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Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2005, Número 4

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Acta Ortop Mex 2005; 19 (4)


Vertebroplastía: Tratamiento del dolor por fractura vertebral compresiva osteoporótica

Cervín SS, Irineo CAB, Flores FP, Osuna RI

Idioma: Español
Referencias bibliográficas: 88
Paginas: 143-151
Archivo PDF: 83.15 Kb.


RESUMEN

Las fracturas compresivas vertebrales afectan en EUA, a 700,000 pacientes por año. Su costo anual es de 10 billones de dólares, 260,000 son dolorosas y refractarias a manejo médico. La cirugía es raramente indicada por morbilidad elevada y fallas en la instrumentación. Calcitonina y vertebroplastía son tratamientos útiles para estos pacientes. Objetivo. Evaluar eficiencia y seguridad de vertebroplastía comparada con calcitonina, para alivio del dolor por fractura vertebral osteoporótica. Diseño. Ensayo clínico controlado. Material y métodos. Entre septiembre 2002 y enero 2004, en nuestra institución 60 pacientes fueron aleatoriamente asignados recibiendo 100 unidades de calcitonina (n = 30) o vertebroplastía percutánea (n = 30). Todos presentaban dolor severo mayor de 3 meses, sin respuesta a tratamiento conservador. La evaluación del dolor se realizó por la escala visual análoga (EVA), y la seguridad por complicaciones determinándose a 1, 30, 60 y 90 días. Éxito fue definido como reducción del dolor ≥ 80%. Se construyeron intervalos de confianza del 95% para tasas de respuesta clínica. Un valor p ‹ 0.05 fue considerado estadísticamente significativo. Se realizó análisis por intención de tratar y modelo estadístico de GEE, para datos longitudinales. Resultados. 60 pacientes (54 femeninos y 6 masculinos), con media de edad 75.5 años; (DE 7.7, rango, 55-92) evaluados durante 3 meses. La valoración completa se realizó en todos los pacientes y ambos grupospresentaron una mediana en intensidad de dolor EVA 8 (P5 = 8 y P95 = 9). Un mejoramiento significativo post-procedimiento en el grupo de vertebroplastía versus calcitonina fue observado al final del seguimiento (p ‹ 0.05 alivio del dolor y en la movilidad p ‹ 0.03). Los efectos adversos fueron similares en ambos grupos 6.6%. Conclusiones. La vertebroplastía mostró un alivio significativo en la mayoría de los pacientes, fue más segura y eficiente que calcitonina.


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