骨粗鬆症性椎体骨折の病態と急性期治療—椎体形成術の適応と手技

Pathology and Acute Phase Treatment of Osteoporotic Vertebral Fractures:Indications and Techniques for Vertebroplasty

Point

・骨粗鬆症性椎体骨折に対する椎体形成術は，優れた鎮痛効果を示す．

・確実な経椎弓根的な椎体穿刺と漏れのないセメント充塡が重要である．

・穿刺は，椎弓根外側頭側から椎体中央に向かって穿刺し，椎体前1/4の点まで進める．

・骨セメントの椎体内の分布には，骨梁内の間隙にしみわたるように分布するパターンと1つの塊のように集積するパターンがある．

・骨セメントの漏れの3つの経路（basivertebral vein，segmental vein，cortical vein）をあらかじめ意識することが安全な注入に必要である．

＊本論文中、［Video］マークのある図につきましては、関連する動画を見ることができます（公開期間：2028年2月まで）。

　Vertebroplasty has shown excellent analgesic effects in patients with osteoporotic vertebral fractures. In Japan, percutaneous vertebroplasty, balloon kyphoplasty, and vertebral body stenting are commonly performed. All of these techniques require precise transpedicular vertebral puncture and complete cement filling without leakage. Puncture should only be performed after accurately identifying the upper and lower end plates of the vertebral body, lateral borders, and pedicles using combined frontal and lateral fluoroscopic images. In the frontal view, the puncture was made from the lateral cranial side of the pedicle toward the center of the vertebral body. In the lateral view, before passing through the medial wall, the tip had entered the vertebral body and advanced to the anterior quarter. Bone cement within the vertebral body can permeate the trabecular spaces or accumulate as a single mass. To prevent leakage, the movement of the injecting finger should be aligned precisely with the fluoroscopic images. Awareness of the three leakage patterns and basivertebral, segmental, and cortical veins, is crucial. Potential lateral leakage outside the vertebral body must be focused. The injection was terminated as the cement reached the posterior quarter.