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Kyphoplastie und Vertebroplastie bei Frakturen im hohen Lebensalter

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Zusammenfassung

Die beiden minimalinvasiven perkutanen Techniken der Zementauffüllung osteoporotischer Wirbelkörperfrakturen—Vertebroplastie und Kyphoplastie mit Instillation von Polymethylmetacrylat (PMMA)—werden als „ultima ratio“ des therapeutischen Regimes von frakturbedingten Komplikationen der Osteoporose im Brust- und Lendenwirbelsäulenbereich vorgenommen. Bei der Vertebroplastie erfolgt die Zementapplikation mono- oder bipedikulär unter hohem Druck über eine Punktionsnadel. Optimalerweise durchdringt der Zement den Wirbelkörper als Ganzes und respektiert dabei die Hinterkante als Barriere gegen einen Zementaustritt nach dorsal. Eine Aufrichtung komprimierter Wirbelkörper erfolgt nicht. Bei der Kyphoplastie instilliert man den PMMA-Zement in zuvor durch aufblasbare Ballons transpedikulär beidseits geschaffene Hohlräume über Arbeitstrokare unter geringem Druck, die Möglichkeit einer Wiederherstellung der ursprünglichen Wirbelkörperhöhe ist damit gegeben. Die Gefahr eines unerwünschten Zementaustrittes ist minimiert.

Abstract

Kyphoplasty and vertebroplasty are two minimally invasive percutaneous techniques used for treatment of osteoporotic vertebral compression fractures in the thoracic and lumbar spine. The injection of polymethylmetacrylate (PMMA) is often a final attempt at therapeutic treatment of complications due to such fractures. Vertebroplasty involves injection of cement via one or both pedicles under high pressure, thus filling and stabilizing the vertebra without reduction of fracture. Extravertebral cement leakage is a common complication: an intact posterior wall normally prevents cement leakage into the epidural space. Kyphoplasty involves transpedicular inflation of balloon tamps, thus creating a cavity which is then filled with PMMA under low pressure. Restoration of vertebral height is possible and the potential for extravertebral cement leakage lessened.

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Correspondence to P.-J. Meeder.

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Meeder, PJ., DaFonseca, K., Hillmeier, J. et al. Kyphoplastie und Vertebroplastie bei Frakturen im hohen Lebensalter. Chirurg 74, 994–999 (2003). https://doi.org/10.1007/s00104-003-0748-x

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