Aparisi Francisco
Hospital Nueve de Octubre, Valencia, Valencia, Spain.
Semin Musculoskelet Radiol. 2016 Sep;20(4):382-391. doi: 10.1055/s-0036-1592431. Epub 2016 Nov 14.
Vertebroplasty and kyphoplasty are minimally invasive treatments and indispensable tools in the treatment of osteoporotic compression fractures. This method of treatment is performed using fluoroscopy or a scanner control an access via the pedicle or the posterolateral angle of the vertebral body. Vertebroplasty requires a smaller caliber needle than kyphoplasty, so it is technically easier. Vertebroplasty uses high-pressure injection, whereas in kyphoplasty the injection is held at low pressure, which together with the effect of compression on the bone that the balloon produces reduces the risk and rate of cement leakage. Vertebroplasty is effective in managing osteoporotic compression vertebral fractures, with improvement in pain and quality of life in the immediate postoperative period and over the medium term.Both techniques have a very low complication rate. There is no consensus on whether the emergence of new fractures in the cases treated by vertebroplasty and kyphoplasty are related to mechanical variations that were introduced or is a complication related to the age and evolution of the patient's osteoporosis. Even with this risk of new fractures, the improvement in quality of life obtained after vertebroplasty and kyphoplasty treatment is worthwhile. The benefits outweigh the risks.
椎体成形术和后凸成形术是治疗骨质疏松性压缩骨折的微创治疗方法及不可或缺的手段。这种治疗方法是在荧光透视或扫描仪控制下,通过椎弓根或椎体后外侧角进行穿刺。椎体成形术所需的穿刺针口径比后凸成形术小,因此在技术上更容易操作。椎体成形术采用高压注射,而后凸成形术则采用低压注射,同时球囊对骨的挤压作用降低了骨水泥渗漏的风险和发生率。椎体成形术在治疗骨质疏松性压缩性椎体骨折方面有效,术后即刻及中期疼痛和生活质量均有改善。两种技术的并发症发生率都很低。对于椎体成形术和后凸成形术治疗的病例中出现的新骨折是否与引入的力学改变有关,或者是否是与患者骨质疏松的年龄和病情进展相关的并发症,目前尚无共识。即使存在新骨折的风险,椎体成形术和后凸成形术治疗后生活质量的改善也是值得的。益处大于风险。