后凸成型術技術現(xiàn)狀與進展

1、Hansen A. Yuan, M.D.Department of Orthopedic and Neurological SurgerySUNY-SyracuseKyphoplasty:Update and Advanced Techniques Vertebral osteoporosis is underdiagnosed, undertreated, unrecognized cause of significant economic, physical and psychosocial consequences, with significant mortalityUS Burden

2、700,000-750,000 vertebral fractures/yr 280,000 clinically-diagnosed fractures150,000 hospital admissionsAve. LOS 9 days5 million days of restricted activity/yrRiggs et al. Bone 1995Nevitt et al. Ann Int Med 1998Ray et al. J Bone Min Res 1997Number of Vertebral Fractures Progressively Decreases Healt

3、h-Related QOL 012340123401234EmotionalStatusPhysicalFunctionSymptomsMean OPAQ ScoreAll decreases in scores statistically significant at p0.001From 0 to 1 fracture, all p-values 0.05Silverman Arth Rheum 2002New Vertebral Fracture Rapidly Increases Risk of Next Vertebral Fracture *p=0.02 vs. patients

4、w/ no prevalent vertebral fractures (12-fold increased risk)Percent (%) of PatientsNumber of Prevalent Vertebral Fractures*20% of Women Fracture Again Within One Year of an Incident FractureThe Risk of Fracture Varies With Prevalent FractureKyphoplasty in Osteoporotic VCF:Update96 patients, 133 frac

5、turesMean age 76 yearsMean duration of symptoms 2.4 mosNo complications12 leaks (9%)Ledlie et al. J Neurosurg (Spine) 2003Kyphoplasty in Osteoporotic VCF:UpdateLedlie et al. J Neurosurg (Spine) 2003Pre and Post-Op Activity LevelsLedlie et al. J Neurosurg (Spine) 2003New Indications for KyphoplastyMu

6、ltiple MyelomaMetastatic Osteolytic LesionsTraumaPedicle Screw AugmentationMultiple Myeloma in the Literature55 fractures, 18 patientsIndications:Vertebral fracture pain Non-responsive to conventional pain managementContradindications:Posterior destructionRetropulsed boneBone fragments Dudeney et al

7、. Kypholasty for Myelomatus Compression Fractures J Clinical Oncology 20 (2002) 2382Multiple Myeloma ResultsHeight restoration 34%Leak rate 4/55 (4%)No complicationsSF-36:Dudeney et al. J Clin Onc 2002p 0.01 pre vs. post (7 months)Multiple Myeloma and Metastatic Lesions27 patientsIndications:Local k

8、yphosis 20Posterior cortical disruptionResults:Pain relief in 80%46% lost height restored0 leaksFourney et al. J Neurosurg (Spine) 2003Female, age 77low back painHemangioma (very hard bone)our Tamps work greatIntact posterior wall (MRI or CT)61 year old male with metastatic colon cancer.9 months of

9、severe low back pain.Had radiation. Currently on narcotics and morphine pump without pain relief.Immediate pain relief.Stopped use of morphine pump and cut back on narcotics.TraumaEarly experience in European centersType A (compression) fracturesKyphosis 15Filler = load-bearing calcium phosphate cem

10、ent not available in the USCompressive strength 60 mPa L2 fx, 50 YO male20 ft fall, treated at 5 daysCourtesy Dr. Maestreati, Fribourg, SwitzerlandPre-op lateral X-ray Pre-op lateral CTL2 fx, 50 YO male 20 ft fall, treated at 5 days Courtesy of Dr. Maestreati, Fribourg, SwitzerlandIBTposition:flat,

11、2-3 mmunderfx lineIBTfinal inflation,lateralviewIBT:final inflation,AP viewFinal fillL2 fx, 50 YO male20 ft fall, treated at 5 daysCourtesy of Dr. Maestreati, Fribourg, SwitzerlandPre-op lateral Post-op lateral Post-op APL2 fx, 50 YO male 20 ft fall, treated at 5 daysCourtesy of Dr. Maestreati, Fribourg, SwitzerlandPre-op lateral Post-op lateral Post-op APL2 fx, 50 YO maleOne week post-opCourtesy of Dr. Maestreati, Fribourg, SwitzerlandL1 fx, 15 YO femaleMotor scooter accidentTreated at 3 daysCourtesy Dr. Francaviglia, Caltanissetta, ItalyPre-op lateralPost-op lateralL1 fx, 15 YO femaleMotor