椎体强化术后骨水泥弥散分布评价的研究进展

椎体强化术治疗骨质疏松性椎体压缩骨折已在临床上广泛开展,评价手术是否成功,除了与临床疗效有关外,两项重要评价指标是伤椎椎体高度恢复和脊椎后凸Cobb角的矫正程度。但是,近年来研究发现骨水泥在伤椎的弥散分布会影响术后患者疼痛的缓解和脊柱功能的恢复,更有报道与术椎再骨折塌陷和临椎骨折相关,被认为是另外一项不可忽略的重要评价指标。然而由于现研究对骨水泥弥散分布的评价方法不一,尚未形成统一的评价标准。本研究从形态特征、弥散等级、位置分布及是否越过骨折线区域等不同角度,对现有有关椎体强化术后骨水泥弥散分布评价的研究进行系统性综述。综合分析后认为,骨水泥理想的弥散分布是呈现弥散型或混合型形态特征,广泛填充并充分覆盖骨折线区域,双侧均匀连续分布于椎体前柱,并同时接触上下椎板的中间部分。

Research progress in the evaluation of diffusion and distribution of bone cement after vertebral augmentation

Vertebral augmentation has been widely used to treat osteoporotic vertebral compression fractures. In addition to evaluate the clinical efficacy, two important indexes for the evaluation of the success of the operation are the height recovery of the injured vertebrae and the correction degree of Cobb angle in kyphosis. However, recent studies have found that the diffusion and distribution of bone cement in the injured vertebrae can affect postoperative pain relief and the recovery of spinal function. Moreover, it has also been reported that they are related to the collapse and refracture of cemented vertebrae and adjacent vertebral fracture. The diffusion and distribution of bone cement is considered as another essential evaluation index that cannot be ignored. However, due to different evaluation methods for the diffusion and distribution of bone cement, no unified evaluation standard has been formed. This study systematically reviews the existing studies on the evaluation of the diffusion and distribution of bone cement after vertebral augmentation from perspectives of morphological characteristics, dispersion grade, location distribution, and whether to cover the fracture line area etc. After comprehensive analysis, it is concluded that the ideal diffusion and distribution of bone cement is characterized by trabecular or mixed pattern with extensive dispersion and full coverage of the fracture line area, uniformly and continuously distributing in the anterior column of the vertebral body on both sides, and contacting the middle part of the upper and lower vertebral endplates at the same time.