단측 도달법과 양측 도달법을 이용한 경피적 척추 성형술에서 골시멘트 분포 및 누출 비교

이재협 ( Jae Hyup Lee ),윤강섭 ( Kang Sup Yoon ),강승백 ( Seung Baik Kang ),조현철 ( Hyun Chul Jo ),이상기 ( Sang Ki Lee ),장봉순 ( Bong Soon Chang ),이춘기 ( Choon Ki Lee ),이지호 ( Ji Ho Lee ) 대한골절학회 2006 대한골절학회지 Vol.19 No.4

목적: 본 연구의 목적은 척추 성형술에서 단측 도달법과 양측 도달법의 골시멘트 분포양상 및 누출 등 방사선학적 결과를 비교하는 것이다. 대상 및 방법: 2002년 5월부터 2006년 1월까지 본 교실에서 척추 성형술을 시행하고 3개월 이상 추시 가능하였던 100추체 중 단측 도달법 (1군)을 이용한 55추체와 양측 도달법 (2군)을 이용한 45추체에 수술 시간, 주입한 골시멘트 양, 전방 추체 높이 회복, 후만각, 골시멘트의 추체 단면 분포, 골시멘트 누출 등의 결과를 비교하였다. 결과: 수술 시간은 1추체 수술 시 1군이 평균 28분, 2군이 평균 29이있다. 주입한 골시멘트 양은 1군이 3.9 cc, 2군이 5.1 cc로 2군이 유의하게 많았다 (p=0.016). 전방 추체 높이비는 1군이 수술 전 71.8%에 비해 수술 후 3개월째 76.1%였고, 2군이 수술 전 78.3%에서 수술 후 3개월째 77.7%였다. 후만각은 1군이 수술 전 10.7도에서 수술 후 3개월에 11.3도였으며 2군은 수술 전 1.5도에서 수술 후 3개월에 3.6도로 양 군에 유의한 차이는 없었다. 골시멘트 분포는 8개 구역 이상에 분포하는 비율은 2군이 유의하게 (p=0.014) 높았으나 전방 추체 전체나 7개 구역 이상에 분포하는 비율은 유의한 차이가 없었다. 골시멘트 누출은 1군이 25추체 (45.5%)였고 2군이 25추체 (55.6%)로 유의한 차이가 없었다. 결론: 단측 도달법을 이용한 경피적 척추 성형술은 양측 도달법에 비해 주입되는 골시멘트양이 적지만 골시멘트의 추체내 분포나 누출이 양측 도달법과 큰 차이가 없으며 3개월 추시상 방사선학적 지표도 유사하여 골다공증성 추체 골절에 사용할 수 있는 유용한 수술법으로 사료된다. Purpose: To evaluate the differences of radiological outcomes of uniportal and biportal vertebroplasty in the point of bone cement distribution and leakage. Materials and Methods: A retrospective study reviewing the period between May 2002 and January 2006 investigated 100 vertebrae which underwent vertebroplasty and followed for more than three months by uniportal approach (55 vertebrae, group 1) and biportal approach (45 vertebrae, group 2). The operative time, the amount of bone cement injected, anterior vertebral height restoration. kyphotic angle, bone cement distribution, and bone cement leakage were evaluated. Results: The amount of injected bone cement of group 1 (3.9 cc) was statistically smaller than that of group 2 (5.1 cc) (p=0.016). There were no significant differences in the operative time, anterior vertebral height reatoration, kyphotic angle in both groups. The rate of bone cement distribution over 8 zones was significantly higher in group 2 than in group 1(p=0.014). However, the rate of bone cement distribution over 7 zones and the rate of bone cement distributed on whole anterior vertebral body were not significantly different in both groups. The cement leakage was not also significantly different in both groups. Conclusion: Although the amount of injected bone cement was smaller in uniportal vertebroplasty, the radiological results and cement leakage were similar to biportal vertebroplasty. These findings suggest that uniportal vertebroplasty can be the operative options in osteoporotic vertebral fracture.Purpose: To evaluate the differences of radiological outcomes of uniportal and biportal vertebroplasty in the point of bone cement distribution and leakage. Materials and Methods: A retrospective study reviewing the period between May 2002 and January 2006 investigated 100 vertebrae which underwent vertebroplasty and followed for more than three months by uniportal approach (55 vertebrae, group 1) and biportal approach (45 vertebrae, group 2). The operative time, the amount of bone cement injected, anterior vertebral height restoration. kyphotic angle, bone cement distribution, and bone cement leakage were evaluated. Results: The amount of injected bone cement of group 1 (3.9 cc) was statistically smaller than that of group 2 (5.1 cc) (p=0.016). There were no significant differences in the operative time, anterior vertebral height reatoration, kyphotic angle in both groups. The rate of bone cement distribution over 8 zones was significantly higher in group 2 than in group 1 (p=0.014). However, the rate of bone cement distribution over 7 zones and the rate of bone cement distributed on whole anterior vertebral body were not significantly different in both groups. The cement leakage was not also significantly different in both groups. Conclusion: Although the amount of injected bone cement was smaller in uniportal vertebroplasty, the radiological results and cement leakage were similar to biportal vertebroplasty. These findings suggest that uniportal vertebroplasty can be the operative options in osteoporotic vertebral fracture.

