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Osteologie 2008; 17(04): 225-233
DOI: 10.1055/s-0037-1621696
Schmerz bei Osteoporose
Schattauer GmbH

Ballonkyphoplastie – ein systematischer Überblick der Methode und Bewertung anhand von 4-Jahres-Ergebnissen

Balloon kyphoplasty – systematic method overview and result evaluation at 4 years
J.-U. Schulz
1   Kooperationsarzt für Orthopädie und Unfallchirurgie, Evangelisches Krankenhaus Kredenbach – Bernhard-Weiss-Klinik, Kreuztal
,
K. Buscher
2   Katholische Kliniken Oberberg gGmbH, Abteilung für Orthopädie und Unfallchirurgie, Engelskirchen
,
M. Fuhs
2   Katholische Kliniken Oberberg gGmbH, Abteilung für Orthopädie und Unfallchirurgie, Engelskirchen
› Author Affiliations
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Publication History

Publication Date:
28 December 2017 (online)

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Zusammenfassung

Mit Zunahme der Lebenserwartung und einer veränderten Lebensführung im Zeitalter der Industrialisierung steigen die Prävalenz der Osteoporose und damit das Risiko, im Laufe des Lebens eine Fraktur eines Wirbelkörpers zu erleiden. Die klassischen Therapieoptionen mit einerseits medikamentöser Unterstützung des Knochenmetabolismus und Schmerztherapie sowie andererseits physikalischen Maßnahmen wie Steigerung des Aktivitätsgrads, Gangschulung, Sturzprophylaxe, Hilfsmittel-und Miederversorgung, werden in den letzten Jahren durch die operativen Verfahren der Vertebro-und Kyphoplastie ergänzt. Beide sind minimal invasive Operationsverfahren, die sich durch schnelle Beseitigung der Schmerzen und Verminderung der Kyphose auszeichnen. Besonders die Kyphoplastie erlaubt eine kontrollierte Stabilisierung des gebrochenen Wirbelkörpers durch Einbringen kontrastmittelgefüllter Ballone, mit denen der betroffene Wirbelkörper gezielt aufgerichtet und der entstandene Hohlraum kontrolliert mit Knochenzement aufgefüllt werden kann. In einem Kollektiv von nunmehr 389 operierten Wirbelkörpern bei 269 Patienten zeigten sich sowohl unmittelbar postoperativ als auch in der Nachsorge bis zu vier Jahre nach der Operation durchweg positive Resultate. Dabei beschränken sich die Ergebnisse nicht nur auf apparativ fassbare Ergebnisse wie Wirbelkörperhöhe, Kyphosewinkel und Zementlokalisation, sondern beziehen auch die Patientenzufriedenheit mit Steigerung des Aktivitätsgrads und Minderung der Schmerzen mit ein.

Summary

Higher life expectancy and lifestyle changes in the industrialized era have brought about an increased prevalence of osteoporosis and with it the risk of sustaining a vertebral fracture at some time in life. Conventional therapies comprise medication to support bone metabolism and pain management on the one hand and physical therapy on the other, including exercises to increase the activity level, gait training, the prevention of falls and the provision of supportive devices and corsets. These therapies have been supplemented by surgical vertebroplastic or kyphoplastic treatment. These minimally invasive surgical procedures are characterized by rapid pain relief and a decrease in kyphosis. Kyphoplasty in particular provides for controlled stabilisation of the fractured vertebra by introduction of radiopaque bone tamps (balloons) which allow for a directed restoration in vertebral height of the affected vertebral body and subsequent controlled filling of the created cavity with bone cement. The results of 389 surgically treated vertebras in 269 patients were consistently positive, both immediately postoperatively as well as during the follow-up period of up to 4 years. These results comprise technically measured parameters like vertebral height, kyphotic angle and cement localisation as well as patient satisfaction with regard to pain relief and the increased level of activity.

