经皮椎体成形术在椎体压缩骨折及椎体肿瘤治疗中的临床应用

目的 总结分析经皮椎体成形术(PVP)在骨质疏松性椎体压缩骨折及椎体肿瘤治疗中临床应用的疗效.方法 宣武医院神经外科2007年1月至2012年6月应用PVP治疗45例患者共62个病变椎体,随访时间点为术后24h、3、6、12、24及36个月,采用VAS、ODI评价其临床疗效,椎体前缘高度及Cobb角评估影像学结果.结果 平均随访时间(13.9±7.8)个月,术后24 h,患者VAS疼痛评分、ODI指数及Cobb角分别由术前(7.3±1.9)分、32.0±3.4和15.0°±2.3°降至术后(4.8±1.6)分、22.1±2.1和14.0°±1.9°(P＜0.05),椎体前缘高度由术前(16.0±1.8) mm升至(19.0±2.1)mm(P＜0.05).3～36个月随访期内,VAS评分、椎体前缘高度及Cobb角差异无统计学意义(P＞0.05).随访中约54％患者VAS评分维持在5分以内.结论 PVP是治疗骨折及肿瘤所致的椎体源性疼痛简单有效的微创疗法,临床疗效稳定.     

经皮椎体成形术治疗伴裂缝的椎体压缩性骨折

目的探讨应用经皮椎体成形术治疗伴裂缝的椎体压缩性骨折的技术及疗效,并总结分析压缩骨折中裂缝产生的原因及治疗方法。方法16例伴裂缝的椎体压缩性骨折患者术前均行X线平片、CT检查。X线平片或透视下可见裂缝的5例(组1),其中3例为仅在注射骨水泥时发现新出现的裂缝;术前仅CT可见裂缝的11例(组2)。所有患者均行6点疼痛评分及运动能力评分。组1中患者的平均疼痛评分为(4.45±0.47)分,运动能力评分(4.66±0.43)分;组2中患者的平均疼痛评分为(4.07±0.52)分,运动能力评分为(4.45±0.49)分。16例患者中6例有明确的外伤史,5例有轻微的外伤史,余5例没有明确的外伤史。所有患者均行活检,病理报告均为变性或坏死的骨组织。结果16例手术都获得成功,注射骨水泥3～7ml,14例疼痛完全缓解,2例明显缓解。术后2d重新进行疼痛及运动能力评分,组1的平均疼痛评分为(0.41±0.57)分,运动功能评分为(1.43±0.45)分;组2的平均疼痛评分为(0.47±0.41)分,运动功能评分为(1.56±0.39)分;配对t检验术前、术后有明显差异(P<0.01)。全部病例中共有2例骨水泥渗漏到椎间盘,没有骨水泥渗漏到椎体周围组织。术后随访1～9个月,无复发迹象,影像学检查提示骨水泥和椎体稳定。结论伴裂缝的椎体压缩性骨折是经皮椎体成形术的明确的适应证。椎体压缩性骨折一旦发现裂缝,尽早行经皮椎体成形术治疗可取得良好的疗效。     

Efficacy and safety of vertebral stenting for painful vertebral compression fractures in patients with metastatic disease

Abstract

Background and Purpose:

Painful vertebral compression fractures in cancer patients reduce quality of life and may limit survival. We assessed pain relief, vertebral height restoration, and kyphosis correction following vertebral augmentation using a novel expandable titanium stent implant in cancer patients with painful vertebral compression fractures.

Materials and Methods:

Patients >18 years of age with metastatic disease who presented symptomatic compression fractures of vertebral bodies T5–L5, with or without a history of osteoporosis, were included in the study. Back pain at presentation, immediately after vertebral stenting, and at 1-, 3-, 6-, and 12-month follow-up was estimated using the visual analog scale (VAS). Vertebral height and local kyphotic angle (alpha angle) were measured on lateral standing X-ray before and 1–3 months after stenting.