골다공증에 의한 척추체 압박골절에 대한 경피적 추체 성형술 260예 대한 임상 치험예

민상혁 ( Sang Hyuk Min ),김명호 ( Myung Ho Kim ),박희곤 ( Hee Gon Park ),백호동 ( Ho Dong Paik ) 대한골절학회 2006 대한골절학회지 Vol.19 No.3

목적: 골다공증에 의한 척추체 압박골절에서 경피적 추체 성형술의 효과와 안정성을 확인하고 임상적 결과 및 합병증 등을 후향적으로 조사하여 유용성을 확인하고자 하였다. 대상 및 방법: 1999년 7월부터 2004년 7월까지 골다공증에 의한 척추체의 압박골절을 치료하기 위해서 경피적 추체 성형술을 시행하였던 260명을 대상으로 하였다. 남자가 55명, 여자가 205명이었으며 평균 나이는 69.4세 (55-91세)였다. 골 시멘트를 이용한 경피적 추체 성형술을 시행하였으며, 시술 전후로 통증의 등급표를 작성하여 이를 기준으로 통증의 변화 정도를 관찰하였다. 시술 후 단순 방사선 사진과 컴퓨터 단층촬영, 동맥혈검사, 단순 흉부 방사선검사 촬영을 통해 합병증 여부를 평가하였다. 1주째 추시 방사선 검사를 시행하였고 환자의 증상 호전 정도 및 시술 후 합병증 등을 파악하였다. 외래추시 1년마다 골밀도 검사를 하였으며 2년 이상 골다공증약 투여를 권장하였다. 1년째 외래추시상 평가한 임상결과는 우수, 양호, 저하, 불량으로 나누어 평가하였다. 또한 VAS (visual analogue scale, 0∼10) 동통점수를 이용하여 시술 1주째와 1년째에 대해 변화를 평가하였다. 통계학적 분석은 SPSS (version 11.0)을 사용하여 t-test를 이용하였고 p<0.05를 통계적 유의 수준으로 하였다. 결과: 시술 후 증상의 호전 정도는 1주째에 우수 73명 (28.3%), 양호 123명 (45.5%), 보통 45명 (17.8%), 불량 23명 (8.5%)으로 전체 대상 환자의 73.8%에서 양호 이상의 호전을 보였으며 1년 추시상에서 우수 76명 (29.3%), 양호 120명 (44.3%), 보통 43명 (16.8%), 불량 25명 (9.6%)으로 전체 대상 환자의 73.6%에서 양호 이상의 호전을 보여 시술 직후와 1년 추시상 결과에 큰 차이가 없었다. 합병증으로 혈흉으로 인한 사망이 1예, 부정맥이 발생이 4예 있었으며, 인접 추체의 추가 압박 골절이 15명 (21추체)에서 관찰되었다. 결론: 골 시멘트를 이용한 경피적 추체 성형술은 골다공증성 척추체 압박골절 환자의 치료에 있어 수술 후 즉각적인 통증의 완화와 장기 추시상 큰 차이가 없어 고령의 환자에서 장기간의 견인술 및 침상 안정에 따른 합병증을 예방할 수 있으며, 보조기 착용 없이 조기보행이 가능하여 골다공증에 의한 척추체 흉요추부 압박 골절 환자의 치료에 유용한 술식으로 생각된다. Purpose: To evaluate retrospectively the results regarding pain relief, complication after percutaneous vertebroplasty, for an osteoporotic compression fractures. Materials and Methods: 260 patients (male 55, female 260, mean age 69.4 years old) treated by percutaneous vertebroplasty in Dankook University Hospital from July 1997 to July 2004 were reviewed. We performed percutaneous vertebroplasty and observed the degree of pain relief using pain scale pre-/postoperation. we evaluate the complication by plain radiographs and computed tomography, ABGA and chest X-ray. we evaluate pain relief and complication for 1 week by follow- up plain radiographs. we recommended BMD follow-up per 1 year and osteoporosis medication at least 2 years. A clinical result was evaluated as excellent, good, fair, poor and visual analogue scale (VAS 0∼10) for 1 year. We prefaced a statistical analysis by T-test using SPSS (version 11.0) correlating 1 week and 1 years effects. Results: 73 (28.3%) of the patients were evaluated as excellent: 123 (45.5%), as good: 45 (17.8%), as fair; and 23 (8.5%), as poor, show 73.8% over good in 1 week. 76 (29.3%) of the patients were evaluated as excellent; 120 (44.3%), as good; 43 (16.8%), as fair; and 25 (9.6%), as poor in 1 year, show 73.6% over good result. 1 week follow-up and 1 year follow-up show similar results. 1 patient had death (hemothorax), 4 patients had arrhythmia, 15 patients (21 vertebrae) had fracture around vertebroplasty. Conclusion: Percutaneous vertebroplasty using PMMA is valuable method in the treatment of osteoporotic compression fracture, providing immediately pain relief, long term pain relief, prevention of complication originated from long term traction and bed rest, unwearing brace and early ambulation.

