骨粗鬆症性脊椎圧迫骨折に対するballoon kyphoplasty (BKP) 治療経験と短期手術成績
2011年2月∼7月に当科で保存的治療が無効の有痛性骨粗鬆症性脊椎圧迫骨折 (osteoporotic VCF) に対してballoon kyphoplasty (BKP) を施行し, 3カ月以上フォローアップ可能であった7症例につき臨床成績, 放射線学的所見を検討しBKPの有効性, 安全性につき検証した. 全例で即時的な疼痛緩和, ADL改善を認めた. また椎体高回復, 局所後弯角改善も認め, 共に統計学的に有意であった. 合併症としては1例のみBKP施行1カ月後に隣接椎体に新規骨折を認めたが, 全例でセメント漏出は認めず神経学的, 全身性合併症も認めなかった. BKPはosteoporot...
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| Published in | 脳神経外科ジャーナル Vol. 21; no. 12; pp. 959 - 966 |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本脳神経外科コングレス
20.12.2012
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 0917-950X 2187-3100 |
| DOI | 10.7887/jcns.21.959 |
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| Abstract | 2011年2月∼7月に当科で保存的治療が無効の有痛性骨粗鬆症性脊椎圧迫骨折 (osteoporotic VCF) に対してballoon kyphoplasty (BKP) を施行し, 3カ月以上フォローアップ可能であった7症例につき臨床成績, 放射線学的所見を検討しBKPの有効性, 安全性につき検証した. 全例で即時的な疼痛緩和, ADL改善を認めた. また椎体高回復, 局所後弯角改善も認め, 共に統計学的に有意であった. 合併症としては1例のみBKP施行1カ月後に隣接椎体に新規骨折を認めたが, 全例でセメント漏出は認めず神経学的, 全身性合併症も認めなかった. BKPはosteoporotic VCFの遷延する疼痛に対して, 有効かつ安全に施行可能な低侵襲治療であると考えられる. |
|---|---|
| AbstractList | 2011年2月∼7月に当科で保存的治療が無効の有痛性骨粗鬆症性脊椎圧迫骨折 (osteoporotic VCF) に対してballoon kyphoplasty (BKP) を施行し, 3カ月以上フォローアップ可能であった7症例につき臨床成績, 放射線学的所見を検討しBKPの有効性, 安全性につき検証した. 全例で即時的な疼痛緩和, ADL改善を認めた. また椎体高回復, 局所後弯角改善も認め, 共に統計学的に有意であった. 合併症としては1例のみBKP施行1カ月後に隣接椎体に新規骨折を認めたが, 全例でセメント漏出は認めず神経学的, 全身性合併症も認めなかった. BKPはosteoporotic VCFの遷延する疼痛に対して, 有効かつ安全に施行可能な低侵襲治療であると考えられる. |
| Author | 上坂, 十四夫 渡邊, 水樹 高橋, 敏行 花北, 順哉 倉石, 慶太 武澤, 正浩 千原, 英夫 |
| Author_xml | – sequence: 1 fullname: 高橋, 敏行 organization: 藤枝平成記念病院脊髄脊椎疾患治療センター – sequence: 1 fullname: 上坂, 十四夫 organization: 藤枝平成記念病院脊髄脊椎疾患治療センター – sequence: 1 fullname: 武澤, 正浩 organization: 藤枝平成記念病院脊髄脊椎疾患治療センター – sequence: 1 fullname: 千原, 英夫 organization: 藤枝平成記念病院脊髄脊椎疾患治療センター – sequence: 1 fullname: 渡邊, 水樹 organization: 藤枝平成記念病院脊髄脊椎疾患治療センター – sequence: 1 fullname: 花北, 順哉 organization: 藤枝平成記念病院脊髄脊椎疾患治療センター – sequence: 1 fullname: 倉石, 慶太 organization: 藤枝平成記念病院脊髄脊椎疾患治療センター |
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| References | 41) 湯田康正 : 椎体減圧術 (経椎体法). ペインクリニック 27 : 628-640, 2006. 14) Jensen ML, Evans AJ, Mathis JM, Kallmes DF, Cloft HJ, Dion JE : Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures : technical aspects. AJNR Am J Neuroradiol 18 : 1897-1904, 1997. 6) Fourney DR, Scomer DF, Nader R, Chlan-Fourney J, Suki D, Ahrar K, Rhines LD, Gokaslan ZLh : Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients. J Neurosurg 98 : 21-30, 2003. 17) 小橋芳浩, 松浦恒明, 石谷栄一, 進 訓央, 園田康男 : 骨粗鬆症による胸腰椎圧迫骨折に対する椎体減圧術の経験. 整・災外 49 : 833-839, 2006. 22) Linville DA 2nd : Vertebroplasty and kyphoplasty. South Med J 95 : 583-587, 2002. 16) Keller TS, Kosmopoulos V, Liebschner MA : Modeling of bone damage and fracture in osteoporosis. in Szpalski M, Gunzburg R (eds) : Vertebral osteoporotic compression fractures. Philadelphia, Lippincott, 2003, pp.35-50. 10) Gold DT : The clinical impact of vertebral fractures : quality of life in women with osteoporosis. Bone 18 (suppl) : 185-189, 1996. 28) Padovani B, Kasriel O, Brunner P, Peretti-Viton P : Pulmonary embolism caused by acrylic cement : a rare complication of percutaneous vertebroplasty. AJNR Am J Neuroradiol 20 : 375-377, 1999. 30) Pradhan BB, Bae HW, Kropf MA, Patel VV, Delamarter RB : Kyphoplasty reduction of osteoporotic vertebral compression fractures : correction of local kyphosis versus overall sagittal alignment. Spine 31 : 435-441, 2006. 