Journal of the Korean Fracture Society (대한골절학회지)

The Korean Fracture Society (대한골절학회)
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Treatment Options of Osteoporotic Vertebral Compression Fractures

골다공증성 압박성 척추 골절의 치료

  • Kim, Yu Mi (Department of Orthopaedic Surgery, Wonkwang University Sanbon Hospital) ;
  • Kim, Tae Kyun (Department of Orthopaedic Surgery, Wonkwang University School of Medicine) ;
  • Shim, Dae Moo (Department of Orthopaedic Surgery, Wonkwang University School of Medicine) ;
  • Lim, Kyeong Hoon (Department of Orthopaedic Surgery, Wonkwang University School of Medicine)
  • 김유미 (원광대학교 의과대학 산본병원 정형외과) ;
  • 김태균 (원광대학교 의과대학 정형외과학교실) ;
  • 심대무 (원광대학교 의과대학 정형외과학교실) ;
  • 임경훈 (원광대학교 의과대학 정형외과학교실)
  • Published : 2018.07.25
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Abstract

This paper reviews previous studies on the treatment of osteoporotic vertebral compression fractures in elderly patients to determine what factors should be considered for successful treatment. In osteoporotic vertebral compression fractures, the primary treatment is conservative treatments. Other treatments include osteoporosis treatment, pain control, orthosis, and physical therapy. Recently, percutaneous catheterization or balloon plasty is performed for rapid pain recovery and early ambulation. Percutaneous catheterization or balloon posterior plasty is effective in reducing pain and improving the activity ability. Surgical treatment should be considered in cases of nonunion or osteonecrosis, dent, deformation, and spinal cord compression after conservative treatment has failed. In surgical treatment, posterior spinal fixation and vertebroplasty are more advantageous in terms of the amount of bleeding, operation time compared to the anterior approach, but the most appropriate method should be selected through the patient's condition and understanding of each surgical method.

고령 환자의 골다공증성 척추 압박골절의 치료법에 대하여 문헌을 통해 고찰해보고 환자의 일상생활로의 복귀와 성공적인 치료를 위해 어떤 사항들을 고려해야 하는지 알아보고자 한다. 골다공증성 척추 압박골절에서는 일차적으로 보존적 치료를 시행하게 되며, 골다공증 치료제, 통증 조절, 보조기 착용, 물리치료 등을 시행한다. 최근에는 빠른 통증 회복 및 조기 보행을 위해 경피적 추체 성형술 또는 풍선 성형술을 시행하기도 한다. 경피적 추체 성형술 또는 풍선 후만 성형술 모두에서 통증 경감 및 활동 능력의 개선에 있어 효과적인 것으로 보고되고 있으나 추체 높이의 회복에 있어서는 풍선 후만 성형술이 척추 성형술보다 더 뛰어난 것으로 알려져 있다. 보존적 치료에 실패하여 불유합 또는 골괴사, 함몰 및 변형, 척수 압박을 일으키게 되어 지연성 함몰이 발생한 경우나 경피적 시술 후 감염, 시멘트의 이탈 등의 합병증이 발생한 경우에 수술적 치료를 고려해야 한다. 수술적 치료 시에는 전방접근법에 비하여 후방 척추 고정술 및 척추 성형술이 출혈량, 수술 시간, 측면에서 유리하여 일차 선택으로 권장될만하나 환자의 손상 상태와 각 수술 방법에 대한 이해를 기반으로 가장 적절한 방법을 선택해야 한다. 수술 시에는 나사못의 고정력이 성공적인 수술 결과에 영향을 미치기 때문에 견고한 고정력을 얻기 위한 여러 방법들을 사용해야 한다.

Keywords

Acknowledgement

Supported by : Wonkwang University

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