This is the 4699th article of Da Yi Xiao Nursing
Grandma Wang, a neighbor, fell a few days ago and sat on the ground with her buttocks, although she could barely stand up, but her back pain was not good for a few days, and she went to the hospital for a check-up accompanied by her children. After CT and magnetic resonance examinations, she was diagnosed with a lumbar compression fracture, and the doctor recommended that she undergo a minimally invasive surgery to inject bone cement into the vertebral body with a puncture needle to treat the fracture. Grandma Wang and her family were very surprised by this, they had only heard of fractures with steel nails, but they had never heard of fracture injections, and this is the vertebroplasty we are going to introduce today.
Percutaneous vertebroplasty (PVP)
Percutaneous balloon kyphoplasty (PKP)
Percutaneous vertebroplasty (PVP) was invented and first applied by Deramond in 1984, first applied to the treatment of vertebral hemangioma by French physician Galibert in 1987, and first reported in the United States in 1994 for the treatment of osteoporotic vertebral fractures. Percutaneous vertebroplasty (PVP) and its modified percutaneous balloon kyphoplasty (PKP) are minimally invasive techniques that fill and wedge the fracture gap through bone cement, so as to stabilize the fracture and relieve pain, which has the advantages of minimally invasive, fast and inexpensive.
The whole process of PKP intraoperative fluoroscopic imaging
Vertebroplasty has been widely used in clinical practice with good results, both to eliminate or relieve painful symptoms and to strengthen and strengthen the vertebral body to prevent further collapse. It does not require scalpels, stitches, or stitches, and all operations are performed under X-ray fluoroscopy, making it truly minimally invasive. Here, I will introduce a few issues that everyone is concerned about in detail.
1. Who is vertebroplasty suitable for?
Vertebroplasty is suitable for the treatment of osteoporotic vertebral compression fractures, usually used in middle-aged and elderly people over 60 years old, and the oldest patients can be more than 100 years old. Vertebroplasty has less bleeding, and even patients taking anticoagulant and antiplatelet drugs such as aspirin and Taijia can undergo PVP surgery.
2. Which is better, vertebroplasty or bed rest?
Vertebroplasty has significant advantages over long-term bed rest.
The first is analgesia, whether it is balloon dilation PKP or traditional PVP, it has a reliable and efficient analgesic effect, and some scholars have reported that the pain relief rate is 70%~95%. It can also prevent further compression and collapse of the fractured vertebrae. For fracture reduction and correction of kyphotic deformity, balloon dilation PKP is superior to traditional PVP. It has also been reported that the effective rate of immediate pain relief with PVP can reach 97%, the pain score decreases from severe pain to mild pain, and the overall satisfaction rate of patients is more than 80%. Clinical experience has also confirmed that PVP has a rather amazing early analgesic effect, and it can be said that no current drug treatment can achieve such an effective analgesic effect.
The second is to reduce complications, the PVP operation time is about 30 minutes, and the patient can leave the bed and return to normal life under the protection of external fixation 24 hours after surgery, which reduces the incidence of bed-related complications related to fracture and rest. Due to the early activity of patients, complications such as pneumonia, pressure ulcers, urinary tract infections and other complications caused by long-term bed rest and nursing inconvenience are avoided, and the vicious circle of osteoporosis caused by bone loss caused by long-term bed rest is avoided. In the later stage, it can also prevent symptoms such as back pain, stomach distension and discomfort and even difficulty standing upright caused by vertebral compression and kyphotic deformity.
3. Are there any risks associated with vertebroplasty?
Any clinical treatment will not be perfect, vertebroplasty is no exception, the first is bone cement reaction, that is, the patient is allergic to bone cement, the incidence of this situation is very low, it is reported in the literature to be about 3 per thousand, once it occurs, it can even cause death. Secondly, the patient is performing the surgery while awake, and if the patient is unable to lie prone for a longer period of time or cooperate with the surgery due to physical or mental reasons, the surgery cannot be performed. In addition, postoperative residual pain is also a relatively common adverse reaction, with an incidence of about 7.8%, and the causes of postoperative residual pain include osteoporosis, soft tissue injury of the lower back, sagittal imbalance, bone cement leakage, infection, etc., most of which can be alleviated by symptomatic treatment.
4. What is the difference between PVP and PKP?
PKP is an improvement on PVP, which restores the height of the vertebral body by inserting special tools (balloons, stents, etc.) into the vertebral body to maintain the physiological curvature of the patient's spine. In vitro experiments comparing the effects of PKP and PVP in restoring vertebral body height, the results showed that 97% of the lost height was recovered using a balloon, compared to only 30% with conventional PVP. Of course, compared with traditional PVP, PKP is more expensive and can be selected according to the specific clinical situation and the patient's family conditions.
PKP balloon material
New Balloon with Stent (VBS-PKP)
The whole process of intraoperative fluoroscopic imaging with stent balloon (VBS-PKP).
More than ten years ago, the elderly lumbar vertebral fracture was sent to the hospital, the doctor usually recommended that you go home and stay in bed for three months for conservative treatment, now vertebroplasty has become more and more the first treatment for osteoporotic vertebral compression fracture in the elderly, minimally invasive treatment allows more elderly people to quickly return to normal life, greatly reducing the burden on family and society.
Author: Department of Orthopedics, Putuo District Central Hospital, Shanghai
Yu Luchao
Some of the pictures are taken from the Internet, if there is any infringement, please inform us and delete it.
所有人名和地名均为化名，如有雷同，纯属巧合。