Chen Lih-Hui, Lai Po-Liang, Chen Wen-Jer
Department of Orthopaedic Surgery, Spine Section, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Chang Gung Med J. 2011 Jul-Aug;34(4):352-9.
Vertebral compression fracture is the most common complication of osteoporosis. It may result in persistent severe pain and limited mobility, and significantly impact the quality of life. Conservative therapy using external bracing, bed rest and analgesics is necessary for pain control in these patients. However, some patients may experience protracted or ongoing pain even with these measures. Surgical treatment is indicated when conservative treatment fails, or in patients with spinal instability or neurologic deficit. Elderly patients often have comorbilities, and because of osteoporosis, high risk of postoperative complications such as implant loosening, and further adjacent fractures. Vertebroplasty involves a percutaneous injection of bone cement into the collapsed vertebrae under fluroscopic imaging guidance. It was first reported in 1987 for the management of a painful, aggressive hemangioma of a vertebral body. Since then, vertebroplasty has been widely accepted for the treatment of vertebral osteoporotic compression fractures without neurological damage. This article summarizes the advances in vertebroplasty, and discusses the indications, technique, alternative methods, results and complications. The contents include a review of the supporting evidence to provide a comparison of the safety and efficacy of vertebroplasty and kyphoplasty.
椎体压缩骨折是骨质疏松症最常见的并发症。它可能导致持续的剧痛和活动受限，并显著影响生活质量。对于这些患者，采用外部支具、卧床休息和镇痛药的保守治疗对于控制疼痛是必要的。然而，即使采取这些措施，一些患者仍可能经历持续或反复的疼痛。当保守治疗失败，或患者存在脊柱不稳定或神经功能缺损时，应考虑手术治疗。老年患者常伴有多种合并症，并且由于骨质疏松，术后发生诸如植入物松动及进一步相邻椎体骨折等并发症的风险较高。椎体成形术是在透视成像引导下经皮向塌陷的椎体注射骨水泥。1987年首次报道其用于治疗椎体疼痛性侵袭性血管瘤。从那时起，椎体成形术已被广泛接受用于治疗无神经损伤的椎体骨质疏松性压缩骨折。本文总结了椎体成形术的进展，并讨论了其适应证、技术、替代方法、结果及并发症。内容包括对支持证据的综述，以比较椎体成形术和后凸成形术的安全性和有效性。
