Older adults over 60 should be enjoying a happy life in their old age, but vertebral fractures secondary to osteoporosis cause many older adults to suffer from back pain. Osteoporosis is a systemic natural degeneration characterized by loss of bone calcium that often occurs in the elderly and can result in compression fractures of the spine under minor external forces. Patients may experience back pain, require prolonged bed rest, and have a significantly reduced quality of life. Due to the compression of the vertebrae, the spine becomes kyphotic and certain organs of the thoracic and abdominal cavities are compressed, causing dysfunction of the respiratory, cardiac and digestive systems.
Traditional treatment methods include bed rest, drug analgesia, and external fixation of braces, which can easily lead to further bone decalcification and osteoporosis, forming a vicious circle. The open surgical treatment is also limited by the patient’s osteoporosis and poor general condition. In recent years, new minimally invasive techniques such as vertebroplasty and kyphoplasty have been introduced and are widely performed in developed countries such as Europe and the United States with encouraging results, opening up a whole new avenue for the treatment of osteoporotic vertebral compression fractures in the elderly.
Percutaneous vertebroplasty (PVP) is an imaging system-mediated percutaneous injection of a certain amount of bone cement and other materials into the vertebral body to increase the strength of the vertebral body, prevent collapse, and provide pain relief.
Based on this, percutaneous kyphoplasty (PKP) was developed, in which an expandable balloon is placed into the vertebral body percutaneously and through the pedicle, the balloon expands and expands, the fractured vertebral body is repositioned, a safe and effective space is created in the fractured vertebral body, the balloon is deflated and the bone cement is injected under low pressure. PKP not only corrects the kyphosis, but also provides rapid pain relief and early return to functional exercise. Not only is it less invasive and quicker to recover, but it also provides time and possibility for subsequent etiologic treatment.
PKP was first introduced in the United States in 1994, and the technique quickly gained recognition for its efficacy and safety in various related disciplines, including radiology, orthopedics and neurosurgery, and became popular worldwide. In the United States alone, 38,000 procedures were performed in 2002. PKP is now advocated as a first-line treatment option for osteoporotic vertebral compression fractures in Europe and the United States.
The advantages of using this treatment are
1. Minimally invasive intervention under local anesthesia, with a short operation time, incision of 0.5-0.8 cm, bleeding of 2-3 ml, and a clear pain relief effect. It has the effect of relieving pain and rebuilding the biomechanical strength of the bone at the same time.
2. For elderly and debilitated patients, surgery is a serious intervention, but with PKP treatment, the surgical risk borne by patients is greatly reduced and potential complications caused by brake fixation are avoided.
3. The postoperative recovery is quick and the hospitalization is short (usually 3-5 days).
4, due to the timely relief of pain thus avoiding the toxic side effects of drugs, drug dependence, improve the quality of life.
5.Significantly reduces the time of bed rest and the need for escorts for patients with vertebral compression fractures.
PKP is developing very rapidly as a promising treatment method. Referring to the standards of the American College of Radiology (ACR), the
Its surgical suitability mainly includes the following.
1, osteoporotic vertebral compression fracture, support or drug treatment is ineffective;
2. Benign tumors or malignant metastases of the vertebral body;
3, vertebral fracture with osteonecrosis or fracture does not heal;
4, unstable compression fracture or multi-segmental vertebral compression fracture;
5, burst fracture with intact posterior wall of the vertebral body.
In addition, with the deepening of research and the gradual expansion of PKP technology in China, its indications are gradually expanding.
For example, based on the treatment of a large number of PKP cases, the orthopedic spine department of the Affiliated Hospital of the Armed Forces Medical College has successfully used this technique for fresh acute traumatic vertebral compression fractures, especially in patients who do not have a fracture mass protruding into the spinal canal causing occupancy, and who end up with the anterior and posterior walls of the vertebral body intact, using the PKP technique instead of the traditional posterior decompression nailing surgery, which not only greatly reduces the It not only greatly reduces the medical trauma and long-term complications caused by surgery, but also reduces the cost of treatment and shortens the recovery time.
For severe vertebral burst fractures, the hospital has successfully combined the arch root fixation with PKP technique, the innovation of which lies in the implantation of bone cement from the injured vertebral body to restore the height of the vertebral body at the same time of internal fixation, so that the vertebral body resection, artificial vertebral body replacement and posterior internal fixation, which should be performed in combination with the anterior and posterior approaches, become a simple posterior operation, which is not only easy to operate but also maximizes the preservation of the patient’s The immediate and long-term results are significantly better than those of traditional surgery.