首页 | 本学科首页   官方微博 | 高级检索  
相似文献
 共查询到10条相似文献,搜索用时 140 毫秒
1.
Percutaneous vertebroplasty for pain relief and spinal stabilization   总被引:151,自引:0,他引:151  
Barr JD  Barr MS  Lemley TJ  McCann RM 《Spine》2000,25(8):923-928
STUDY DESIGN: This was a retrospective review of 47 consecutive patients (1995-1998) in whom percutaneous intraosseous methylmethacrylate cement injection (percutaneous vertebroplasty) was used to treat osteoporotic vertebral compression fractures and spinal column neoplasms. OBJECTIVES: To present initial results regarding pain relief, spinal stabilization, and complications after treatment with percutaneous vertebroplasty. SUMMARY OF BACKGROUND DATA: Percutaneous vertebroplasty was developed in France in the late 1980s. Several European reports have described excellent results for treatment of compression fractures and neoplasms. The procedure was not performed in the United States until 1994. Only a single series of 29 patients treated in the United States has been reported. METHODS: A retrospective review was conducted of 47 consecutive patients with 84 vertebrae treated with percutaneous vertebroplasty. Thirty-eight patients with 70 vertebrae had symptomatic, osteoporotic fractures and had failed medical therapy. Eight patients with 13 vertebrae had primary or metastatic neoplasms. One patient had a hemangioma. Immediate and long-term pain response, spinal stability, and complications were evaluated. RESULTS: Among the 38 patients treated for osteoporotic fractures, 24 (63%) had marked to complete pain relief, 12 (32%) moderate relief and 2 (5%) no significant change. Only 4 of the 8 patients with malignancies had significant pain relief. In 7 of these patients, no further vertebral compression occurred, and spinal canal compromise was prevented. The patient with the hemangioma had no significant pain reduction. Minor complications occurred in 3 (6%) patients. CONCLUSIONS: Percutaneous vertebroplasty provided significant pain relief in a high percentage of patients with osteoporotic fractures. The procedure provided spinal stabilization in patients with malignancies but did not produce consistent pain relief. Complications were minor and infrequent. Percutaneous vertebroplasty is a promising therapy for patients with osteoporotic fractures and for selected vertebral column neoplasms.  相似文献   

2.
Cho DY  Lee WY  Sheu PC 《Neurosurgery》2003,53(6):1354-60; discussion 1360-1
OBJECTIVES: We aimed to evaluate the efficacy of reinforcing short-segment pedicle screw fixation with polymethyl methacrylate (PMMA) vertebroplasty in patients with thoracolumbar burst fractures. METHODS: We enrolled 70 patients with thoracolumbar burst fractures for treatment with short-segment pedicle screw fixation. Fractures in Group A (n = 20) were reinforced with PMMA vertebroplasty during surgery. Group B patients (n = 50) were not treated with PMMA vertebroplasty. Kyphotic deformity, anterior vertebral height, instrument failure rates, and neurological function outcomes were compared between the two groups. RESULTS: Kyphosis correction was achieved in Group A (PMMA vertebroplasty) and Group B (Group A, 6.4 degrees; Group B, 5.4 degrees). At the end of the follow-up period, kyphosis correction was maintained in Group A but lost in Group B (Group A, 0.33-degree loss; Group B, 6.20-degree loss) (P = 0.0001). After surgery, greater anterior vertebral height was achieved in Group A than in Group B (Group A, 12.9%; Group B, 2.3%) (P < 0.001). During follow-up, anterior vertebral height was maintained only in Group A (Group A, 0.13 +/- 4.06%; Group B, -6.17 +/- 1.21%) (P < 0.001). Patients in both Groups A and B demonstrated good postoperative Denis Pain Scale grades (P1 and P2), but Group A had better results than Group B in terms of the control of severe and constant pain (P4 and P5) (P < 0.001). The Frankel Performance Scale scores increased by nearly 1 in both Groups A and B. Group B was subdivided into Group B1 and B2. Group B1 consisted of patients who experienced instrument failure, including screw pullout, breakage, disconnection, and dislodgement (n = 11). Group B2 comprised patients from Group B who did not experience instrument failure (n = 39). There were no instrument failures among patients in Group A. Preoperative kyphotic deformity was greater in Group B1 (23.5 +/- 7.9 degrees) than in Group B2 (16.8 +/- 8.40 degrees), P < 0.05. Severe and constant pain (P4 and P5) was noted in 36% of Group B1 patients (P < 0.001), and three of these patients required removal of their implants. CONCLUSION: Reinforcement of short-segment pedicle fixation with PMMA vertebroplasty for the treatment of patients with thoracolumbar burst fracture may achieve and maintain kyphosis correction, and it may also increase and maintain anterior vertebral height. Good Denis Pain Scale grades and improvement in Frankel Performance Scale scores were found in patients without instrument failure (Groups A and B2). Patients with greater preoperative kyphotic deformity had a higher risk of instrument failure if they did not undergo reinforcement with vertebroplasty. PMMA vertebroplasty offers immediate spinal stability in patients with thoracolumbar burst fractures, decreases the instrument failure rate, and provides better postoperative pain control than without vertebroplasty.  相似文献   

