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| 篇名 |
Transpedicular PMMA vertebroplasty for the treatment of osteoporotic vertrbral compression fracture |
| 作者 |
Chung-Nan Lin, Tu-Chuan Wu, Nai-Phon Wang |
| 卷期/出版年月 |
35卷2期 (2002/4) |
| 頁次 |
74-81 |
| 摘要 |
The study was undertaken to report our clinical experience with bilateral transpedicular vertebroplasty and to determine the degree of pain relief as well as mechanical strength restoration when using PMMA (polymethyl methacrylate) for the treatment of osteoporotic vertebral compression fracture.
Over a period of 8 months from March 2001 to October 2001, 23 patients with 29 vertebral fractures at different levels (T8-L5) were treated with vertebroplasty with the intention to relieve pain and increase mobility. The series included 9 men and 14 women. Seven patients had corticosteroid induced osteoporosis, twelve patients had post-menopausal osteoporosis, and four patients gad male osteoporosis. The mean duration of symptoms was 9.5 months and symptomatic levels were identified by correlating the clinical data with MRI findings. The procedures were performed with surgically controlled bilateral transpedicular injection of PMMA into the vertebral bodies. Before injection, sites were identified on vertrbral phleborgraphy under C-Arm guidance to evaluate the fillinf pattern and potential cement leakage. Pre and post-operative radiographs were compared to calculate the percentage of height restored. Clinical follow-up involved an evaluation using a questionnaire for assessment of pain (10 point scale) and mobility (walking ability, 4 grades). The following results were obtained: (1) Immediate satisfactory postoperative (within 7 days) pain relief (of at least 4 points) occurred in 83% (19/23) of patients. However, gradual pain improvement and remission of pain character was observed within 8 months in all but one patient. (2) Vertebral bodies repaired with PMMA had an average 34% initial radiographic height restoration and significantly greater strength (walking ability improved an average of 2.1 grades) relative to prefracture states. (3) Complications occirred in 1 patient and were thought to be mainly related to cement leakage which caused nerve root compression and required emergency laminectomy. The other patients had no adverse events or vertebral fractures. (4) An average of 3-10 ml of PMMA was injected. However, the magnitude of pain relief and strength restoration did not correlate with the volume of cement injected.
PMMA relieves pain and restores vertebral body strength. It is promising in transpedicular vertefroplasty treatment of persistant painful osteoportic compression fractures. The mechanism of pain relief as well as strength restoration may be due to thermal destruction of the nerve endings and stabilization of microfractures. |
| 關鍵詞 |
vertebroplasty, PMMA, osteoporosis, vertebral compression fracture |
| 分類 |
Original Article |
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