对经皮椎体强化术的再认识

Re-understanding of percutaneous vertebral augmentation

多年来,以椎体成形术和椎体后凸成形术为代表的椎体强化术(PVA)已成功用于治疗骨质疏松性和肿瘤性椎体骨折。2009年发表于New England Journal of Medicine的两篇文章对椎体成形术治疗椎体压缩骨折的疗效提出质疑。然而随后大量的反驳文献陆续发表。PVA仍被广泛应用于临床。文章的目的是在临床参数(疼痛,残疾,生活质量,新发骨折)及影像学表现等方面,比较非手术治疗和PVA的治疗效果,讨论"非手术治疗失败"的定义和PVA骨水泥渗漏等不良反应。根据临床证据,探讨治疗骨质疏松性和肿瘤性椎体骨折最佳方案。

For many years, percutaneous vertebral augmentation （PVA）, represented by vertebroplasty （VP） and kyphoplasty （KP）, have been successfully employed in clinical treatment of osteoporotic and neoplastic vertebral fractures. In 2009, two open randomized controlled trials published in the New England Journal of Medicine questioned the value of vertebroplasty in treating vertebral compression fractures. Then, a large number of academic papers have been published to refute the above views. So far, PVA has still been used in clinical practice. This paper aims to make a comparison of therapeutic effectiveness between nonsurgical management and PVA in the aspects of clinical parameters （pain, disability, quality of life and new fractures） as well as imaging findings, and to discuss the definition of ＂nonsurgical treatment failure＂ and the adverse reactions such as cement leakage. The evidence-based optimal therapeutic schemes for osteoporotic and neoplastic vertebral fractures are also discussed.