3.
Spinal metastatic tumor is a common problem and represents a challenging problem in oncology practice. Patients with osteolytic metastases often suffer from intractable local and/or radicular pain. Percutaneous vertebroplasty is a minimally invasive, radiologically guided procedure whereby bone cement is injected into structurally weakened vertebrae to provide immediate biomechanical stability. Vertebroplasty is also used to relieve pain by stabilizing metastatically compromised vertebrae that are at risk of pathological burst fracture. In this retrospective study, a total of 57 patients (78 vertebrae) with spinal metastatic tumor were treated with PMMA vertebroplasty. The mean value of the visual analogue scale (VAS) was 8.1 +/- 0.67 preoperatively, and significantly decreased to 3.8 +/- 1.9 (1-8, p < 0.015) one day after vertebroplasty. The mean VAS value 6 months after vertebroplsty was 2.8 +/- 2.0 (p < 0.001). Mean injected bone cement amount in our study is 5.16 +/- 1.6 mL. The complication rate is about 21.8%, bone cement extravasation without neurological deficit is the most common complication. No new or adjacent vertebral fracture has occurred in more than 2 years follow-up. Percutaneous vertebroplasty is a minimally invasive procedure that offers a remarkable advantage of effective and immediate pain relief with few complications.  相似文献   

4.
目的探讨经皮椎体成形术治疗骨质疏松性胸腰椎椎体新鲜压缩骨折和陈旧性压缩骨折的疗效。方法应用经皮椎体成形术治疗骨质疏松性椎体压缩骨折患者62例,共80个椎体。其中新鲜骨折(A组)42例,56个椎体;陈旧性骨折(B组)20例,24个椎体。对两组患者单个椎体的手术时间、骨水泥渗漏、术后伤椎高度增加、Cobb角纠正度数及手术前后VAS评分进行比较。结果术后疼痛均明显缓解或消失。A组术前VAS评分(6.8±1.3)分,术后1 d(2.2±0.6)分;B组术前VAS评分(6.1±1.4)分,术后1 d(2.1±0.8)分。组间术后与术前比较差异有统计学意义(P〈0.05),两组间比较差异无统计学意义(P〉0.05)。A组术后伤椎高度增加值(2.5±1.7)mm,B组(0.8±0.4)mm;两组间比较差异有统计学意义(P〈0.05)。A组Cobb角纠正度数(5.7±1.2)°,B组(1.4±1.3)°,两组间比较差异有统计学意义(P〈0.05)。随访6~30个月,平均16.2个月,无患椎再骨折和邻近椎体骨折发生,伤椎高度A、B两组均无明显丢失,两组间比较差异无统计学意义。骨水泥渗漏:A组15例17个椎体;B组8例9个椎体,两组间比较差异无统计学意义(P〉0.05)。结论经皮椎体成形术治疗骨质疏松性椎体压缩新鲜与陈旧性骨折安全有效,新鲜骨折的复位效果优于陈旧性骨折,短期疗效满意。  相似文献   