13) 伊藤公一, 市丸勝二, 今給黎篤弘 : 骨粗鬆症性椎体偽関節に対するリン酸カルシウム骨ペーストを使用した局所麻酔下経皮・経椎弓根的椎体形成術. 脊椎脊髄 15 : 1085-1092, 2002. 12) Hulme PA, Krebs J, Ferguson SJ, Berlemann U : Vertebroplasty and kyphoplasty : a systematic review of 69 clinical studies. Spine 31 : 1983-2001, 2006. 37) Teng MM, Cheng H, Ho DM, Chang CY : Intraspinal leakage of bone cement after vertebroplasty : a report of 3 cases. AJNR Am J Neuroradiol 27 : 224-229, 2006. 39) Uppin AA, Hirsch JA, Centenera LV, Pfiefer BA, Pazianos AG, Choi IS : Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis. Radiology 226 : 119-124, 2003. 38) Trout AT, Kallmes DF, Kaufmann TJ : New fractures after vertebroplasty : adjacent fractures occur significantly sooner. AJNR Am J Neurordiol 27 : 217-223, 2006. 1) Barr JD, Barr MS, Lemley TJ, McCann RM : Percutaneous vertebroplasty for pain relief and spinal stabilization. Spine 25 : 923-928, 2000. 33) Silverman S : The clinical consequences of vertebral compression fracture. Bone 13 (suppl) : 27-32, 1992. 35) Syed MI, Jan S, Patel NA, Shaikh A, Marsh RA and Stewart RV : Fatal fat embolism after vertebroplasty : identification of the high-risk patient. AJNR Am J Neuroradiol 27 : 343-345, 2006. 32) Ross PD, Davis JW, Epstein RS, Wasnich RD : Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med 114 : 919-923, 1991. 7) Fribourg D, Tang C, Sra P, Delamarter R, Bae H : Incidence of subsequent vertebral fracture after kyphoplasty. Spine 29 : 2270-2276, 2004. 21) Lindsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB, Licata A, Benhamou L, Geusens P, Flowers K, Stracke H, Seeman E : Risk of new vertebral fracture in the year following a fracture. JAMA 285 : 320-323, 2001. 20) Lee TO, Jo DJ, Kim SM : Outcome and efficacy of height gain and sagittal alignment after kyphoplasty of osteoporotic vertebral compression fractures. J Korean Neurosurg Soc 42 : 271-275, 2007. 9) Garfin SR, Yuan HA, Reiley MA : New Technologies in Spine : Kyphoplasty and Vertebroplasty for the Treatment of Painful Osteoporotic Compression Fractures. Spine 26 : 1511-1515, 2001. 25) Nevitt MC, Ettinger B, Black DM, Stone K, Jamal SA, Ensrud K, Segal M, Genant HK, Cummings SR : The association of radiographically detected vertebral fractures with back pain and function : a prospective study. Ann Intern Med 15 : 793-798, 1998. 24) Mathis JM, Petri M, Naff N : Percutaneous vertebroplasty treatment of steroid-induced osteoporotic compression fractures. Arthritis Rheum 41 : 171-175, 1998. 5) Evans AJ, Jensen ME, Kip KE, DeNardo AJ, Lawler GJ, Negin GA : Vertebral compression fractures : pain reduction and improvement in functional mobility after percutaneous polymethylmethacrylate vertebroplasty-retrospective report of 245 cases. Radiology 226 : 366-372, 2003. 23) Masala S, Fiori R, Massari F, Cantonetti M, Postorino M, Simonetti G : Percutaneous kyphoplasty : Indications and technique in the treatment of vertebral fractures from myeloma. Tumori 90 (1) : 22-26, 2004. 34) Spivak JM, Johnson MG : Percutaneous treatment of vertebral body pathology. J Am Acad Orthop Surg 13 : 6-7, 2005. 18) Ledlie JT, Renfro M : Balloon kyphoplasty : one-year outcomes in vertebral body height restoration, chronic pain, and activity levels. J Neurosurg 98 : 36-42, 2003. 31) Robinson Y, Heyde CE, Försth P, Olerud C : Kyphoplasty in osteoporotic vertebral compression fractures-Guidelines and technical considerations. J Orthop Surg Res 6 : 43, 2011. 