Schlüsselwörter

Osteoporosebehandlung - Ballonkyphoplastie - Langzeitergebnisse

Keywords

Osteoporosis treatment - ballon kyphoplasty - long term results
 

  • Literatur

  • 1 Kritz-Silverstein D, Barret-Connor E. Grip strength an bone mineraly density in older women. J Bone Miner Res 1994; 09: 45-51.
    Google Scholar
  • 2 Dachverband Osteologie e.V. DVO-Leitlinie zur Prophylaxe, Diagnostik und Therapie der Osteoporose bei Frauen ab der Menopause, bei Männern ab dem 60. Lebensjahr. 2006
    PubMedGoogle Scholar
  • 3 World Health Organisation. Assessment of fracture risk an its application to screening for postmenopausal osteoporosis. Report of a WHO study group. World Health Organ Tech Rep Ser 1994; 843: 1-129.
    PubMedGoogle Scholar
  • 4 Felsenberg D, Silman AJ, Lunt M. et al. Incidence of vertebral fracture in europe: results from the European Prostective Osteoporosis Study (EPOS). J Bone Miner Res 2002; 17: 716-724.
    CrossrefPubMedGoogle Scholar
  • 5 Gold D. The clinical impact of vertebral fractures: quality of life in women with osteoporosis. Bone 1996; 18 (03) 1855-1895.
    Google Scholar
  • 6 Silverman S. The clinical consequences of vertebral compression fracture. Bone 1992; 13: 27-31.
    Google Scholar
  • 7 Leech J, Dulberg C, Kellie S. et al. Relationship of lung function to severity of osteoporosis in women. Am Rev Respir Dis 1990; 141: 68-71.
    CrossrefPubMedGoogle Scholar
  • 8 Garfin SR, Buckley RA, Ledlie J. Ballon kyphoplasty for symptomatic vertebral body compression fractures results in rapid, significant an sustained improvements in back pain, function an quality of live for elderly patients. Spine 2006; 31 (19) 2213-2220.
    CrossrefPubMedGoogle Scholar
  • 9 Ledlie JT, Renfro MB. Kyphoplasty treatment of vertebral fractures: 2-year outcomes show sustained benefits. Spine 2006; 31 (01) 57-64.
    CrossrefPubMedGoogle Scholar
  • 10 Gaitanis IN. et al. Ballon kyphoplasty for the treatment of pathological vertebral compressive fractures. Eur Spine J 2005; 14 (03) 250-260.
    CrossrefPubMedGoogle Scholar
  • 11 Lieberman IH, Dudeney S, Reinhardt MK. et al. Initial outcome and efficacy of „kyphoplasty” in the treatment of painful osteoporotic vertebral compression fractures. Spine 2001; 26: 1631-1638.
    CrossrefPubMedGoogle Scholar
  • 12 Fourny DR, Schomer DF, Nader R. et al. Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients. J Neurosurg 2003; 98 (01) 21-30.
    CrossrefPubMedGoogle Scholar
  • 13 Lane JM. et al. Minimally invasive options for the treatment of osteoporotic vertebral compression fratures. Orthop Clin North Am 2002; 33 (02) 431-438.
    CrossrefPubMedGoogle Scholar
  • 14 Liebermann I, Reinhardt MK. Vertebroplasty and kyphoplasty for osteolytic vertebral collapse. Clin Orthop Relat Res 2003; 415 (Suppl): 176-186.
    CrossrefPubMedGoogle Scholar
  • 15 Dudeney S. et al. Kyphoplasty in the treatment of osteolytic compression fractures as a result of multiple myeloma. J Clin Oncol 2002; 20 (09) 2382-2387.
    CrossrefPubMedGoogle Scholar
  • 16 Hillmeier J, Meeder PJ, Nöldge G. et al. Augmentation von Wirbelkörperfrakturen mit einem neuen Calciumphosphat-Zement nach Ballon-Kyphoplastie. Orthopäde 2004; 33: 31-39.
    CrossrefPubMedGoogle Scholar
  • 17 Magerl F, Aebi M, Gertzbein D. et al. A comprehensive classification of thoracic an lumbar injuries. Eur Spine J 1994; 03: 184-201.
    CrossrefPubMedGoogle Scholar