5.
Background contextThoracolumbar burst fractures have good outcomes when treated with early ambulation and orthosis (TLSO). If equally good outcomes could be achieved with early ambulation and no brace, resource utilization would be decreased, especially in developing countries where prolonged bed rest is the default option because bracing is not available or affordable.PurposeTo determine whether TLSO is equivalent to no orthosis (NO) in the treatment of acute AO Type A3 thoracolumbar burst fractures with respect to their functional outcome at 3 months.Study designA multicentre, randomized, nonblinded equivalence trial involving three Canadian tertiary spine centers. Enrollment began in 2002 and 2-year follow-up was completed in 2011.Patient sampleInclusion criteria included AO-A3 burst fractures between T11 and L3, skeletally mature and older than 60 years, 72 hours from their injury, kyphotic deformity lower than 35°, no neurologic deficit. One hundred ten patients were assessed for eligibility for the study; 14 patients were not recruited because they resided outside the country (3), refused participation (8), or were not consented before independent ambulation (3).Outcome measuresRoland Morris Disability Questionnaire score (RMDQ) assessed at 3 months postinjury. The equivalence margin was set at δ=5 points.MethodsThe NO group was encouraged to ambulate immediately with bending restrictions for 8 weeks. The TLSO group ambulated when the brace was available and weaned from the brace after 8 to 10 weeks. The following competitive grants supported this work: VHHSC Interdisciplinary Research Grant, Zimmer/University of British Columbia Research Fund, and Hip Hip Hooray Research Grant. Aspen Medical provided the TLSOs used in this study. The authors have no financial or personal relationships that could inappropriately influence this work.ResultsForty-seven patients were enrolled into the TLSO group and 49 patients into the NO group. Forty-six participants per group were available for the primary outcome. The RMDQ score at 3 months postinjury was 6.8±5.4 (standard deviation [SD]) for the TLSO group and 7.7±6.0 (SD) in the NO group. The 95% confidence interval (?1.5 to 3.2) was within the predetermined margin of equivalence. Six patients required surgical stabilization, five of them before initial discharge.ConclusionsTreating these fractures using early ambulation without a brace avoids the cost and patient deconditioning associated with a brace and complications and costs associated with long-term bed rest if a TLSO or body cast is not available.  相似文献   

6.
BACKGROUND: Percutaneous vertebroplasty has become an option for the treatment of painful osteoporotic compression fractures in patients in whom conservative medical management has failed. AIM: This paper assessed the effectiveness and safety of percutaneous vertebroplasty in patients with focal pain caused by compression vertebral body fractures. MATERIALS AND METHODS: Over a twenty-five-month period 63 patients underwent percutaneous vertebroplasty, and ten of these patients were subsequently retreated, for a total of 73 operations on 93 vertebrae. The patients were affected by osteoporotic compression fractures (n=57) or by benign or malignant infiltrative processes (n=6). All patients were examined at discharge and thereafter to assess the level of pain and investigate possible changes in the quality of life. The mean length of follow-up was 15.2 months. RESULTS: After treatment, almost 90% of patients reported complete disappearance or significant alleviation of the pain. In 7 of 63 of the patient (11%) there were small asymptomatic leakages of cement outside the vertebral body. A substantial number of patients with osteoporosis, 19% of the study population, experienced new fractures following treatment with vertebroplasty. DISCUSSION: Our experience confirms the effectiveness of vertebroplasty to pain caused by vertebral fractures. If the indications are strictly followed, improvement of symptoms is often immediate, allowing the return of mobility, and patient satisfaction with surgery is higher. The use of appropriate systems limits the number of complications.  相似文献   

7.
目的探讨经皮椎体成型术在骨质疏松性椎体压缩骨折中的临床疗效。方法对笔者所在医院就诊的18例患者采用经皮椎体成型术治疗骨质疏松性胸腰椎压缩骨折,手术在C臂机监测下,经皮向椎体内穿刺并注入骨水泥,并对患者术后椎体疼痛症状及椎体前缘高度进行分析。结果术后全部患者获得随访,随访时间1~18个月,平均11个月,患者腰背部疼痛明显好转,椎体前缘高度无明显继发丢失,椎体后凸角度无明显增大。结论经皮椎体成型术治疗骨质疏松性椎体压缩骨折安全有效,疗效满意。  相似文献   

