Zítka R, Gakhar H, Clamp J, Bommireddy R, Klezl Z
University Hospitals Derby and Burton NHS Foundation Trust, UK.
Acta Chir Orthop Traumatol Cech. 2019;86(3):188-192.
PURPOSE OF THE STUDY With the ageing of population the vertebral insufficiency fractures are increasing in number and occur ever more frequently. Symptomatic relief is often difficult to achieve by non-operative treatment. The aim of this study was to determine the level of pain relief and functional outcomes in patients who failed initial non-operative treatment and, because of persisting or growing symptoms, underwent kyphoplasty. MATERIAL AND METHODS Total number of 303 patients who underwent balloon kyphoplasty between January 2011 and December 2016 were included in our study. These 303 patients had 357 surgeries. This is a retrospective review of a prospectively updated database maintained by our spinal surgery department. In total, 575 levels were augmented. The patients were mostly females (246). The age of the patients ranged from 30 years to 98 years, with the mean age being 72.6 years. The average follow-up for our series was 17.2 months (2-63 months). Pain relief was assessed using the Visual Analogue Scale (VAS) and functional outcome using the Oswestry Disability Index (ODI). RESULTS The average pre-operative VAS was 6.34 (p = 0.00003). At 6 weeks postoperatively the average VAS decreased to 3.80 (p = 0.00000). In our series, the VAS scores showed a progressive decline progressing from the mean value of 3.18 (p = 0.15890) at 1 year to the mean value of 2.85 (p = 0.00205) at 2 years. The average pre-operative ODI was 25.65 (p = 0.03604). At 6 weeks, the value improved to 17.69 (p = 0,00120) and further improvements were seen at 1 year (ODI 14.13) and at 2 years (ODI 12.08). In our series no clinically significant complications were reported. The social drift was observed in 17 patients in our study. DISCUSSION The pain relief and the improvement of functional outcomes were maintained even at a two-year follow-up. No clinically significant complications were reported that would require further surgical intervention and that would affect the good clinical results of our study. CONCLUSIONS Balloon kyphoplasty proved to be a safe surgical technique and should be considered in patients with an ongoing pain following vertebral insufficiency fractures that do not improve with the initial non-operative treatment. Cement augmentation significantly improves pain levels and as well functional status in elderly patients. Key words:cement augmentation, osteoporotic fracture, kyphoplasty, vertebroplasty, osteoporotic spine fracture.
研究目的 随着人口老龄化，椎体骨质疏松性骨折的数量不断增加，且愈发常见。非手术治疗往往难以实现症状缓解。本研究的目的是确定初始非手术治疗失败且因症状持续或加重而接受椎体后凸成形术的患者的疼痛缓解程度和功能结局。材料与方法 纳入2011年1月至2016年12月期间接受球囊椎体后凸成形术的303例患者。这303例患者共进行了357次手术。这是对我们脊柱外科前瞻性更新数据库的回顾性研究。总共强化了575个椎体节段。患者以女性居多（246例）。患者年龄范围为30岁至98岁，平均年龄为72.6岁。我们系列研究的平均随访时间为17.2个月（2 - 63个月）。使用视觉模拟量表（VAS）评估疼痛缓解情况，使用Oswestry功能障碍指数（ODI）评估功能结局。结果 术前平均VAS为6.34（p = 0.00003）。术后6周平均VAS降至3.80（p = 0.00000）。在我们的系列研究中，VAS评分呈逐渐下降趋势，从1年时的平均值3.18（p = 0.15890）降至2年时的平均值2.85（p = 0.00205）。术前平均ODI为25.65（p = 0.03604）。6周时，该值改善至17.69（p = 0.00120），1年时（ODI 14.13）和2年时（ODI 12.08）进一步改善。在我们的系列研究中，未报告有临床意义的并发症。在我们的研究中观察到17例患者出现社会功能减退。讨论 即使在两年的随访中，疼痛缓解和功能结局的改善仍得以维持。未报告有需要进一步手术干预且会影响本研究良好临床结果的有临床意义并发症。结论 球囊椎体后凸成形术被证明是一种安全的手术技术，对于椎体骨质疏松性骨折初始非手术治疗后仍持续疼痛的患者应予以考虑。骨水泥强化显著改善了老年患者的疼痛程度和功能状态。关键词：骨水泥强化；骨质疏松性骨折；椎体后凸成形术；椎体成形术；骨质疏松性脊柱骨折
