医学交流课件：后凸成型术技术现状与进展 .pptVIP

Kyphoplasty:Update and Advanced Techniques Vertebral osteoporosis is underdiagnosed, undertreated, unrecognized cause of significant economic, physical and psychosocial consequences, with significant mortality US Burden700,000-750,000 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 1997 Number of Vertebral Fractures Progressively Decreases Health-Related QOL 012340123401234EmotionalStatusPhysicalFunctionSymptomsMean OPAQ ScoreAll decreases in scores statistically significant at p0.001From 0 to 1 fracture, all p-values 0.05Silverman Arth Rheum 2002 New Vertebral Fracture Rapidly Increases Risk of Next Vertebral Fracture *p=0.02 vs. patients 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 Fracture Kyphoplasty in Osteoporotic VCF:Update96 patients, 133 fracturesMean age 76 yearsMean duration of symptoms 2.4 mosNo complications12 leaks (9%)Ledlie et al. J Neurosurg (Spine) 2003 Kyphoplasty in Osteoporotic VCF:UpdateLedlie et al. J Neurosurg (Spine) 2003 Pre and Post-Op Activity LevelsLedlie et al. J Neurosurg (Spine) 2003 New Indications for KyphoplastyMultiple MyelomaMetastatic Osteolytic LesionsTraumaPedicle Screw Augmentation Multiple Myeloma in the Literature55 fractures, 18 patientsIndications:Vertebral fracture pain Non-responsive to conventional pain managementContradindications:Posterior destructionRetropulsed boneBone fragments Dudeney et al. Kypholasty for Myelomatus Compression Fractures J Clinical Oncology 20 (2002) 2382 Multiple 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 Metastat