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Ergebnisse der Ballonkyphoplastie in der Behandlung von osteoporotischen Wirbelkörperfrakturen

Results of balloon kyphoplasty in the treatment of osteoporotic vertebral compression fractures

Der Unfallchirurg Aims and scope Submit manuscript

Zusammenfassung

Das Ziel dieser Untersuchung ist es, die Schmerzreduktion, die Verbesserung der Wirbelkörperdeformität, unerwünschte Wirkungen sowie die mittelfristigen Behandlungsergebnisse nach Ballonkyphoplastie bei osteoporotischen Wirbelkörperkompressionsfrakturen darzustellen.

Es wurden 87 Patienten mit 145 osteoporotischen Wirbelkörperfrakturen, bei denen eine medikamentöse Therapie fehlschlug, mittels Ballonkyphoplastie behandelt und sämtliche Daten prospektiv erfasst. Die Verbesserung der Wirbelkörperhöhe wurde in CT-Untersuchungen mittels Messung von Cobb- und Kyphosewinkel, anteriorer, mittlerer sowie posteriorer Wirbelköperhöhe ermittelt. Das Schmerzausmaß wurde anhand einer visuellen Analogskala (VAS) erfasst.

Der Vergleich der präoperativen mit den postoperativen CT-Untersuchungen zeigte eine signifikante Reduktion des Kyphosewinkels von im Mittel 5,7° (2°–24°). Die Schmerzen besserten sich in der VAS signifikant von 7,8±2,4 auf 2,0±1,5 (Schmerzverbesserung bei 95,5% der Patienten). Ein symptomfreier Austritt des Knochenzements aus dem Wirbelkörper wurde in 28/145 Fällen (19,3%) beobachtet. Nach im Mittel 13 Monaten (12–16 Monate) konnten bisher 35 Patienten mit 51 Wirbelkörperfrakturen nachuntersucht werden (CT und VAS). Es zeigten sich eine anhaltende Schmerzreduktion und kein signifikanter Korrekturverlust des Kyphosewinkels. Erneute Frakturen mit Symptomen sind in diesem Kollektiv bei 4 Patienten, klinisch stumme neue Frakturen bei 5/35 Patienten aufgetreten. Sieben Frakturen lagen dabei im Anschluss an die initiale Fraktur, 2 Frakturen an einer entfernten Lokalisation. Bei 2 Patienten konnte im CT ein symptomfreier Höhenverlust des mittels Kyphoplastie versorgten Wirbels beobachtet werden.

Mit Hilfe der Ballonkyphoplastik kann bei Patienten mit schmerzhaften osteoporotischen Wirbelkörperfrakturen mittelfristig eine erhebliche Besserung der Schmerzsymptomatik und eine Aufrichtung der Wirbelkörper erreicht werden. Bei 26% der Patienten traten jedoch vermehrt in Nachbarsegmenten neue Frakturen auf, von denen ca. 50% symptomfrei verlaufen.

Abstract

The aim of this study was to evaluate the reduction of pain, improvement of sagittal alignment, complications and intermediate term results of balloon kyphoplasty in the treatment of osteoporotic vertebral compression fractures (VCF).

The study group consisted of 87 patients with 145 VCFs which were not responsive to non-operative treatment. All data were collected prospectively. Improvement of sagittal alignment (Cobb and kyphotic angles, anterior, middle and posterior height) was determined from CT scans. Pain was evaluated by means of a visual analogue scale (VAS).

Postoperative CT scans revealed a significant reduction of the mean kyphotic angle of 5.7° (range 2-24°) and a significant reduction of pain from 7.8±2.4 to 2.0±1.5 in the VAS (improvement of pain in 95.5% of patients). An asymptomatic leakage of cement was observed in 28 out of 145 vertebrae (19.3%). The outcome of 35 patients with 51 VCFs was evaluated after a mean of 13 (range 12-70) months (CT and VAS) and there was a persisting reduction of pain and no loss of reduction. In this group of patients new symptomatic fractures were evident in 4 and clinically asymptomatic (only seen on CT) fractures were detected in 5 out of 35 patients, 7 fractures were adjacent to and 2 fractures were remote from the initially treated level. In two patients an asymptomatic moderate loss of reduction was detected.

These intermediate term results indicate that kyphoplasty reduces pain and improves sagittal alignment in patients with VCF. However, in 26% of patients new fractures occurred, predominantly in adjacent levels but approximately 50% of these fractures were clinically asymptomatic.

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Der korrespondierende Autor weist auf folgende Beziehungen hin: Referententätigkeit und Studienberatung für Kyphon Europe.

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Voggenreiter, G., Brocker, K., Röhrl, B. et al. Ergebnisse der Ballonkyphoplastie in der Behandlung von osteoporotischen Wirbelkörperfrakturen. Unfallchirurg 111, 403–413 (2008). https://doi.org/10.1007/s00113-008-1453-5

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