胸腰椎部骨粗鬆症性脊椎破裂骨折に対するハイドロキシアパタイトを用いた局麻下経皮的椎体形成術

Percutaneous Vertebroplasty with Hydroxyapatite for Osteoporotic Vertebral Burst Fractures

　胸腰椎部の骨粗鬆症性脊椎破裂骨折に対し，整復後に骨量が著しく減少した椎体内前方部にハイドロキシアパタイトを充填し，1～6年（平均2.2年）追跡した．対象は25例で，24例が骨癒合し，体動時腰痛は27週以内に全例で消失した．椎体前方圧縮率は術前中央値48％であった．術直後5％にまで改善したが最終観察時19％になった．脊柱管内陥入骨片占拠率は術前中央値18％が最終時10％となり，占拠率20％以上の新鮮例がよく回復した．腰痛は早期に消失し，椎体圧縮率や脊柱管面積は改善し，本法は骨粗鬆症性破裂骨折に有用な方法と思われる．

　Reduction of osteoporotic vertebral burst fractures causes a large defect in the anterior third of the vertebral body. This defect is filled with Hydroxyapatite. Subjects were 25 patients followed up 1 to 6 years (mean, 2.2 years). No complication were seen, including neurovascular damage. All patients were completely relieved from low back pain in 1 to 27 weeks (median, 4.5 weeks) after surgery. Compression of anterior vertebral height was 24-84％ (median, 48％) on admission, which improved to 0-29％ (median, 5％) after surgery and rebounded to 0-56％ (median, 19％) at the latest observation. The estimated area of bony fragment retropulsed into the spinal canal using CT was firstly 5-37％ (median, 18％), and unchanged or gradually improved to 5-29％ (median, 10％) at final evaluation. Percutaneous vertebroplasty with hydroxyapatite in the osteoporotic vertebral burst fracture restored vertebral body height, and improved the spinal canal, besides bringing early pain relief.