Results:

Forty-one cancer patients with painful vertebral compression fractures underwent vertebral stenting procedures at 55 levels. There was no perioperative mortality and no significant complication. Median preoperative VAS was 8·0 (range 8–10), falling to 2·0 immediately postop (range 1–6, P = 0·000) and 0 at all subsequent follow-up (P ≤ 0·012). Mean preoperative vertical height loss was 25·8% (range 0–84·0%) versus a postoperative mean of 18·0% (range 0–66·0%, P = 0·000). Median pre- and postoperative kyphotic angle improved from 8·3° (range 0·2°–54·0°) to 7·1° (range 0·2°–25·0°, P = 0·000). Wilcoxon signed rank test or student's t-test was used for comparisons.

Conclusions:

Vertebral augmentation using a novel vertebral stenting system provided immediate and enduring pain relief and improved vertebral height loss and kyphotic angle.     

Safety and therapeutic efficacy of the second treatment for new fractures developed after initial vertebroplasty performed for painful vertebral compression fractures

Abstract

Objectives: There is no report on the safety and therapeutic efficacy of the second treatment for new vertebral fractures developed after vertebroplasty. This study aims to examine the therapeutic effects and clinical characteristics in patients undergoing a second vertebroplasty for these new fractures.

Methods: The initial treatment group included 182 patients (276 vertebrae) who underwent vertebroplasty. Among 182 patients, the second treatment group included 34 patients (36 vertebrae) who developed new fractures postoperatively, which were retreated. Analgesic effects on the day following surgery, frequency of new fractures during the 12 month period after surgery, and other clinical characteristics were compared between the initial and second treatment groups. Furthermore, similar comparisons were performed between patients with adjacent and non-adjacent vertebral fractures in the second treatment group.

Results: The improvement rates in visual analogue scale (VAS) scores before and after surgery were 83·4% in the initial treatment group and 85·6% in the second treatment group (P = 0·27). The frequencies of new fractures occurring within 12 months after surgery were 20·9% and 20·6%, respectively.

Within the second treatment group, the VAS improvement rates were 76·7% in the adjacent and 88·2% in the non-adjacent vertebral fracture groups (P = 0·83). However, the frequencies of subsequent new fractures after the second treatment were 31·6% and 5·9%, respectively, being significantly higher in the adjacent vertebral fracture group (P < 0·05).

Conclusions: Additional vertebroplasty for new fractures exerts analgesic effects similar to those of the initial procedure. However, we must note that the second treatment for new adjacent vertebral fractures frequently causes more subsequent new fractures in comparison with non-adjacent fractures.     

经皮椎体成形术治疗椎体压缩性骨折与血管瘤

目的总结经皮椎体成形术治疗疼痛性椎体压缩性骨折和症状性椎体血管瘤的临床经验,评估其治疗疗效。方法回顾性分析35例疼痛性椎体压缩性骨折和7例症状性椎体血管瘤的椎体成形术治疗,其中腰椎30例,胸椎10例,颈椎2例,40例采用单侧或双侧椎弓根入路,2例颈椎血管瘤采用颈椎前外侧入路。注射13%～20%的骨水泥,使骨水泥在椎体内分布、铸形。结果42例治疗都获得成功,注射骨水泥0.5～7mL。42例随访3～15个月,33例患者术后3个月疼痛完全缓解,7例明显缓解,2例有所缓解。42例疼痛评分和自理生活能力评分术后均显著下降(P<0.01)。无复发迹象。结论采用经皮椎体成形术治疗疼痛性椎体压缩性骨折及症状性椎体血管瘤是一种微创、安全、有效的治疗手段。     

经皮椎体成形术治疗椎体恶性肿瘤(附23例报告)