골다공증에 의한 압박 골절의 치료에 있어서 경피적 추세 성형술의 의의

최재영,윤승환,조준,문창택,장상근 건국대학교 의과학연구소 2001 건국의과학학술지 Vol.11 No.-

Percutaneous vertebroplasty has recently been introduced as a therapeutic alternative for the treatment of pain associated with osteoporotic compression fractures and performed popularly at a few centers by neurosurgeons. This technique allows marked pain relief through stabilization of microfractures and strengthening of weakened vertebral body. Authors retrospectively analyzed the clinical outcome of 100 patients with osteoporotic compression fractures for investigating the therapeutic effectiveness of percutaneous vertebroplasty. They were treated with vertebroplasty from April to August 1999. Plain X-ray of all patients showed osteoporotic compression fractures at more than one level.

Intracardiac Foreign Body (Bone Cement) after Percutaneous Vertebroplasty

양준호,김종우,박현오,최준영,장인석,이정은 대한흉부외과학회 2013 Journal of Chest Surgery (J Chest Surg) Vol.46 No.1

Percutaneous vertebroplasty is a relatively easy and minimally invasive procedure used in treating vertebral fractures. However, the procedure has many complications, one of which is bone cement leakage, which happens frequently. Leakage to the paravertebral venous system, in particular, may lead to especially devastating consequences. Here we report a case of a 65-year-old male patient with an intracardiac foreign body (bone cement)that generated a perforation on the right ventricle, and result in hemopericardium after percutaneous vertebroplasty. We performed open heart surgery to remove the foreign body.

Percutaneous Vertebroplasty for Pregnancy-Associated Osteoporotic Vertebral Compression Fractures

Kim, Han-Woong,Song, Jae-Wook,Kwon, Austin,Kim, In-Hwan The Korean Neurosurgical Society 2010 Journal of Korean neurosurgical society Vol.47 No.5

Osteoporosis is a worldwide problem and it mainly affects postmenopausal women. Osteoporosis associated with pregnancy or lactation is a rare condition. The incidence and mechanism of this phenomenon has not been clarified, but it can cause one or more vertebral compression fractures with severe, prolonged back pain in the affected women. We experienced this uncommon case, treated it with percutaneous vertebroplasty. A 35-old-woman visited our hospital with complaints of severe back pain and flank pain 2 months after normal vaginal delivery. She was diagnosed with osteoporotic vertebral compression fractures on the T5, 8, 9 and 11 vertebral bodies and we performed percutaneous vertebroplasty on the T8, 9 and 11 vertebrae with a good result. We present here an unusual case of pregnancy-associated compression fractures treated by percutaneous vertebroplasty.

