Bousson Valérie, Hamze Bassam, Odri Guillaume, Funck-Brentano Thomas, Orcel Philippe, Laredo Jean-Denis
Service de Radiologie Ostéoarticulaire, Viscérale et Vasculaire, Hôpital Lariboisière, APHP, Université Paris-Diderot, Paris, France.
Service de Chirurgie Orthopédique et Traumatologique, Hôpital Lariboisière, APHP, Université Paris-Diderot, Paris, France.
Semin Intervent Radiol. 2018 Oct;35(4):309-323. doi: 10.1055/s-0038-1673639. Epub 2018 Nov 5.
Percutaneous vertebral augmentation/consolidation techniques are varied. These are vertebroplasty, kyphoplasty, and several methods with percutaneous introduction of an implant (associated or not with cement injection). They are proposed in painful osteoporotic vertebral fractures and traumatic fractures. The objectives are to consolidate the fracture and, if possible, to restore the height of the vertebral body to reduce vertebral and regional kyphosis. Stabilization of the fracture leads to a reduction in pain and thus restores the spinal support function as quickly as possible, which is particularly important in the elderly. The effectiveness of these interventions on fracture pain was challenged once by two randomized trials comparing vertebroplasty to a sham intervention. Since then, many other randomized studies in support of vertebroplasty efficacy have been published. International recommendations reserve vertebroplasty for medical treatment failures on pain, but earlier positioning may be debatable if the objective is to limit kyphotic deformity or even reexpand the vertebral body. Recent data suggest that in osteoporotic fracture, the degree of kyphosis reduction achieved by kyphoplasty and percutaneous implant techniques, compared with vertebroplasty, is not sufficient to justify the additional cost and the use of a somewhat longer and traumatic procedure. In young patients with acute traumatic fractures and a significant kyphotic angle, kyphoplasty and percutaneous implant techniques are preferred to vertebroplasty, as in these cases a deformity reduction has a significant positive impact on the clinical outcome.
经皮椎体强化/巩固技术多种多样。这些技术包括椎体成形术、后凸成形术以及几种经皮植入植入物的方法（是否联合骨水泥注射）。它们被应用于疼痛性骨质疏松性椎体骨折和创伤性骨折。其目的是巩固骨折部位，并在可能的情况下恢复椎体高度以减少椎体和局部后凸畸形。骨折的稳定可减轻疼痛，从而尽快恢复脊柱支撑功能，这对老年人尤为重要。这些干预措施对骨折疼痛的有效性曾受到两项比较椎体成形术与假手术干预的随机试验的质疑。从那以后，又发表了许多支持椎体成形术疗效的其他随机研究。国际指南将椎体成形术保留用于疼痛治疗失败的情况，但如果目标是限制后凸畸形甚至使椎体再膨胀，更早进行手术是否合理仍存在争议。最近的数据表明，在骨质疏松性骨折中，与椎体成形术相比，后凸成形术和经皮植入技术实现的后凸畸形减少程度不足以证明额外的成本以及采用稍长且有创伤性的手术是合理的。在患有急性创伤性骨折且后凸角度明显的年轻患者中，后凸成形术和经皮植入技术优于椎体成形术，因为在这些情况下畸形的减少对临床结果有显著的积极影响。