目的探讨经皮椎体成形术治疗椎体恶性肿瘤引起的剧烈疼痛的有效性。方法椎体恶性肿瘤患者共23例,肺癌椎体转移11例,乳腺癌椎体转移5例,骨髓瘤2例,原发性淋巴瘤2例,膀胱癌椎体转移1例,不明来源的恶性椎体肿瘤2例。诊断根据平片、CT、MR和ECT。入院时所有患者均有背部疼痛症状,6点疼痛评分为4.18±0.51分,运动能力评分4.83±0.39分。采用椎弓根入路,以配套活检针抽取组织学标本,配置1.3~1.8g/ml的骨水泥,将骨水泥缓慢注射到椎体中,使骨水泥在椎体病灶内分布、铸形。结果23例33节椎体成形术都获得成功,每节椎体注射骨水泥0.5~7ml。术后2d评估疗效9例患者术后疼痛完全缓解,10例明显缓解,2例中度改善,2例改善不明显。平均疼痛评分降为0.81±0.67,平均运动功能评分1.72±0.41。配对t检验术前、术后比较,有统计学意义(P<0.01)。结论采用经皮椎体成形术治疗椎体恶性肿瘤是一种创伤小、安全、有效的治疗手段,可以明显提高晚期恶性椎体肿瘤患者的生存质量。     

Analysis of Results Using Percutaneous Vertebroplasty for the Treatment of Avascular Necrosis of the Vertebral Body

Objective

Avascular necrosis (AVN) of the vertebral body is known as a relatively uncommon phenomenon in a vertebral compression fracture (VCF). The outstanding radiologic findings of AVN are intravertebral vacuum phenomenon with or without fluid collection. Several reports revealed that PVP or balloon kyphoplasty might be the effective treatment modalities for AVN. We also experienced excellent results when using PVP for the treatment of AVN of the vertebral body, and intend to describe the treatment''s efficacy in this report.

Methods

Thirty-two patients diagnosed with AVN of the vertebral body were treated with PVP. We measured the pre- and post-operative anterior body height and kyphotic angulation. The visual analogue scale (VAS) was used to determine the relief of back pain.

Results

The anterior body height (pre-operative : 1.49 cm, post-operative : 2.22 cm) and kyphotic angulation (pre-operative : 14.47 degrees, post-operative : 6.57 degrees) were significantly restored (p<0.001). VAS was improved from 8.9 to 3.7. Pseudoarthrosis was corrected in all cases, which was confirmed by dynamic radiographs. Fluid collection was found in sixteen cases and was aspirated with serous nature. No organism and tumor cell were noted.

Conclusion

PVP proved to be an effective procedure for the treatment of AVN of the vertebral body, which corrected dynamic instability and significantly restored the anterior body height and kyphotic angulation.     

Post-traumatic osteoporotic vertebral osteonecrosis treated using balloon kyphoplasty

Nineteen patients with post-traumatic osteoporotic vertebral osteonecrosis were treated using percutaneous balloon kyphoplasty. The anterior and middle vertebral heights, as well as the kyphotic angle, were measured using a standing lateral radiograph before surgery, 2 days after surgery and at the final follow-up. At the same time points, a visual analog scale and the Oswestry Disability Index were used to evaluate pain status and functional activity, respectively. The mean follow-up was 24.7 months (range: 7-36 months). Statistically significant improvements were observed between the preoperative and postoperative assessments for each evaluated measure (p < 0.05). There were no statistically significant differences between the postoperative and final follow-up assessments (p > 0.05). Asymptomatic cement leakage into the intervertebral disc occurred in three patients. This study suggests that balloon kyphoplasty is a safe and effective procedure for treating this disease entity.     

Percutaneous vertebroplasty in the treatment of osteoporotic compression fractures

Percutaneous vertebroplasty is an innovative and successful approach to the treatment of painful osteoporotic compression fractures refractory to medical therapy. We encourage all neuroradiologists to take an active interest in bringing this exciting technology to their patients and their practices.     

Extreme Multi-Level Percutaneous Vertebroplasty for Newly Developed Multiple Adjacent Compression Fractures

Osteoporotic patients who undergo percutaneous vertebroplasty (PVP) have the risk of a repeated collapse of their adjacent vertebral body due to alteration of load transfer into the adjacent vertebral body. The authors have experienced a rare case of repeated osteoporotic vertebral compression fractures (VCF) resulting in extreme multi-level PVP. A 74-year-old female developed severe back pain after slipping down one month ago. Her X-ray and MR images indicated a T11 VCF. She underwent successful PVP with polymethylmethacrylate (PMMA). Two weeks later, she returned to our hospital due to a similar back pain. Repeated X-ray and MR images showed an adjacent VCF on T12. A retrial of PVP was performed on T12, which provided immediate pain relief. Since then, repeated collapses of the vertebral body occurred 12 times in 13 levels within a 24-month period. Each time the woman was admitted to our hospital, she was diagnosed of newly developed VCFs and underwent repeated PVPs with PMMA, which finally eased back pain. Based on our experience with this patient, repeated multiple PVP is not dangerous because its few and minor complications. Therefore, repeated PVP can serve as an effective treatment modality for extreme-multi level VCFs.     