Tuberculous Spondylitis after Percutaneous Vertebroplasty: Misdiagnosis or Complication?

강정훈,김현숙,김석원 대한척추신경외과학회 2013 Neurospine Vol.10 No.2

So far, there have been few previous reports of tuberculous spondylitis occurring after percutaneous vertebroplasty. We report an unusual case of tuberculous spondylitis diagnosed after percutaneous vertebroplasty in a patient who had a history of pulmonary tuberculosis for the first time. A 58-year-old woman, who had a history of complete recovery from pulmonary tuberculosis six years previously, was hospitalized due to severe back pain after a fall. Radiological studies revealed a fresh compression fracture at the T12 thoracic vertebra. The back pain improved dramatically, and the patient was discharged two days after the vertebroplasty. However, cold sweats and a low grade fever with severe back pain developed four weeks after the procedure. Magnetic resonance imaging revealed a severe kyphosis and the T11-T12 disc space had collapsed with heterogeneous signal intensity. The results of the culture of the biopsy specimens were negative, and did not lead to identification of the causative micro-organism. However, the polymerase chain reaction for Mycobacterium tuberculosis was positive. Treatment for tuberculous spondylitis was started and she underwent posterior fusion and instrumentation from T9-L2 after the markers for infection returned to normal. After surgical intervention, the pain improved and the kyphotic deformity was corrected.

Predictive Risk Factors for Refracture after Percutaneous Vertebroplasty

Sang-Kuk Kang,Chan Woo Lee,Noh Kyoung Park,Tae-Wook Kang,Jeong-Wook Lim,Ki Yong Cha,김정환 대한재활의학회 2011 Annals of Rehabilitation Medicine Vol.35 No.6

Objective To identify risk factors for developing a vertebral refracture after percutaneous vertebroplasty. Method A retrospective analysis of 60 patients who had undergone percutaneous vertebroplasty between January 2008 and April 2010 was conducted. All patients were observed for a 1 year follow-up period, and fracture was defined when it was both clinically reported and radiographically confirmed. Twenty-seven patients with a refractured vertebra and 33 patients without a refracture were included. Of the 60 patients, 20 presented with a refracture from a cemented vertebra, whereas the remaining 40 patients did not. Clinical, imaging and procedurerelated factors for each group were analyzed by the Fisher’s exact, chi-square, and the Mann–Whitney U-tests. Results Local kyphotic angle and sagittal index were significant as a result of researching various risk factors related to vertebral refracture (p<0.001, p<0.001, respectively) and refracture from a cemented vertebra itself (p=0.004, p<0.001, respectively). Other factors were not significant. Conclusion Patients who had a high preoperative local kyphotic angle and a high sagittal index required a close follow-up and attention. Method A retrospective analysis of 60 patients who had undergone percutaneous vertebroplasty between January 2008 and April 2010 was conducted. All patients were observed for a 1 year follow-up period, and fracture was defined when it was both clinically reported and radiographically confirmed. Twenty-seven patients with a refractured vertebra and 33 patients without a refracture were included. Of the 60 patients, 20 presented with a refracture from a cemented vertebra, whereas the remaining 40 patients did not. Clinical, imaging and procedurerelated factors for each group were analyzed by the Fisher’s exact, chi-square, and the Mann–Whitney U-tests.

Asymptomatic Bone Cement Pulmonary Embolism after Percutaneous Vertebroplasty: A Case Report

( Hye Jin Shi ),( Sung Eun Kim ),( Won Woo Seo ),( Sung Min Sohn ),( Sung Ho Wang ),( Sung Rock Park ),( Sang Ki Lee ) 대한응급의학회 2016 대한응급의학회지 Vol.27 No.3

Pulmonary embolism is a rare complication after percutaneous vertebroplasty for compression fracture. Embolization is related to cement leakage outside the treated vertebral body into the adjacent venous system. We report on a case of pulmonary embolism with bone cement in the right pulmonary artery in a 75-year-old female who had undergone percutaneous vertebroplasty 2 months before. Her simple X-ray of the spine captured polymethyl metacrylate leakage from the vertebral body, which indicated the pathophysiology of this event.

