Andresen Reimer, Lüdtke Christopher Wilhelm, Radmer Sebastian, Kamusella Peter, Schober Hans-Christof
Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westkuestenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Luebeck and Hamburg, Heide, Esmarchstraße 50, 25746, Heide, Germany,
Eur Spine J. 2015 Apr;24(4):759-63. doi: 10.1007/s00586-014-3638-7. Epub 2014 Oct 31.
In elderly patients with reduced bone quality, insufficiency fractures of the sacrum are relatively common and are typically accompanied by severe, disabling pain. The objective of this study was to evaluate the feasibility of cement augmentation by RFS, as well as to determine postinterventional leakages and present the patients' outcomes.
In 20 patients (18 women, 2 men) with an average age of 80.4 (65-92) years, a fracture of the sacrum was detected by CT and MRI. Clinically manifest osteoporosis with QCT values of below 50 mg/ml was found in all patients. An initially performed conservative treatment over a period of 3 weeks did not achieve a satisfactory reduction in the severe, disabling pain. The cement augmentation was performed under CT guidance by means of RFS under intubation anaesthesia. A Jamshidi needle was advanced into the respective fracture zone in the sacrum from dorsal to ventral (short axis) or from lateral to medial transiliac (transiliac axis). After removing the inner needle, a flexible osteotome was inserted through the positioned hollow needle and used to extend the spongious space in the fracture zone and thus prepare a cavity for the cement filling. The highly viscous polymethyl methacrylate (PMMA) cement, activated by radiofrequency, was then inserted into the prepared fracture zone through a substituted screw cannula. Cement filling was performed discontinuously under instrumental guidance at 1.3 ml/min under CT guidance. Cement leakages were determined in CT images and conventional X-rays on the day after the intervention. Pain was documented on a visual analogue scale (VAS) on the day before the intervention, on the second day, and after 6 and 12 months after the intervention. Additionally occurring complications were recorded, and the patients were asked to state how satisfied they were after 12 months.
RFS was technically feasible in all patients. In the control CT scans and X-rays, sufficient cement distribution and interlocking with vital bone was found along the course of the fracture in the sacrum. 7.2 (4-9) ml of cement were inserted per fracture. Leakage could be ruled out. The mean pain score on the VAS was 8.8 ± 1.2 before the intervention, and a significant reduction in pain (p < 0.001) was seen on the second postoperative day, with an average value of 2.3 ± 0.7, which was stable at 2.2 ± 1.3 after 6 months and 2.1 ± 1.1 after 12 months. All of the patients could be fully re-mobilised and discharged back home. A high level of patient satisfaction was found after 12 months, with 18 of the 20 patients stating that they would undergo the intervention again. One patient died of a stroke, another of cancer over the course.
As a minimally invasive procedure, RFS is an effective and safe method of treatment for rapid, significant and sustained pain reduction.
在骨质质量下降的老年患者中，骶骨不全骨折相对常见，通常伴有严重的致残性疼痛。本研究的目的是评估射频消融术（RFS）进行骨水泥强化的可行性，确定介入后骨水泥渗漏情况并展示患者的治疗结果。
20例患者（18例女性，2例男性），平均年龄80.4（65 - 92）岁，通过CT和MRI检测出骶骨骨折。所有患者均临床诊断为骨质疏松，定量CT值低于50mg/ml。最初进行了为期3周的保守治疗，但严重的致残性疼痛并未得到满意缓解。在插管麻醉下，通过RFS在CT引导下进行骨水泥强化。将Jamshidi针从背侧至腹侧（短轴）或从外侧至内侧经髂骨（经髂骨轴）推进至骶骨相应骨折区域。拔出内针后，通过定位的空心针插入柔性骨凿，用于扩大骨折区域的松质骨空间，从而为骨水泥填充准备一个腔隙。然后将经射频激活的高粘性聚甲基丙烯酸甲酯（PMMA）骨水泥通过替代的螺旋套管插入准备好的骨折区域。在CT引导下，在器械引导下以1.3ml/min的速度间断进行骨水泥填充。在介入后第二天通过CT图像和传统X线检查确定骨水泥渗漏情况。在介入前一天、第二天以及介入后6个月和12个月，采用视觉模拟评分法（VAS）记录疼痛情况。记录额外发生的并发症，并询问患者在12个月后对治疗的满意度。
所有患者的RFS技术上均可行。在对照CT扫描和X线检查中，发现骨水泥在骶骨骨折部位分布充分且与重要骨质相互嵌合。每个骨折部位注入骨水泥7.2（4 - 9）ml。可排除骨水泥渗漏。介入前VAS平均疼痛评分为8.8±1.2，术后第二天疼痛显著减轻（p<0.001），平均值为2.3±0.7，6个月后稳定在2.2±1.3，12个月后为2.1±1.1。所有患者均能完全恢复活动并出院回家。12个月后患者满意度较高，20例患者中有18例表示愿意再次接受该介入治疗。在此期间，1例患者死于中风，另1例死于癌症。
作为一种微创手术，RFS是一种有效且安全的治疗方法，可快速、显著且持续地减轻疼痛。