The Prognostic Factors Influencing on the Therapeutic Effect of Percutaneous Vertebroplasty in Treating Osteoporotic Vertebral Compression Fractures

Objective

This retrospective study of 215 patients with 383 symptomatic osteoporotic vertebral compression fractures (VCFs) treated by percutaneous vertebroplasty (PVP), was performed to evaluate the clinical outcomes, and to analyze the various clinical factors affecting these results.

Methods

The authors assessed the clinical outcome under the criteria such as the pain improvement, activity, requirement of analgesics, and the patient''s satisfaction, and determined the relation to various peri- and intra-operative factors, and postoperative imaging findings.

Results

The outcome was determined as 84.2% in relief of pain, 72.0% in change in activity, 65.7% in analgesics use, and 84.7% of satisfaction rate. More severe focal back pain, high uptake bone scan, and the lower mean T-score were related to the better pain relief following PVP. The longer the duration between fracture and PVP, the less severe focal back pain, low uptake bone scan, and leakage of PMMA into the paravertebral space were related to the less improvement in activity. Female and low uptake bone scan showed a correlation with more analgesic use. The longer the duration between fracture and PVP, low uptake bone scan, and the higher the mean T-score were correlated with the less the patients satisfaction.

Conclusion

Our study suggests that PVP may be more effective in the acute phase of VCFs, more severe focal pain, and far advanced osteoporosis on BMD. Leakage of PMMA into the paravertebral spcae also could be affecting the surgical results.     

Clinical Outcomes after Percutaneous Vertebroplasty for Pathologic Compression Fractures in Osteolytic Metastatic Spinal Disease

Objective

Percutaneous vertebroplasty (VP) can provide immediate stabilization in pathologic fractures of spinal tumors. However, long term follow-up data in cases of pathologic fractures are lacking. The authors report follow-up results of VP in 185 pathologic fractures of 102 spinal tumor patients.

Methods

Percutaneous VP was performed at 185 vertebral bodies of 102 patients from 2001 to 2007. Retrospective analysis was done with medical records and radiological data. The change of visual analogue score (VAS), vertebral body (VB) height and kyphotic angle were measured preoperatively and on postoperative one day and at 3, 6, and 12 months.

Results

The patients were composed of metastatic spine tumors (81%) and multiple myeloma (19%). Involved spinal segments were between T6 and L5. Mean follow-up period was 12.2 months. VAS for back pain was 8.24 preoperatively, 3.59 (postoperative one day), 4.08 (three months) and 5.22 (one year). VB compression ratio changed from 21.33% preoperatively to 13.82% (postoperative one day), 14.36% (three month), and 16.04% (one year). Kyphotic angle changed from 15.35° preoperatively to 12.03° (postoperative one day), 13.64° (three month), and 15.61° (one year).

Conclusion

Immediate pain relief was definite after VP in pathologic compression fracture of osteolytic spinal disease. Although VAS was slightly increased on one year follow-up, VP effect was maintained without significant change. These results indicate that VP could be a safe and effective procedure as a palliative treatment of the spinal tumor patients.     