Asymptomatic Bone Cement Pulmonary Embolism after Percutaneous Vertebroplasty: A Case Report

시혜진,김성은,서원우,손성민,왕성호,박성록,이상기 대한응급의학회 2016 대한응급의학회지 Vol.27 No.3

Pulmonary embolism is a rare complication after percutaneous vertebroplasty for compression fracture. Embolization is related to cement leakage outside the treated vertebral body into the adjacent venous system. We report on a case of pulmonary embolism with bone cement in the right pulmonary artery in a 75-year-old female who had undergone percutaneous vertebroplasty 2 months before. Her simple X-ray of the spine captured polymethyl metacrylate leakage from the vertebral body, which indicated the pathophysiology of this event.

경피적 추체성형술 후 발생한 인접추체 압박골절

김정환,박준석,황재광 대한척추외과학회 2013 대한척추외과학회지 Vol.20 No.4

Study Design: A retrospective study. Objectives: To find out the characteristics and the risk factors of adjacent vertebral compression fracture after percutaneous vertebroplasty. Summary of Literature Review: Percutaneous vertebroplasty is regarded as more effective treatment than conservative care, but additional fracture could cause complications during follow up. Materials and Methods: We analyzed 43 patients who had only one vertebral compression fracture after one vertebroplasty. The number of patients who had additional compression fracture within one level from the operated vertebra were 23 cases (Group I); beyond two levels from the operated vertebra were 20 cases (Group II). We compared the onset period of additional compression fracture, the degree of osteoporosis, age, level, restoration of vertebral body height and kyphosis between the two groups. Results: The onset period of additional compression fracture was 18.7±28.1 months in Group I and 42.7±39.4 months in Group II,showing significant difference between the two groups. Group I had more cases of previous vertebroplasty on thoraco-lumbar vertebra than Group II. The restoration rate of vertebral body height of Group I was 42.3±40.9% and that of Group II was 22.8±21.6%, which shows significant difference between the two. Conclusion: Adjacent vertebral compression fracture after vertebroplasty can occur earlier than non adjacent one. We need to pay attention to the patients who had higher restoration rate of vertebral body height after vertebroplsty as they are more prone to having additional adjacent compression fracture. 연구 계획: 후향적 연구. 목적: 경피적 추체성형술 후 발생한 인접 추체 압박골절의 특성과 위험 요소를 파악하고자 하였다. 선행문헌의 요약: 경피적 추체 성형술은 보존적 치료와 비교하여 우수한 치료법으로 생각되어지고 있으나 추시 기간이 길어짐에 따라 인접 추체의 추가골절 문제가 부각되고 있다. 대상 및 방법: 1개의 골다공증성 압박골절로 경피적 추체성형술을 받은 후 1개의 다른 추체에 골절이 발생한 43례를 대상으로 하였다. 추가 골절이 상하 1분절에 발생한 인접 추체 골절(I군)은 23례(53.5%), 2분절 이상 떨어져 발생한 비인접 추체 골절(II군)은 20례 (46.5%)였다. 두 군 간에 추가 골절 발생시기, 골다공증 정도, 연령, 골절 부위, 술 전 추체 압박률 및 후만각, 골시멘트 누출 여부, 술후 추체 높이 변화 등을 비교하였다. 결과: 다른 추체 골절 발생 시기는 I군이 18.7±28.1개월, II군이 42.7±39.4개월로 차이가 있었으며 1차 골절 및 시술 부위가 흉요추부인 경우가 I군에서II군에 비해 많았다. 술 후 추체 높이 회복률은 I군에서 42.3±40.9%로 II군의 22.8±21.6%보다 유의하게 차이를 보였다. 결론: 경피적 추체성형술 후 인접 추체 골절은 보다 조기에 발생할 수 있으며 술 후 추체 높이 회복률이 높은 경우에 발생하기 쉬워 주의를 요한다.