36) Taylor RS, Taylor RJ, Fritzell P : Ballon kyphoplasty and vertebroplasty for vertebral compression fractures : A comparative systematic review of efficacy and safety. Spine 31 : 2747-2755, 2006. 19) Ledlie JT, Renfro M : Kyphoplasty treatment of vertebral fractures : 2-year outcomes show sustained benefits. Spine 31 : 57-64, 2006. 2) Belkoff SM, Mathis JM, Jasper LE, Deramond H : The biomechanics of vertebroplasty : the effect of cement volume on mechanical behavior. Spine 26 : 1537-1541, 2001. 3) Cortet B, Cotton A, Boutry N, Flipo RM, Duquesnoy B, Chastanet P, Delcambre B : Percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures : an open prospective study. J Rheum 26 : 2222-2228, 1999. 11) Grohs JG, Matzner M, Trieb K, Krepler P : Minimal invasive stabilization of osteoporotic vertebral fractures : a prospective nonrandomized comparison of vertebroplasty and balloon kyphoplasty. J Spinal Disord Tech. 18 : 238-242, 2005. 40) Wagner AL, Baskurt E : Refracture with cement extrusion following percutaneous vertebroplasty of a large interbody cleft. AJNR Am J Neuroradiol 27 : 230-231, 2006. 8) Galibert P, Deramond H, Rosat P, Le Gars D : Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neurochirurgie 33 (2) : 166-168, 1987. 26) 荻原正洋, 赤嶺智教 : 骨粗鬆症性椎体圧迫骨折に対する経椎弓根的椎体骨穿孔術の効果. ペインクリニック 31 : 489-495, 2010. 4) Cotten A, Boutry N, Cortet B, Assaker R, Demondion X, Leblond D, Chastanet P, Duquesnoy B, Deramond H : Percutaneous vertebroplasty : state of the art. Radiographics 18 : 311-320 ; discussion 320-323, 1998. 27) 折茂 肇, 太田博明, 岸本英彰, 白木正孝, 鈴木隆雄, 高岡邦夫, 中村利考 西沢良記, 萩野 浩, 林 泰史, 広田孝子, 福永仁夫, 細井孝之, 松本俊夫, 三木隆己, 楊 鴻生, 和田誠基 : 骨粗鬆症の治療 (薬物療法) に関するガイドライン (2002年度改訂版). Osteoporosis Jpn 10 : 635-709, 2002. 15) Kayanja MM, Ferrara LA, Lieberman IH : Distribution of anterior cortical shear strain after a thoracic wedge compression fracture. Spine J 4 : 76-87, 2004. 29) Phillips FM, Wetzel FT, Lieberman I, Campbell-Hupp M : An in vivo comparison of the potential for extravertebral cement leak after vertebroplasty and kyphoplasty. Spine 27 : 2173-2178, 2002. |
| References_xml | – reference: 18) Ledlie JT, Renfro M : Balloon kyphoplasty : one-year outcomes in vertebral body height restoration, chronic pain, and activity levels. J Neurosurg 98 : 36-42, 2003. – reference: 12) Hulme PA, Krebs J, Ferguson SJ, Berlemann U : Vertebroplasty and kyphoplasty : a systematic review of 69 clinical studies. Spine 31 : 1983-2001, 2006. – reference: 38) Trout AT, Kallmes DF, Kaufmann TJ : New fractures after vertebroplasty : adjacent fractures occur significantly sooner. AJNR Am J Neurordiol 27 : 217-223, 2006. – reference: 2) Belkoff SM, Mathis JM, Jasper LE, Deramond H : The biomechanics of vertebroplasty : the effect of cement volume on mechanical behavior. Spine 26 : 1537-1541, 2001. – reference: 1) Barr JD, Barr MS, Lemley TJ, McCann RM : Percutaneous vertebroplasty for pain relief and spinal stabilization. Spine 25 : 923-928, 2000. – reference: 36) Taylor RS, Taylor RJ, Fritzell P : Ballon kyphoplasty and vertebroplasty for vertebral compression fractures : A comparative systematic review of efficacy and safety. Spine 31 : 2747-2755, 2006. – reference: 15) Kayanja MM, Ferrara LA, Lieberman IH : Distribution of anterior cortical shear strain after a thoracic wedge compression fracture. Spine J 4 : 76-87, 2004. – reference: 27) 折茂 肇, 太田博明, 岸本英彰, 白木正孝, 