골다공증성 척추 압박골절에서 풍선 척추 성형술의 효능 - 1년 이상 추시 결과 - = The Efficacy of Kyphoplasty on Osteoporotic Vertebral Compression Fracture - A 1-Year Follow-up Study -

다국어 초록 (Multilingual Abstract)

Study Design: This is a retrospective study.
Objective: We wanted to evaluate the efficacy of kyphoplasty for treating osteoporotic VCF and we wanted to determine the
risk factors for additional VCF.
Summary of the Literature Review: Successful pain relief with performing kyphoplasty for VCF has been well documented.
However, unsatisfactory reduction and additional VCF are remained problems for kyphoplasty.
Materials and Methods: Sixty-three patients who underwent kyphoplasty were followed up for more than 1 year. The degree of
reduction of the collapsed vertebral height, the vertebral kyphotic angle, the regional Cobb’s angle and the overall sagittal
alignment, the visual analogue scale (VAS), the fracture configuration, the bone mineral density (BMD), the presence of
intradiscal cement leakage and additional VCF were investigated. The risk factors for additional VCF were analyzed.
Results: In terms of deformity correction, the collapsed vertebral height were restored (67.3±15.6% to 82.5±11.8%), the vertebral
kyphotic angle was improved (12.1±6.9˚to 8.1±5.3˚), the degree of the regional Cobb’s angle was reduced (3.1±4.5˚) and
the overall sagittal balance was improved (1.7±5.3 cm to 0.5±3.9 cm) with clinical satisfaction (VAS: 6.9±1.3 points to 2.3±0.9
points). But less than 40% of the patients reached the expected reduction criteria (the vertebral height ＞90%, the vertebral
kyphotic angle and regional Cobb’s angle reduction ＞5˚). Additional VCF occurred in 10 patients (15.9%). The average BMD in
the additional VCF group was T-score of -3.8 and that for the no-additional VCF group was T-score of -3.0 (p=0.025). The
degree of reduction under general anesthesia was twice more than that under local anesthesia. Eleven cases (17.5%) of intradiscal
cement leakages were noticed, but this showed no relevance to the fracture configurations and additional VCF. The overall
sagittal alignment and cement volume showed no relevance to additional VCF.
Conclusion: Kyphoplasty was excellent for pain reduction, but it was unsatisfactory for correcting deformity. Vertebral height
correction was more effectively performed under general anesthesia. Additional VCF was caused by severe osteoporosis.

국문 초록 (Abstract)

연구계획: 후향적 연구
연구목적: 골다공증성 척추 압박골절에서 풍선 척추 성형술의 효능과 인접 척추 골절의 위험 요소를 알아보고자 하였다.
대상 및 방법: 골다공증성 척추 압박골절로 풍선 성형술을 시행받은 92명의 환자 중(평균 나이 70.4±7.0세) 1년 이
상 추시가 가능했던 63명 환자를 대상으로, 방사선학적 붕괴 추체 높이 비율, 추체 후만각, 국소분절 시상 후만각, 척
추 시상면 정렬의 정복 정도와 임상적 만족도를 조사하였다. 단순 방사선 사진과 자기공명영상 상의 골절 양상, 골밀
도, 추간판내 골시멘트 누출과 인접 척추 압박골절 발생을 조사하여 인접 척추 압박골절 발생의 위험 요소를 분석하
였다.
결과: 붕괴 추체 높이 비율은 67.3±15.6%에서 82.5±11.8%로(p=0.000), 추체 후만각은 12.1±6.9˚에서 8.1±5.3˚로
(p=0.000), 국소분절 시상 후만각은 3.1±4.5˚의 정복 정도를 보였다(p=0.009). 시상면 정렬은 1.7±5.3 cm에서 0.5±
3.9cm로 이동되었다(p=0.005). 임상적 만족도는 VAS 점수 6.9±1.3점에서 2.3±0.9점으로 호전되었다(p=0.000). 이러
한 결과는 최종 추시 시까지 유지되었다. 그러나 추체 높이 90% 이상 회복과 추체 후만각과 국소분절 시상 후만각의
정복이 5도 이상 회복되는 경우는 대상 환자의 40% 에도 도달하지 못하였다. 인접 척추 압박골절은 10명(15.9%)에서
발생하였으며(-3.8±0.6 T-점수), 인접 척추 골절이 발생하지 않은 군(-3.0±1.1 T-점수)에 비하여 의미있게 낮은 T-점
수를 나타냈다(p=0.025). 전신 마취 하 시술군에서 국소 마취 시술군 보다 2배 이상의 붕괴 추체 높이의 교정 정도를
얻을 수 있었다. 추간판내 골시멘트 누출은 11명(17.5%)에서 발생하였으나 골절 양상이나 인접 척추 압박골절의 위
험성과 연관성은 보이지 않았다. 위험인자로 의심되었던 척추 시상면 정렬과 주입된 골시멘트 량은 인접 척추 압박
골절과 연관성을 보이지 않았다.
결론: 풍선 척추 성형술은 골다공증성 척추 압박골절 치료에 통증 완화에는 뛰어난 방법이나 추체 후만 변형 회복은
만족스럽지 못하였다. 전신 마취 하 시술시는 국소 마취 시 보다 더 많은 붕괴 척추 높이의 정복을 얻을 수 있었다. 인
접 척추 압박골절은 심한 골다공증을 보이는 환자에서 호발하였다.

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