Shim Jihoon, Lee Kwanghyun, Kim Hunchul, Kang Byungjik, Jeong Haewon, Kang Chang-Nam
Department of Orthopaedic Surgery, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul, 133-792, Korea.
BMC Musculoskelet Disord. 2016 Aug 24;17(1):365. doi: 10.1186/s12891-016-1215-4.
Osteoporosis and osteoporotic fractures are widely known as complications of rheumatoid arthritis. Kyphoplasty (KP) is known as an effective treatment modality for reducing pain and correcting kyphotic deformity in osteoporotic vertebral compression fracture (OVCF). However, cutcomes of KP in rheumatoid patients are not well known. The purpose of the study was to investigate the clinical and radiological outcomes of balloon KP on OVCF in patients with rheumatoid arthritis.
A total of 23 patients (31 vertebral bodies) with rheumatoid arthritis who received KP for OVCF and could be followed up for at least 1 year were examined. For clinical outcomes, visual analogue scale (VAS) and the Korean version of the Oswestry disability index (KODI) were evaluated. For radiological outcomes, changes in anterior vertebral height and local kyphotic angle were measured, alongside cement leakage, adjacent fracture, and the recollapse of cemented vertebra.
The anterior vertebral height was significantly restored after surgery compared with prior to surgery (p < 0.001). Cement leakage was found in 14 cases (45.1 %), and disc space leakage was prevalent (50 %), while vascular cement leakage was found in one case. Adjacent fracture was found in 3 patients (11.5 %). VAS for lumbago showed a significant decrease (p < 0.001) after surgery (VAS = 2.4) compared with that before (VAS = 8.1); it was somewhat increased after the 1-year follow-up (VAS = 2.8; p = 0.223). KODI also decreased (48.8 %) after surgery compared with before (84.6 %). However, it increased somewhat (49.9 %) after the 1-year follow-up.
KP on rheumatoid arthritis patients for OVCF was effective for reducing pain in the early stage and restoring vertebral body height. Recollapse of the treated vertebral body was found relatively frequently alongside the correction loss of local kyphotic angle.
骨质疏松症和骨质疏松性骨折是类风湿关节炎常见的并发症。椎体成形术（KP）是治疗骨质疏松性椎体压缩骨折（OVCF）、减轻疼痛和纠正后凸畸形的一种有效治疗方式。然而，类风湿患者接受KP治疗的效果尚不清楚。本研究旨在探讨球囊KP治疗类风湿关节炎患者OVCF的临床和影像学疗效。
对23例（31个椎体）因OVCF接受KP治疗且随访至少1年的类风湿关节炎患者进行检查。临床疗效评估采用视觉模拟评分法（VAS）和韩国版Oswestry功能障碍指数（KODI）。影像学疗效评估包括测量椎体前缘高度和局部后凸角的变化，以及观察骨水泥渗漏、相邻椎体骨折和骨水泥强化椎体再塌陷情况。
与术前相比，术后椎体前缘高度明显恢复（p＜0.001）。14例（45.1%）发现骨水泥渗漏，椎间盘间隙渗漏最为常见（50%），1例发现血管内骨水泥渗漏。3例（11.5%）患者出现相邻椎体骨折。术后腰痛VAS评分较术前显著降低（p＜0.001）（术前VAS = 8.1，术后VAS = 2.4）；1年随访后有所升高（VAS = 2.8；p = 0.223）。KODI评分术后较术前也有所降低（从84.6%降至48.8%）。然而，1年随访后又有所升高（49.9%）。
KP治疗类风湿关节炎患者的OVCF在早期可有效减轻疼痛并恢复椎体高度。治疗椎体再塌陷相对常见，同时局部后凸角矫正丢失。
