Der Zeitpunkt der Kyphoplastie beeinflusst das Ergebnis: eine prospektive Analyse

Zusammenfassung

Ziel der prospektiven Untersuchung war es, bei der Behandlung von Wirbelkörperfrakturen mittels Ballonkyphoplastie die Schmerzreduktion im Hinblick auf das Frakturalter zu evaluieren. Insgesamt konnten in dieser Studie 106 Patienten (37 männlich und 69 weiblich) mit 128 Wirbelkörperfrakturen mit einem mittleren Alter von 67,5 Jahren (21 bis 92 Jahre) bei einem Bodymaßindex von 26,4 (16–40,4) erfasst werden. Alle Frakturen wurden radiologisch und klinisch ausgewertet. Es wurden die Schmerzintensität (visuelle Analogskala 0–10), der Analgetikaverbrauch (WHO-Stufenschema 1 bis 3), der Oswestryscore und operationsrelevante Daten erhoben (Operationsdauer, Zementverbrauch, Komplikationen). Es wurden 37 A 1.1-, 43 A 1.2-, 43 A 1.3-, 4 A 3.1- und 1 A 2.3-Klassifikationen erhoben. Das Frakturalter in Tagen betrug bei 75 Patienten weniger als 23 Tage, die mittlere Operationszeit betrug 43 Minuten. Der Analgetikaverbrauch konnte von präoperativ 1,8 ± 0,8 auf 1,0 ± 0,6 reduziert werden. Eine signifikante Verbesserung zeigte sich in der Schmerzintensität; diese sank signifikant von 8,2 ± 0,9 präoperativ auf 3,9 ± 0,8 postoperativ. Bezogen auf das Frakturalter und die Schmerzintensität konnte eine deutlich höhere Schmerzreduktion bei den frischen Frakturen zwischen 0 und 23 Tagen erzielt werden. Hier sank die Schmerzintensität auf 2,5 ± 0,5 postoperativ, bei den später versorgten Frakturen lag dieser Wert bei 4,5 ± 0,4. Zusammenfassend kann festgestellt werden, dass die Ballonkyphoplastie eine suffiziente Methode ist Wirbelkörperfrakturen aufzurichten, den Kyphosewinkel zu verbessern und eine Schmerzreduktion zu erreichen.

Abstract

The aim of this prospective study was to evaluate the efficiency of early versus delayed treatment of vertebral fractures by balloon kyphoplasty with regard to fracture age. A total of 106 patients (37 male and 69 female) with 128 vertebral body fractures, an average age of 67.5 years (21 to 92) and a body mass index of 26.4 (16 to 40.4) were recorded. All fractures were evaluated radiologically and clinically. Pain intensity (visual analogue scale 0–10), analgesics consumption (WHO steps 1 to 3) and the relevant surgery data (operating time, cement consumption, complications) were recorded. 37 A 1.1, 43 A 1.2, 43 A 1.3, 4 A 3.1 and 1 A 2.3 classifications were collected. Fracture age in days was less than 23 days in 75 patients; the mean time of surgery was 43 minutes. Analgesics consumption was reduced from 1.8 ± 0.8 preoperatively to 1.0 ± 0.6 postoperatively. A significant improvement was found in pain intensity, which fell significantly from 8.2 ± 0.9 preoperatively to 3.9 ± 0.8 postoperatively. In relation to fracture age and pain intensity, a significantly higher pain reduction was achieved with timing of kyphoplasty between 0 and 23 days. Here, pain intensity decreased to 2.5 ± 0.5 postoperatively, compared with 4.5 ± 0.4 for fractures treated later. Fracture age had no influence on vertebral body alignment or improvement of the kyphotic angle. In summary, it can be stated that balloon kyphoplasty is a sufficient method to treat vertebral body fractures, to improve the kyphotic angle and reduce pain significantly.

Schlüsselwörter

Kyphoplastie - Anamnesedauer - Schmerz - Aufrichtung

Key words

kyphoplasty - medical history - pain - reduction

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