Incidence of subsequent vertebral body fractures after vertebroplasty

The causal relationship between vertebroplasty and new-onset vertebral fractures remains unproved. We undertook a systematic review and meta-analysis of randomized controlled trials to assess whether vertebroplasty increases the incidence of new vertebral fractures and adjacent vertebral fractures. A systematic literature search of PubMed, EMBASE and Cochrane Library databases up to April 2013 was conducted. Eligible studies were randomized controlled trials of osteoporotic vertebral fracture patients receiving vertebroplasty. Risk ratios (RR) and 95% confidence intervals (CI) were calculated and heterogeneity was assessed with both the chi-squared test and the I² test. Four studies with a total of 454 patients met the inclusion criteria. All four studies described the incidence of new vertebral fractures and three studies described adjacent vertebral fractures. The pooled results revealed that vertebroplasty was not associated with a significant increase in the incidence of new vertebral fractures (RR 1.12, 95% CI 0.75–1.67; p = 0.59) or adjacent vertebral fractures (RR 2.31, 95% CI 0.36–15.06; p = 0.38). Based on available evidence, it cannot be concluded that vertebroplasty can significantly increase the postoperative rate of new vertebral fractures and adjacent vertebral fractures. However, due to some limitations, the results of this meta-analysis should be cautiously accepted, but further studies are needed.     

Early and long-term outcomes of vertebroplasty for single osteoporotic fractures

BACKGROUND AND PURPOSE : Percutaneous vertebroplasty (PVP) is a minimally invasive vertebral augmentation procedure for the treatment of recent, osteoporotic vertebral compression fractures. The aim of the study was to determine the early and late outcomes of PVP for osteoporotic vertebral compression fractures. MATERIAL AND METHODS: We prospectively assessed outcomes of PVP in 200 patients with single, osteoporotic vertebral compression fracture. Follow-up assessment was made 12 hours after surgery as well as after 7 days, 30 days, 3 months, 6 months, and 1 year after surgery. A subgroup of 80 patients was evaluated also 2 years after PVP. A 100-mm visual analogue scale of pain was used for outcome measurement. RESULTS : Twelve hours after PVP, very significant relief of pain was obtained in 85% of patients; on the 7th and 30th day a very good result of treatment was noted in 96%. The same result was noted in 92% of patients at the 6th month, and in 90% of patients at the 12th month. Among the 80 patients followed for 2 years, 3 patients reported recurrence of pain and were subsequently diagnosed with new osteoporotic fractures. CONCLUSIONS : Percutaneous vertebroplasty is a minimally invasive method of treatment for fresh osteoporotic fractures, which provides a significant and sizeable reduction of pain in the short as well as long term after surgery. Complete relief of pain was noted 12 hours after PVP in 94% of patients, and was noted in 90% two years after treatment. Despite some literature data suggesting no beneficial effect of PVP, it can be concluded that PVP is the most effective and the safest method for fresh vertebral compression fracture treatment.     

Percutaneous Vertebroplasty for Pregnancy-Associated Osteoporotic Vertebral Compression Fractures

Osteoporosis is a worldwide problem and it mainly affects postmenopausal women. Osteoporosis associated with pregnancy or lactation is a rare condition. The incidence and mechanism of this phenomenon has not been clarified, but it can cause one or more vertebral compression fractures with severe, prolonged back pain in the affected women. We experienced this uncommon case, treated it with percutaneous vertebroplasty. A 35-old-woman visited our hospital with complaints of severe back pain and flank pain 2 months after normal vaginal delivery. She was diagnosed with osteoporotic vertebral compression fractures on the T5, 8, 9 and 11 vertebral bodies and we performed percutaneous vertebroplasty on the T8, 9 and 11 vertebrae with a good result. We present here an unusual case of pregnancy-associated compression fractures treated by percutaneous vertebroplasty.     

Percutaneous transpedicular vertebroplasty with polymethyl methacrylate for pathological fracture of the spine

