Palm Hans-Georg, Steinbach Mario, Lang Patricia, Hackenbroch Carsten, Friemert Benedikt, Riesner Hans-Joachim
Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm.
Klinik für Radiologie und Neuroradiologie, Bundeswehrkrankenhaus Ulm.
Z Orthop Unfall. 2018 Jun;156(3):281-286. doi: 10.1055/s-0043-123832. Epub 2018 Jan 25.
Kyphoplasty is used to alleviate pain and to restore the initial height of osteoporotic vertebral fractures (OVF). One of the most recent procedures is radiofrequency-targeted vertebral augmentation (RFTVA). We investigated whether restoration with this method is similar and as adequate as with the established procedure of balloon kyphoplasty (BKP), as assessed by the anatomical height of the vertebral body. The aim of our study was to compare the intravertebral angles (base-endplate) post- and preoperatively with these two procedures.
The base and endplate angles were measured on 142 vertebral bodies treated by kyphoplasty (67 BKP and 75 RFTVA), on the basis of pre- and postoperative X-rays in the upright position in 87 volunteers (46 BKP and 41 RFTVA). The main object was to detect the degree of correction (Δpost-preop) with BKP compared to RFTVA. Furthermore, the sagittal alignment of the adjacent heathy levels were measured.
Significant correction was detected with both BKP (BKPpre: 11.5 ± 6.0°, BKPpost: 6.2 ± 4.6°, p < 0.001) and RFTVA (RFTVApre: 9.9 ± 6.2°, RFTVApost: 6.3 ± 4.4°, p < 0.001). Potential correction was greater with BKP than with RFTVA (Δpost-pre BKP: - 5.3 ± 4.4°, Δpost-pre RFK: - 3.6 ± 4.4°, p = 0.03). Neither procedures gave a significant change in the sagittal angle in the adjacent segment (segment BKPpre: 13.8 ± 8.0°, Segment BKPpost: 12.5 ± 9,2°, p = 0.638; Segment RFTVApre: 18,8 ± 14,3°, Segment RFTVApost: 15.0 ± 13.2°, p = 0.330).
BKP gave significantly better correction, even though both methods were able to restore significant improvement in the kyphotic angle. In the adjacent levels, correction of the sagittal angle was not significant, although the influence of the intervention on alignment tended to be less.
椎体后凸成形术用于缓解骨质疏松性椎体骨折（OVF）的疼痛并恢复其初始高度。最新的手术方法之一是射频靶向椎体强化术（RFTVA）。我们通过椎体的解剖高度评估，研究了用这种方法恢复椎体高度是否与已确立的球囊椎体后凸成形术（BKP）相似且效果相当。我们研究的目的是比较这两种手术前后的椎体内角度（椎体基底-终板）。
在87名志愿者（46例行BKP，41例行RFTVA）中，根据术前和术后的直立位X线片，测量了142个接受椎体后凸成形术治疗的椎体（67个BKP椎体和75个RFTVA椎体）的基底和终板角度。主要目的是检测BKP与RFTVA相比的矫正程度（术后-术前差值）。此外，还测量了相邻健康节段的矢状位对线情况。
BKP（BKP术前：11.5±6.0°，BKP术后：6.2±4.6°，p<0.001）和RFTVA（RFTVA术前：9.9±6.2°，RFTVA术后：6.3±4.4°，p<0.001）均检测到显著矫正。BKP的潜在矫正效果大于RFTVA（BKP术后-术前差值：-5.3±4.4°，RFTVA术后-术前差值：-3.6±4.4°，p=0.03）。两种手术均未使相邻节段的矢状角发生显著变化（BKP节段术前：13.8±8.0°，BKP节段术后：12.5±9.2°，p=0.638；RFTVA节段术前：18.8±14.3°，RFTVA节段术后：15.0±13.2°，p=0.330）。
尽管两种方法都能使后凸角得到显著改善，但BKP的矫正效果明显更好。在相邻节段，矢状角的矫正不显著，尽管干预对对线的影响往往较小。
