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国外椎体成型术治疗指南

Society of Interventional Radiology Quality Improvement Guidelines for Percutaneous Vertebroplasty

J.Kevin McGraw,MD,John Cardella,MD,John Dean Barr,MD,John M.Mathis,MD,Orestes Sanchez,MD, Marc S.Schwartzberg,MD,Timothy L.Swan,MD,and David Sacks,MD,for the SIR Standards of Practice Committee

J Vasc Interv Radiol2003;14:827–831

PREAMBLE

THE membership of the Society of In-terventional Radiology(SIR)Stan-dards of Practice Committee repre-sents experts in a broad spectrum of interventional procedures from the private and academic sectors of medi-cine.Generally,Standards of Practice Committee members dedicate the vast majority of their professional time to performing interventional procedures; as such,they represent a valid,broad expert constituency of the subject mat-ter under consideration for standards production.

Technical documents specifying the exact consensus and literature review methodologies as well as the institu-tional affiliations and professional cre-dentials of the authors of this docu-ment are available on request from the Society of Interventional Radiology,10201Lee Highway,Suite500,Fairfax,

VA22030.

METHODOLOGY

SIR produces its Standards of Prac-

tice documents with use of the follow-

ing process:Standards documents of

relevance and timeliness are conceptu-

alized by the Standards of Practice

Committee members.A recognized

expert is identified to serve as the

principal author for the standard.Ad-

ditional authors may be assigned de-

pending on the magnitude of the

project.

An in-depth literature search is per-

formed with use of electronic medical

literature databases.Then,a critical re-

view of peer-reviewed articles is per-

formed with regard to the study meth-

odology,results,and conclusions.The

qualitative weight of these articles is

assembled into an evidence table,

which is used to write the document

so it contains evidence-based data

with respect to content,rates,and

thresholds.

When the evidence of literature is

weak,conflicting,or contradictory,

consensus for the parameter is reached

by a minimum of12Standards of

Practice Committee members with use

of a Modified Delphi Consensus

Method(1,2).For the purposes of

these documents,consensus is defined

as80%Delphi participant agreement

on a value or parameter.

The draft document is critically re-

viewed by the Standards of Practice

Committee members by telephone

conference call or face-to-face meeting.

The finalized draft from the Commit-

tee is sent to the SIR membership for

further input/criticism during a

30-day comment period.These com-

ments are discussed by the Standards

of Practice Committee and appropri-

ate revisions are made to create the

finished standards document.Before

its publication,the document is en-

dorsed by the SIR Executive Council.

VERTEBRAL FRACTURES

Each year,more than700,000verte-

bral fractures secondary to osteoporo-

sis are diagnosed in the United States

population,resulting in115,000hospi-

tal admissions(3).The lifetime risk of

a vertebral body compression fracture

is16%for women and5%for men,

and the incidence of osteoporotic frac-

tures is anticipated to increase four-

fold worldwide in the next50years

(3).Other causes of painful compres-

sion fracture include malignant in-

volvement of the spinal column(me-

tastasis,myeloma,and lymphoma),

hemangioma,and vertebral osteone-

crosis.In addition to pain,spinal col-

umn instability may also be present.

Regardless of etiology,treatment for

compression fractures has been

largely conservative and directed to-

ward pain control,usually consisting

of narcotic analgesia,bedrest,and

back bracing.For osteoporosis,current

preventive drug regimens,including

hormonal replacement therapy,bi-

From the Department of Interventional Radiology

(J.K.M.),Riverside Methodist Hospital,Columbus,

Ohio;Department of Radiology(J.C.),SUNY Up-

state Medical University,Syracuse,New York;Mid-

South Imaging and Therapeutics(J.D.B.),Memphis,

Tennessee;Department of Radiology(J.M.M.),

Lewis-Gale Hospital,Salem,Virginia;Department

of Radiology(O.S.),Passaic Beth Israel Hospital;

Radiology Associates of Central Florida(M.S.S.),

Leesburg,Florida;Department of Radiology(T.L.S.),

Marshfield Clinic,Marshfield,Wisconsin;and De-

partment of Radiology(D.S.),The Reading Hospital

and Medical Center,Reading,Pennsylvania.Ad-

dress correspondence to SIR,10201Lee Highway,

Suite500,Fairfax,VA22030.

J.M.M.has identified a potential conflict of interest.

©SIR,2003

DOI:10.1097/01.RVI.0000082822.75926.4c

Standards of Practice

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