We aimed to evaluate the safety and therapeutic efficacy of percutaneous transpedicular vertebroplasty (PVP) using polymethyl methacrylate (PMMA) in patients with symptomatic metastatic spine lesions. We included 31 patients in this retrospective study who were treated with PMMA from 2003 to 2005 for intractable pain due to metastatic spine lesions. The types of cancer (and numbers of patients) included: lung cancer (9), breast cancer (7), gastrointestinal (GI) tract cancers (5), hepatobiliary malignancies (3), and other types of cancer (7). All patients received vertebroplasty, resulting in 41 treatments (16 in thoracic, 25 in lumbar spine). Preoperative and postoperative visual analog scale (VAS) scores for pain were measured in all patients. Image studies including contrast-enhanced MRI were performed in all patients. Results showed characteristic metastatic lesions. Suspicious lesions were further confirmed as malignant by a bone scan, a positron emission tomography (PET) scan, and pathological exam. Vertebroplasty resulted in complete or partial pain relief in 29 patients (95%), and provided no pain relief in 2 patients (5%). The mean preoperative VAS score of 8.9 (±0.93) was higher than the mean postoperative VAS score (2.6 ± 1.71). Metastatic spine lesions were most common in lung and breast cancer patients and these lesions were located more often on segments T12 to L2 (53.6%). Patients with malignancy of hepatobiliary origin did not show improvement in pain scores as dramatically as patients with other types of malignancies, although only a few cases were included in this study. No patients experienced worsening of symptoms or suffered from vertebroplasty complications. We conclude that vertebroplasty is a safe, effective, and simple treatment for the management of intractable spinal pain due to metastases.     

Open vertebroplasty in the treatment of spinal metastatic disease

Background

Metastatic spine tumors can cause vertebral body (VB) osteolysis, microfractures, and/or compression fractures, and requires restabilization of the VB. Curative or curettage surgery, such as vertebrectomy and reconstruction, is currently the main method of treatment. In certain situations however, such as a patient's poor condition, multi-level involvement, or a limited life expiration, major surgery is not recommended.

Objective

To evaluate a new method of open vertebroplasty (OVP) in the treatment of VB metastasis and to investigate the indications for, limitations of, and the result of this new procedure.

Methods

Between May 2007 and May 2010, the authors treated 18 patients with VB metastasis disease by OVP. Patients consisted of 12 men and 6 women with a mean age of 53 years. All patients suffered severe back pain preoperatively (mean VAS score of 6.82). Spinal cord compression resulted in eight and isolated radicular compression occurred in three of the 18 patients. In these 18 patients, 28 vertebral levels were treated: three levels in 3 patients; two levels in 4 patients; and one level in the remaining 11 patients. OVP was used accompanied by vertebral fixation or medullary compression.

Results

The mean duration of the OVP procedure was 37 min. Blood loss ranged from 50 to 150 ml. In all patients, pain improved within seven days after the intervention, and the mean VAS score decreased to 2.31. Patients who suffered from neurological dysfunction preoperatively improved in Frankel degree (the result of spinal cord decompression). Most patients reached an excellent score, according to the Modified MacNab Criteria. Postoperative radiography revealed cement leaks into pulmonary veins in one case. After OVP or PVP, all patients underwent radiotherapy or chemotherapy.

Conclusions

OVP has a comprehensive application in metastasis spinal column disease, being easily performed and accompanied by few complications. Importantly, this procedure allows decompression of the spinal cord and consolidation of the VB, thus stabilizing the vertebral column. Results from the clinic demonstrate that patients experience pain relief and neural function recovery following the OVP procedure.     

