圧迫骨折に対する経皮的椎体形成術

Percutaneous Vertebroplasty for Vertebral Compression Fracture

Ⅰ．は じ め に

　圧迫骨折を生じて立つことはおろか，寝返りすら困難になった高齢者が，局所麻酔の30分ほどの処置で翌日には痛みから解放され，ADLの著明な改善が得られる画期的な治療，それが経皮的椎体形成術である．圧迫骨折に対する経皮的椎体形成術は，本邦でも広まりつつある．本研究では，われわれが行ってきた圧迫骨折に対する経皮的椎体形成術の治療成績，合併症，問題点を検討し，文献的考察を加える．

　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.