8.
Percutaneous vertebroplasty is a useful procedure for patients with vertebral osteoporotic compression fractures; however, there has been no mention in the literature of the use of percutaneous vertebroplasty for the treatment of traumatic spinal fractures. The authors report the case of a 33-year-old man who harbored L-1, L-2, and L-5 burst fractures sustained in a work-related accident. The patient was successfully treated by percutaneous vertebroplasty with polymethylmethacrylate. The authors propose this procedure as a useful intervention in selected patients with lumbar burst fractures. The complications associated with major surgical procedures are absent.  相似文献   

9.
The results of percutaneous vertebroplasty with polymethylmethacrylate (PMMA) of vertebral metastases were evaluated by a retrospective review of a consecutive series of 21 patients, with special reference to functional outcome. Patients complained of vertebral pain in all cases. Walking was impossible for 13 patients. Ten patients presented neurological deficit. Treatment included percutaneous vertebroplasty in all patients, radiotherapy in 15 patients and neural decompression surgery in 3 patients. Mean duration of hospitalization was 14.1 days (range 2-60 days) and the mean follow-up was 5.6 months (range 1-18 months). Preprocedural pain, measured by the visual analog scale (VAS), was 9.1, decreasing to 3.2 after the procedure and 2.8 at the last follow-up visit. Morphinics were discontinued in 7 of 14 patients following discharge from hospital. Ten out of 13 (77%) patients recovered walking capacity. Neurological status improved in three out of five patients. No further vertebral compression occurred in the vertebrae treated. Overall, 81% of the patients in this study were satisfied or very satisfied with the procedure. One patient (5%) had transitory radicular neuritis after the procedure. No major complications were observed. In conclusion, percutaneous vertebroplasty with PMMA proved to be safe and beneficial, providing significant and early improvement in the functional status of patients with spinal metastasis.  相似文献   

10.

Background

Vertebral compression fractures are common in multiple myeloma. Percutaneous vertebroplasty is used to stabilize vertebral collapse and treat the pain. The major technical drawbacks of percutaneous vertebroplasty are the potential for neural comprise and pulmonary embolism of cement from leakage of polymethylmethacrylate into epidural space and perivertebral veins. We have retrospectively evaluated the safety and complication of percutaneous vertebroplasty in the vertebral compression fractures resulting from multiple myeloma.

Methods

From August 2003 to July 2008, we describe 24 patients with multiple myeloma who were treated for vertebral compression fractures with percutaneous vertebroplasty to a total of 36 vertebrae. There were 4 male and 20 female patients with an average age of 67 (range 54–81?years). The pain symptoms were measured on a visual analog pain scale and quality of life as measured by the physical component summary scale of the Short Form-36 before operation and at 24?h, at 3?months and at 1?year following vertebroplasty. Radiography was reviewed for evidence of cement leakage and pulmonary complication.

Results

The mean visual analog pain scale decreased from a preoperative value of 9.0–3.8 at 24?h following operation and SF-36 score improved from 22.1 to 41.8. Of the twenty-four patients, four had cement leakage (2 leak through inferior endplate into disc, 2 leak into perivertebral vessels). There were no intra-postoperative neurologic or pulmonary complications. Eight patients died 2–18?months post-operatively due to multiple myeloma-related organ failure.

Conclusions

In this study, vertebroplasty significantly improved pain scores and function and, thereby, the quality of life. There were no major procedure-related complications in this study. Direct cytotoxic effect, polymerization and biomechanical microfractures stabilizer of polymethylmethacrylate play multiple roles in pain relief. In multiple myeloma, when pathological spinal compression fractures cause intractable pain and are unresponsive to conservative treatment, vertebroplasty remains the best option for pain relief and is effective in increasing quality of life.  相似文献   

设为首页 | 免责声明 | 关于勤云 | 加入收藏

Copyright©北京勤云科技发展有限公司  京ICP备09084417号