102例经皮椎体成形术22例骨水泥渗漏原因分析及防治

老年人骨质疏松所致的椎体压缩性骨折（VCF）可致伤椎椎体塌陷,脊柱稳定性下降,疼痛和神经功能丧失。传统的治疗方法采用长期卧床休养等治疗,患者生活质量严重下降,且易出现坠积性肺炎、下肢深静脉血栓,褥疮等并发症,尤其对高龄,基础疾病较多者;有的学者尝试使用开放手术,然而对于老年VCF患者特别是高龄患者,骨质对内固定物的把持力不够,容易出现内固定在椎体内的切割,松动现象,导致内固定物松动,拔出致治疗失败。1984年首次应用经皮椎体成形术治疗椎体血管瘤,1997年开始采用经皮椎体成形术(Percutancousvertebroplasty,PVP)成功治疗老年VCF。该方法为微创性手术,早期止痛效果好,术后患者可早期下地活动,避免了患者长期卧床引起的各种并发症,目前在国内外得到了广泛的应用,但不可忽视的是PVP术由于骨水泥自身具有一定流动性性状所致的渗漏比例较高,大量临床资料显示这种渗漏多不至造成严重神经血管症状,如致死性大出血,不可逆性脊髓,外周神经损伤,但由于骨水泥在凝固过程中于局部释放大量热量,最高可达80C°-90C°,且渗漏后的固体骨水泥块位移及定位位置具有一定随机性,不可控性,如占位于关键点部位,如椎管内,神经根孔等处,仍有一定机率出现严重,不可逆性后果,如截瘫等,如何在临床工作中尽量减少骨水泥渗漏机率,减轻骨水泥渗漏后造成的影响,有必要从PVP术手术适应症,具体操作细节等方面做深入探讨。目的：探讨经皮椎体成形术(Percutaneous vertebroplasty,PVP)骨水泥渗漏的防治措施。方法：经皮椎体成形术治疗VCF102例131个椎体,方法再完善一些患者俯卧位或侧卧位,在X线机透视下定位伤椎,选定穿刺点,经单侧椎弓根至椎体前中1／3处,透视下注入并观察骨水泥PMMA填充、弥散情况,至填充、弥散满意后3～5 min,拔出穿刺针,24 h后鼓励患者下地活动。观察术后疼痛缓解情况及术后1月一般健康状况,手术疗效及骨水泥渗漏情况,。。结果与结论：所有患者术后疼痛即明显缓解,术前术后VAS疼痛评分分别为(8.78±0.58)分、(1.13±0.34)分,术前术后VAS分值具有明显差异(P<0.05),术后半年和术后一年VAS疼痛评分分别为(1.12±0.32)分、(1.55±0.50)分,VAS分值差异无统计学意义(P>0.05)。术前术后SF-36生活质量积分比较(mean±SD),PVP术后患者疼痛改善状况,总体健康,活力完成社会职能方面与术前比较有差异有统计学意义,术后优于术前。骨水泥渗漏22例：渗漏至椎管1例,改行开放手术后患者恢复良好;渗漏至神经根管3例,经保守治疗后缓解;渗漏至椎间隙内10例,椎旁8例,无明显临床症状。聚甲基丙烯酸骨水泥（PMMA）与成人骨成分一致,组织相容性好,即使长期留置体内也不会有排斥反应,PVP治疗VCF效果良好,但是骨水泥渗漏发生率较高,需严格掌握手术适应证,减少骨水泥渗漏的发生。     

Early mobilization reduces the medical care cost and the risk of disuse syndrome in patients with acute osteoporotic vertebral fractures

Study designA retrospective observational study.PurposeTo compare two conservative treatments for acute osteoporotic vertebral fractures (OVFs).Overview of literatureSeveral studies have reported conservative treatments for OVFs in terms of using a brace, rehabilitation, and bed rest. However, there is no consensus about the conservative treatment for OVFs.MethodsWe evaluated 68 patients with acute OVF treated in our hospital from 2007 to 2011. Thirty-four patients treated in prolonged bed rest (PBR) regimen underwent rehabilitation wearing a Jewett’s brace after three weeks of bed rest. In contrast, the other 34 patients underwent rehabilitation wearing a Jewett’s brace as soon as possible, which we called a stir-up (SU) regimen. We compared two treatment groups for medical costs, hospital length of stay (LOS), pain according to the numeric rating scale (NRS), the activities of daily living (ADL), and imaging studies.ResultsThe average hospital LOS was significantly shorter in patients treated by the SU regimen, which resulted in the medical costs reduction. There was no significant difference in the NRS through 6 months between the two groups. Although many patients in both groups experienced at least one level reduction in ADL at 6 months after the injury, patients in the SU group tended to maintain their pre-injury ADL, which almost agrees with past reports. In terms of imaging studies, patients in the PBR group showed milder vertebral compression rate over time. Pseudoarthrosis occurred in 2 patients in the SU group, who presented with mild pain, which had little influence on their daily lives.ConclusionWe compared two conservative treatments for OVFs. Early rehabilitation was useful treatment for OVFs to minimize the risk for disuse syndrome, maintain pre-injury ADL status, and reduce the medical costs.