Lečenje subakutnih kompresivnih fraktura osteoporotičnih pršljenova primenom perkutane vertebroplastike

  • Zoran Aleksić Fakultet medicinskih nauka, Univeryitet u Kragujevcu, Katedra ya anatomiju i sudsku medicinu
  • Ivana Stanković Ambulance of Brigade of Guards, Belgrade, Serbia
  • Ivana Živanović-Mačužić Clinical Center of Kragujevac, Kragujevac, Serbia
  • Dejan Jeremić University of Kragujevac, Department of Anatomy and Forensic Medicine, Kragujevac, Serbia
  • Aleksandar Radunović Military Medical Academy, Clinic for Orthopedic Surgery, Belgrade, Serbia
  • Zoran Milenković Clinical Center of Kragujevac, Department of Orthopedics and Traumatology, Kragujevac, Serbia
  • Andjelka Stojković University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
  • Aleksandra Simović University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
  • Ivan Stojadinović Military Medical Academy, Clinic for Orthopedic Surgery, Belgrade, Serbia
  • Maja Vulović Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP170130037A
Ključne reči: kičmeni pršljenovi, prelomi;, prelomi, kompresivni;, osteoporoza;, bol;, vertebroplastika;, lečenje, ishod.

Sažetak


Apstrakt

 

Uvod. Perkutana vertebroplastika (PVP), kao mini invazivni pristup u lečenju bolesnika sa kompresivnom frakturom osteoporotičnog pršljena (KFOP), obezbeđuje stabilizaciju kičmenog stuba i otklanja bol. Najčešće se primenjuje u periodu od tri do sest nedelja, pre pojave kriv­ljenja/pogrbljenja kičme. Potpuni prestanak bola je lakše postići ako se leče “manje zreli” prelomi. Cilj prikaza je da se pokaže da je PVP efikasna i bezbedna i kod starih fraktura. Prikaz bolesnika. Bolesnik starosti 77 godina, posle minimalne traume, zadobio je stabilnu kompresivnu frakturu tela trećeg lumbalnog (L3) pršljena koja je klinički i radiološki verifikovana. Zbog permanentnog bola i tipa frakture primarno je uključeno konzervativno lečenje (lum­bosakralna ortoza-mider), analgetici i fizikalna terapija. Posle dva meseca bol je i dalje perzistirao, ali sada u torakalnom segmentu kičmenog stuba gde je dao radiološki konstatovane frakture tela osmog torakalnog (Th8) i desetog torakalnog (Th10) pršljena, bez neurološkog deficita. Ordinirana je konzervativna terapija, ali zbog perzistentnog bola 6 meseci kasnije postavljena je indikacija za operativno lečenje u smislu PVP tela Th 8 i Th 10. Bol je kupiran i bolesnik je otpušten iz klinike drugog postoperativnog dana. Kontrolni pregledi bili su uredni. Zaključak. Kod bolesnika sa stabilnom KFOP, PVP je efikasna terapija za redukciju bola i poboljšanje mobilnosti i kod preloma starih šest meseci.

Reference

References

Liu L, Cheng S, Lu R, Zhou Q. Extrapedicular Infiltration An-esthesia as an Improved Method of Local Anesthesia for Unipedicular Percutaneous Vertebroplasty or Percutane¬ous Kyphoplasty. Bio Med Res Int 2016; 2016: 5086414.

Lamy O, Uebelhart B, Aubry-Rozier B. Risks and benefits of percutaneous vertebroplasty or kyphoplasty in the man-agement of osteoporotic vertebral fractures. Osteoporos Int 2014; 25(3): 807–19.

Stephenson MB, Glaenzer B, Malamis A. Percutaneous Mini-mally Invasive Techniques in the Treatment of Spinal Me-tastases. Curr Treat Options Oncol 2016; 17(11): 56.

Peh WC, Gilula LA. Percutaneous vertebroplasty: Indica¬tions, contraindications, and technique. Br J Radiol 2003; 76(901): 69–75.

Alexandru D, So W. Evaluation and management of verte¬bral compression fractures. Perm J 2012; 16(4): 46–51.