鈴木隆雄, 高岡邦夫, 中村利考 西沢良記, 萩野 浩, 林 泰史, 広田孝子, 福永仁夫, 細井孝之, 松本俊夫, 三木隆己, 楊 鴻生, 和田誠基 : 骨粗鬆症の治療 (薬物療法) に関するガイドライン (2002年度改訂版). Osteoporosis Jpn 10 : 635-709, 2002. – reference: 10) Gold DT : The clinical impact of vertebral fractures : quality of life in women with osteoporosis. Bone 18 (suppl) : 185-189, 1996. – reference: 34) Spivak JM, Johnson MG : Percutaneous treatment of vertebral body pathology. J Am Acad Orthop Surg 13 : 6-7, 2005. – reference: 13) 伊藤公一, 市丸勝二, 今給黎篤弘 : 骨粗鬆症性椎体偽関節に対するリン酸カルシウム骨ペーストを使用した局所麻酔下経皮・経椎弓根的椎体形成術. 脊椎脊髄 15 : 1085-1092, 2002. – reference: 17) 小橋芳浩, 松浦恒明, 石谷栄一, 進 訓央, 園田康男 : 骨粗鬆症による胸腰椎圧迫骨折に対する椎体減圧術の経験. 整・災外 49 : 833-839, 2006. – reference: 11) Grohs JG, Matzner M, Trieb K, Krepler P : Minimal invasive stabilization of osteoporotic vertebral fractures : a prospective nonrandomized comparison of vertebroplasty and balloon kyphoplasty. J Spinal Disord Tech. 18 : 238-242, 2005. – reference: 19) Ledlie JT, Renfro M : Kyphoplasty treatment of vertebral fractures : 2-year outcomes show sustained benefits. Spine 31 : 57-64, 2006. – reference: 39) Uppin AA, Hirsch JA, Centenera LV, Pfiefer BA, Pazianos AG, Choi IS : Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis. Radiology 226 : 119-124, 2003. – reference: 3) Cortet B, Cotton A, Boutry N, Flipo RM, Duquesnoy B, Chastanet P, Delcambre B : Percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures : an open prospective study. J Rheum 26 : 2222-2228, 1999. – reference: 20) Lee TO, Jo DJ, Kim SM : Outcome and efficacy of height gain and sagittal alignment after kyphoplasty of osteoporotic vertebral compression fractures. J Korean Neurosurg Soc 42 : 271-275, 2007. – reference: 24) Mathis JM, Petri M, Naff N : Percutaneous vertebroplasty treatment of steroid-induced osteoporotic compression fractures. Arthritis Rheum 41 : 171-175, 1998. – reference: 32) Ross PD, Davis JW, Epstein RS, Wasnich RD : Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med 114 : 919-923, 1991. – reference: 41) 湯田康正 : 椎体減圧術 (経椎体法). ペインクリニック 27 : 628-640, 2006. – reference: 21) Lindsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB, Licata A, Benhamou L, Geusens P, Flowers K, Stracke H, Seeman E : Risk of new vertebral fracture in the year following a fracture. JAMA 285 : 320-323, 2001. – reference: 23) Masala S, Fiori R, Massari F, Cantonetti M, Postorino M, Simonetti G : Percutaneous kyphoplasty : Indications and technique in the treatment of vertebral fractures from myeloma. Tumori 90 (1) : 22-26, 2004. – reference: 37) Teng MM, Cheng H, Ho DM, Chang CY : Intraspinal leakage of bone cement after vertebroplasty : a report of 3 cases. AJNR Am J Neuroradiol 27 : 224-229, 2006. – reference: 6) Fourney DR, Scomer DF, Nader R, Chlan-Fourney J, Suki D, Ahrar K, Rhines LD, Gokaslan ZLh : Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients. J Neurosurg 98 : 21-30, 2003. – reference: 29) Phillips FM, Wetzel FT, Lieberman I, Campbell-Hupp M : An in vivo comparison of the potential for extravertebral cement leak after vertebroplasty and kyphoplasty. Spine 27 : 2173-2178, 2002. – reference: 8) Galibert P, Deramond H, Rosat P, Le Gars D : Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neurochirurgie 33 (2) : 166-168, 1987. – reference: 16) Keller TS, Kosmopoulos V, Liebschner MA : Modeling of bone damage and fracture in osteoporosis. in Szpalski M, Gunzburg R (eds) : Vertebral osteoporotic compression