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1、ManagementofOsteoporoticFracturesoftheThoracolumbarSpine胸腰椎骨质疏松骨折的处理GregoryP.Gebauer,MD,MS,andA.JayKhanna,MD,MBAApproximately2millionpeoplesustainanosteoporoticfractureintheUnitedStateseachyear;25%ofthosearevertebralcompressionfractures.Mostfracturescanbetreated
2、nonoperatively,usingacombinationofbracing,physicaltherapy,andpainmedications.Surgicaltreatmentmaybeconsideredforpatientswithseverepainorwhohavefailednonoperativeoptions.Surgicaltreatmentoptionsincludevertebroplastyandkyphoplasty,whichinvolvetheinjectionofbonecem
3、ent(polymethylmethacrylate)toaugmentvertebralbonestrength;kyphoplastyaddsthein?ationofaballoontamptohelpreducethefractureandcreateaspaceforthecement.Theriskofcementextravasationisrelativelyhigh,especiallyduringvertebroplasty;however,theincidenceofsymptomaticleak
4、sisrelativelylow.Overall,bothproceduresofferlowcomplicationrates,excellentpainrelief,andimprovedfunctionaftervertebralcompressionfractures.SeminSpineSurg22:58-66?2010ElsevierInc.Allrightsreserved.KEYWORDSvertebralcompressionfracture,osteoporosis,vertebroplasty,k
5、yphoplasty,man-Agement在美国，每年大约有200万人发生骨质疏松骨折，其中25％是椎体压缩性骨折。大多数骨折可以采用支具、理疗、止痛药等联合的非手术治疗，对于严重疼痛或非手术治疗失败者可以采用手术治疗。手术治疗包括后凸成形和椎体成形术，通过注入骨水泥（聚甲基丙烯酸甲酯）增强椎体。后凸成形通过球囊扩张来复位骨折，并为骨水泥制造一个空间。骨水泥渗漏的机会比较高，特别是椎体成形术。但产生症状者较少。总体而言，两种手术的并发症都很低，都能显著缓解疼痛，提高椎体压缩性骨折的功能。关键词：椎体压缩性骨折，骨质疏
6、松，椎体成形术，后凸成形术，治疗。SpectrumofDiseaseSenileorinsuf?ciencyfracturesareprimarilytheresultofosteopeniaandosteoporosis,de?nedbytheWorldHealthOrganizationasatscorelessthan1andlessthan2.5,respectively.1Thetscoreisthenumberofstandarddevia-tionsbetweenthepatient’sboneminer
7、aldensity(BMD)andthatofthereferencevalueoftheBMDofayoungadult.Itisbelievedthatosteoporosisdevelopsbecauseoftheuncou-plingofthenormalbalancebetweenboneresorptionandnewboneformation,2resultinginanetdecreaseinbonemass.Osteoporosiscanbeprimary,secondary,oridiopathic
8、.Primaryosteoporosis,themostcommonform,canbedividedinto2subgroups,senileandpostmenopausal.Senileosteopo-rosisisaslow,graduallossofbonemass,andisconsideredanormalparto