Röllinghoff M, Zarghooni K, Schlüter-Brust K, Sobottke R, Schlegel U, Eysel P, et al. Indications and contraindications for verte-broplasty and kyphoplasty. Arch Orthop Trauma Surg 2010; 130(6): 765–74.

Dohm M, Black CM, Dacre A, Tillman JB, Fueredi G. A Ran-domized Trial Comparing Balloon Kyphoplasty and Vertebro-plasty for Vertebral Compression Fractures due to Osteoporo-sis. AJNR Am J Neuroradiol 2014; 35(12): 2227–36.

Vanni D, Galzio R, Kazakova A, Pantalone A, Grillea G, Bar¬tolo M, et al. Third-generation percutaneous vertebral augmenta-tion systems. J Spine Surg 2016; 2(1): 13–20.

Anderson PA, Froyshteter AB, Tontz WL Jr. Meta-analysis of vertebral augmentation compared with conservative treatment for osteoporotic spinal fractures. J Bone Miner Res 2013; 28(2): 372–82.

Yokoyama K, Kawanishi M, Yamada M, Tanaka H, Ito Y, Kuroiwa T. Long-term therapeutic effects of vertebroplasty for painful vertebral compression fracture: A retrospective comparative study. Br J Neurosurg 2017; 31(2): 184–8.

Balkarli H, Kilic M, Balkarli A, Erdogan M. An evaluation of the functional and radiological results of percutaneous verte-broplasty versus conservative treatment for acute symptomat-ic osteoporotic spinal fractures. Injury 2016; 47(4): 865–71.

Layton KF, Thielen KR, Koch CA, Luetmer PH, Lane JI, Wald JT, et al. Vertebroplasty, first 1000 levels of a single center: eval-uation of the outcomes and complications. AJNR Am J Neu-roradiol 2007; 28(4): 683–9.

Cheng X, Long HQ, Xu JH, Huang YL, Li FB. Comparison of unilateral versus bilateral percutaneous kyphoplasty for the treatment of patients with osteoporosis vertebral com¬pression fracture (OVCF): a systematic review and meta-analysis. Eur Spine J 2016; 25(11): 3439–49.

Chen D, An ZQ, Song S, Tang JF, Qin H. Percutaneous verte-broplasty compared with conservative treatment in patients with chronic painful osteoporotic spinal fractures. J Clin Neu-rosci 2014; 21(3): 473–7.

Teles AR, Mattei TA, Righesso O, Falavigna A. Controver¬sies on vertebroplasty and kyphoplasty for vertebral com¬pression fractures. Coluna/Columna (São Paulo) 2015; 14(4): 324–9.

Takahara K, Kamimura M, Moriya H, Ashizawa R, Koike T, Hidai Y, et al. Risk factors of adjacent vertebral collapse after percutaneous vertebroplasty for osteoporotic verte¬bral frac-ture in postmenopausal women. BMC Muscu¬loskelet Disord 2016; 17: 12.

Papanastassiou ID, Phillips FM, van Meirhaeghe J, Berenson JR, Andersson GBJ, Chung G, et al. Comparing effects of kypho-plasty, vertebroplasty, and non-surgical manage¬ment in a sys-tematic review of randomized and non-ran¬domized controlled studies. Eur Spine J 2012; 21(9): 1826–4.

Tan HY, Wang LM, Zhao L, Liu YL, Song RP. A prospec¬tive study of percutaneous vertebroplasty for chronic pain¬ful oste-oporotic vertebral compression fracture. Pain Res Manag 2015; 20(1): 8–11.

Brown DB, Gilula LA, Sehgal M, Shimony JS. Treatment of chronic symptomatic vertebral compression fractures with percutaneous vertebroplasty. AJR Am J Roentgenol 2004; 182(2): 319–22.

Objavljeno
2020/12/21
Broj časopisa
Vol. 75 Br. 10 (2018): Vojnosanit Pregl 2018; October Vol. 75 (No. 10)
Rubrika
Prikaz bolesnika