fractures. Philadelphia, Lippincott, 2003, pp.35-50. – reference: 5) Evans AJ, Jensen ME, Kip KE, DeNardo AJ, Lawler GJ, Negin GA : Vertebral compression fractures : pain reduction and improvement in functional mobility after percutaneous polymethylmethacrylate vertebroplasty-retrospective report of 245 cases. Radiology 226 : 366-372, 2003. – reference: 26) 荻原正洋, 赤嶺智教 : 骨粗鬆症性椎体圧迫骨折に対する経椎弓根的椎体骨穿孔術の効果. ペインクリニック 31 : 489-495, 2010. – reference: 31) Robinson Y, Heyde CE, Försth P, Olerud C : Kyphoplasty in osteoporotic vertebral compression fractures-Guidelines and technical considerations. J Orthop Surg Res 6 : 43, 2011. – reference: 40) Wagner AL, Baskurt E : Refracture with cement extrusion following percutaneous vertebroplasty of a large interbody cleft. AJNR Am J Neuroradiol 27 : 230-231, 2006. – reference: 4) Cotten A, Boutry N, Cortet B, Assaker R, Demondion X, Leblond D, Chastanet P, Duquesnoy B, Deramond H : Percutaneous vertebroplasty : state of the art. Radiographics 18 : 311-320 ; discussion 320-323, 1998. – reference: 22) Linville DA 2nd : Vertebroplasty and kyphoplasty. South Med J 95 : 583-587, 2002. – reference: 7) Fribourg D, Tang C, Sra P, Delamarter R, Bae H : Incidence of subsequent vertebral fracture after kyphoplasty. Spine 29 : 2270-2276, 2004. – reference: 9) Garfin SR, Yuan HA, Reiley MA : New Technologies in Spine : Kyphoplasty and Vertebroplasty for the Treatment of Painful Osteoporotic Compression Fractures. Spine 26 : 1511-1515, 2001. – reference: 25) Nevitt MC, Ettinger B, Black DM, Stone K, Jamal SA, Ensrud K, Segal M, Genant HK, Cummings SR : The association of radiographically detected vertebral fractures with back pain and function : a prospective study. Ann Intern Med 15 : 793-798, 1998. – reference: 35) Syed MI, Jan S, Patel NA, Shaikh A, Marsh RA and Stewart RV : Fatal fat embolism after vertebroplasty : identification of the high-risk patient. AJNR Am J Neuroradiol 27 : 343-345, 2006. – reference: 30) Pradhan BB, Bae HW, Kropf MA, Patel VV, Delamarter RB : Kyphoplasty reduction of osteoporotic vertebral compression fractures : correction of local kyphosis versus overall sagittal alignment. Spine 31 : 435-441, 2006. – reference: 28) Padovani B, Kasriel O, Brunner P, Peretti-Viton P : Pulmonary embolism caused by acrylic cement : a rare complication of percutaneous vertebroplasty. AJNR Am J Neuroradiol 20 : 375-377, 1999. – reference: 33) Silverman S : The clinical consequences of vertebral compression fracture. Bone 13 (suppl) : 27-32, 1992. – reference: 14) Jensen ML, Evans AJ, Mathis JM, Kallmes DF, Cloft HJ, Dion JE : Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures : technical aspects. AJNR Am J Neuroradiol 18 : 1897-1904, 1997. |
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| Snippet | 2011年2月∼7月に当科で保存的治療が無効の有痛性骨粗鬆症性脊椎圧迫骨折 (osteoporotic VCF) に対してballoon kyphoplasty (BKP) を施行し, 3カ月以上フォローアップ可能であった7症例につき臨床成績, 放射線学的所見を検討しBKPの有効性, 安全性につき検証した.... |
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| StartPage | 959 |
| SubjectTerms | balloon kyphoplasty (BKP) local kyphotic angle percutaneous vertebroplasty (PVP) sagittal alignment vertebral compression fracture (VCF) |
| Subtitle | 治療経験と短期手術成績 |
| Title | 骨粗鬆症性脊椎圧迫骨折に対するballoon kyphoplasty (BKP) |
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| ispartofPNX | 脳神経外科ジャーナル, 2012, Vol.21(12), pp.959-966 |
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