的住院和门诊出院数据库中确定了 VP 和 KP 的住院病例。使用国际疾病分类，第九版诊断代码与 ICD-9 手术代码和当前程序术语代码交叉参考，选择患者。排除 40 岁以下或同时接受两种手术的患者。
最终人群包含 61851 例 VAP（35805 例 KP 和 26046 例 VP）。后凸成形术的住院和门诊利用率增加。椎体成形术的利用率仍然很低，为每 10 万人 6 例。后凸成形术患者的合并症多于椎体成形术患者。2008 年在佛罗里达州，放射科医生进行了大多数 VP（52.3%），骨科医生进行了大多数 KP（35.45%）。术后并发症发生率存在显著差异；KP 组有 0.79%的患者出现心脏并发症，VP 组为 0.57%（p=.0073）。KP 组有 0.83%的患者出现呼吸系统并发症，VP 组为 0.49%（p<.0001）。
从 2004 年到 2008 年，椎体增强手术的使用持续增加。后凸成形术的使用率明显超过椎体成形术。后凸成形术使用率增加的原因可能包括经济激励、进行后凸成形术的专业、对椎体高度恢复的安全性和有效性的认识。关于哪种手术更安全的证据相互矛盾，需要进一步评估。
