椎體成型術運用於骨質疏鬆症合併脊椎壓迫性骨折之治療

Vertebroplasty on Patients with Osteoporotic Vertebral Compression Fractures

10.6315/2005.33(4)02

李宗穎(Tsung-Ying Li)；姜蜀海(Shuu-Hai Jiang)；董和銳(Ho-Jui Tung)；林明奇(Ming-Chi Lin)；蔡高宗(Kao-Chung Tsai)

壓迫性骨折 ； 骨質疏鬆症 ； 復健 ； 脊椎 ； 椎體成型術 ； compression fracture ； osteoporosis ； rehabilitation ； vertebrae ； vertebroplasty

台灣復健醫學雜誌

33卷4期（2005 / 12 / 01）

197 - 204

繁體中文

目前台灣六十五歲以上罹患骨質疏鬆合併脊椎椎體骨折超過三十萬人，治療模式包括內科保守治療、外科手術治療、復健治療。1987年首先在歐洲採用經皮椎體成型術(vertebroplasty)來治療脊椎椎體血管瘤，隨後被廣泛應用於治療脊椎椎體壓迫性骨折，其治療有相當成效。本院於90年10月開始採用椎體成型術治療骨質疏鬆合併脊椎椎體壓迫性骨折。本研究係就本院引進椎體成型術的前後，針對骨質疏鬆合併胸椎或腰椎椎體壓迫性骨折之病患採用保守治療、傳統脊椎固定術及椎體成型術之間進行觀察。分別收集89年l月l日至89年12月31日的19人、及92年l月l日至92年12月31日的103人，因骨質疏鬆合併脊椎椎體壓迫性骨折而住院之病患的病歷來進行分析研究。結果發現，脊椎椎體壓迫性骨折受傷位置以第一腰椎及第十二胸椎較多。而受傷模式以創傷性的傷害較多（如跌倒），性別以女性較多（男：女＝l:3）。而接受椎體成型術比傳統脊椎內固定術及內科保守治療，有較少的住院天數。70歲以上較易發生多節脊椎椎體壓迫性骨折。我們的結論是，預防骨質疏鬆合併脊椎壓迫性骨折應從減少骨質流失及避免跌倒來進行。椎體成型術可以有效減少病患住院天數、侵犯性小、病患接受度高，可以是藥物及傳統復健治療疼痛無效的另一選擇，後續復健的運動治療亦可提早開始。

Introduction: There are more than three hundred thousand cases of osteoporotic vertebral compression fractures in Taiwan. To hasten the healing process and minimize the related complications of fracture, various treatments have been evolved. In 1987, the technique of percutaneous vertebroplasty was first developed in Europe by a group of radiologists. Before that, conservative treatment, rehabilitation intervention and a surgical approach had been used, with diverse outcomes, as reported in various studies. Although these methods had been developed over several years, they had rarely been compared in terms of outcome and prognosis, in our hospital. Methods: A retrospective study of treatment outcomes was conducted on patients (n=19 and n=103 respectively) with osteoporotic compression fracture(s), who had been admitted to our hospital during the periods January 2000 to December 2000 and January 2003 to December 2003. Various treatments were carried out, including conservative treatment, the conventional surgical approach (open reduction and internal fixation (ORIF)) and vertebroplasty. Results: The most common location of a compression fracture was L1 or T12. Traumatic accidents (e.g. falls) were the most common cause. A greater incidence was noted in females than in males (3:1). Significantly shorter hospitalization was demonstrated after vertebroplasty therapy than after traditional ORIF or conservative treatment. Multiple levels of vertebral fracture occurred more frequently in elderly patients over 70 years of age. Conclusion: The use of vertebroplasty significantly reduced the duration of hospital stay. Vertebroplasty could be a useful treatment, in addition to early rehabilitation intervention, for patients with osteoporotic vertebral compression fractures.

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