  • 18 Diamond TH, Champion B, Clark WA. Management of acute osteoporotic fractures: a non-randomized trial comparing percutaneous vertebroplasty with conservative therapy. American J Med 2003; 114: 257-265.
    CrossrefPubMedGoogle Scholar
  • 19 Bouza C, Lopez T, Margro A. et al. Effiacy and safety of ballon kyphoplasty in the treatment of vertebral compression fratures: a systematic review. Eur Spine J 2006; 15: 1068-1069.
    CrossrefPubMedGoogle Scholar
  • 20 Müller M, Biedermann M, Strecker W. Komplikationen im Rahmen der Kyphoplastie. Orthopäde 2006; 11: 1183-1186.
    Google Scholar
  • 21 Taylor RS, Taylor RJ, Fritzell P. Ballon kyphoplasty an vertebroplasty for vertebral compression fractures. A comperative systematic review of effiacy an safety. Spine 2008; 31: 2747-2755.
    Google Scholar
  • 22 Berlemann U, Franz T, Orler R, Heini PF. Kyphoplasty for treatment of osteoporotic vertebral fractures: a prospective non-randomized study. Eur Spine J 2004; 13: 496-501.
    CrossrefPubMedGoogle Scholar
  • 23 Coumans JVCE, Reinhardt MK, Liebermann IH. Kyphoplasty for vertebral compression fractures: 1-year clinical outcomes from a prospective study. J Neurosurg (Spine) 2003; 99: 44-50.
    CrossrefPubMedGoogle Scholar
  • 24 Grafe I, Da Fonseca K, Hillmeier J. et al. Reduction of pain an fracture incidence after kyphoplasty: 1 year outcome of a prospective controlled trial of patients with primary osteoporosis. Osteoporosis Int 2005; 16: 2005-2012.
    CrossrefPubMedGoogle Scholar
  • 25 Voggenreiter G, Lenz E, Obertacke U, Ascherl R. Effektivität von Vertebroplastie und Kyphoplastie in der Aufrichtung osteoporotischer Wirbelkörperfrakturen. Akt Traumatol 2006; 36: 1-5.
    Article in Thieme ConnectGoogle Scholar
  • 26 Voggenreiter G. Ballon Kyphoplasty is effective in deformity correction of osteoporotic vertebral compression fratures. Spine 2005; 30 (24) 2806-2812.
    CrossrefPubMedGoogle Scholar
  • 27 Shindle MK, Gardner MJ, Koob J. et al. Vertebral height restoration in osteoporotic compression fractures: kyphoplasty ballon tamp is superior to postural correction alone. Osteoporosis International 2006; 17 (12) 1815-1819.
    CrossrefPubMedGoogle Scholar
  • 28 Villagra LM, Cripton PA, Bellazza AJ. et al. Knochen und Knochen-Zement-Belastungen in der thorakolumbalen Wirbelsäule nach Kyphplastik. Orthopäde 2004; 33: 48-55.
    CrossrefPubMedGoogle Scholar
  • 29 Berlemann U, Ferguson SJ, Nolte LP, Heini PF. Adjacent vertebral failure after vertebroplasty. J Bone Joint Surg 2002; 84: 748-752.
    CrossrefPubMedGoogle Scholar
  • 30 Trout AT, Kallnes DF, Layton KF. et al. Vertebral endplate fratures: an indicator of the abnormal forces generated in the spine after vertebroplasry. J Bone Min Res 2006; 21: 1797-1802.
    CrossrefPubMedGoogle Scholar
  • 31 Fribourg D, Tang C, Sra P. et al. Incidence of subsequent vertebral fracture after kyphoplasty. Spine 2004; 29: 2270-2276.
    CrossrefPubMedGoogle Scholar
  • 32 Lin EP, Ekholm S, Hiwatashi A, Westesson PL. Vertebroplasty: cement leakage int the disc increases the risk of new fracture of adjacent vertebral body. Am J Neuroradiol 2004; 25: 175-180.
    PubMedGoogle Scholar
  • 33 Kim SH, Kang HS, Choi JA, Ahn JM. Risk factors of new compression fractures in adjacent vertebrae after percutaneous vertebroplasty. Acta Radiol 2004; 45: 440-445.
    CrossrefPubMedGoogle Scholar
  • 34 Boonen S. et al. Impact of balloon kyphoplasty on quality of life and risk of recurrent vertebral fracturen: a randomized trial in patients with acute vertebral compression fractures. ECTS. May 2008
    PubMedGoogle Scholar