经皮椎体后凸成形治疗中骨水泥渗漏对椎体高度恢复的影响

摘要 背景：将经皮椎体后凸成形通过球囊加压扩张在椎体内形成周围有相对致密松质骨的空腔,可有效降低骨水泥渗漏率,同时扩张的球囊有助于塌陷椎体的复位,矫正脊柱后凸畸形。 目的：回顾性分析手法复位后将经皮椎体后凸成形注入骨水泥治疗骨质疏松性椎体压缩骨折渗漏情况及对椎体高度恢复的影响。 方法：选择2008-02/2010-06华北石油总医院骨科行经皮椎体后凸成形治疗骨质疏松性椎体压缩骨折患者31例,41椎体。平均年龄69(53~82)岁。并于术前手法按压使腰部过伸复位。观察患者术后疼痛缓解、椎体高度恢复以及骨水泥渗漏情况。 结果与结论: 所有患者术后随访8~13(11.0±1.6)个月。患者视觉模拟疼痛评分由术前6.7±1.9下降至术后1.3±1.2,差异有显著性意义(P < 0.05)。椎体高度由术前(15.7±5.2) mm恢复至(20.2±4.5) mm,椎体高度显著恢复(P < 0.05)。发生骨水泥渗漏3例,均无明显临床症状。说明术前手法复位后经皮椎体后凸成形将骨水泥注入骨质疏松性椎体压缩骨折可以显著恢复椎体高度,止痛效果良好且无严重渗漏发生。 关键词：经皮椎体后凸成形;骨质疏松;骨质疏松性椎体压缩骨折;骨水泥;生物材料 doi:10.3969/j.issn.1673-8225.2010.42.038     

球囊扩张椎体后凸成形注入骨水泥治疗骨质疏松性脊柱骨折58例

背景：探讨球囊扩张椎体后凸成形注入骨水泥治疗骨质疏松性脊柱骨折的疗效。 方法：采用球囊扩张椎体后凸成形治疗老年人骨质疏松性单节段椎体压缩性骨折58例,58个椎体。病变位于T6~L4椎体,以T10~L2胸腰段发生多见。所有患者均采用局麻方法,患者俯卧于脊柱外科手术架上,在C臂透视下行单侧或双侧椎弓根穿刺,注入骨水泥。 结果：发生骨水泥渗漏8例,骨水泥沿后纵韧带渗漏至邻近椎体后缘1例,椎体外边缘6例,皮下1例,但患者没有临床症状。治疗后脊柱 X射线片显示椎体高度有所恢复,脊柱后凸畸形改善。所有患者疼痛明显缓解,疼痛缓解率100%,视觉模拟评分、后凸角度、活动能力评分治疗前与治疗后6个月比较,差异有显著性意义(P < 0. 05),治疗后6个月与随访结束时比较差异无显著性意义(P > 0. 05)。 结论：球囊扩张椎体后凸成形注入骨水泥治疗能够明显缓解骨质疏松性脊柱骨折导致的疼痛,并可以部分恢复椎体高度和脊柱后凸畸形,有利于改善脊柱的功能,提高患者的生活质量。 关键词：球囊扩张椎体后凸成形术;骨质疏松;胸腰椎骨折 doi:10.3969/j.issn.1673-8225.2009.47.040     

骨质疏松性椎体压缩骨折患者经皮椎体成形注入黏丝期骨水泥后的再骨折

背景：目前经皮椎体成形术已成为治疗骨质疏松性椎体压缩骨折的首选方法,但其骨水泥注入后邻近椎体骨折并发症也在逐年增加,椎体成形过程中常采用黏丝期骨水泥注射,而骨水泥注射时状态可影响其在椎体内分布。 目的：回顾性分析骨质疏松性椎体压缩骨折经皮椎体成形注入黏丝期骨水泥后再骨折的原因。 方法：2006-07/2009-11对112例骨质疏松性椎体压缩骨折行经皮椎体成形术,术中DSA机透视引导下经单侧或双侧椎弓根入路,调配聚甲基丙烯酸甲酯骨水泥至黏丝期后经工作通道注入,并观察疗效。 结果与结论：每个椎体注入骨水泥2.4~6.0 mL,平均(3.40±1.02) mL。术中骨水泥渗漏至椎旁14例,椎间隙内15例。患者术后全部得到随访,随访时间6~15个月,平均(9.61±2.82)个月,未发现特殊的材料和宿主反应,29例患者疼痛再发,其中15例经MRI证实手术相邻椎体发生新鲜骨折,再次给予经皮椎体成形手术后疼痛症状缓解。结果提示经皮椎体成形注入黏丝期的骨水泥后应力集中、术中灌注剂渗漏椎间隙等综合因素增加了术后相邻椎体再次发生骨折的危险,寻找理想的骨水泥替代物将成为今后临床研究的方向。 关键词：骨水泥;骨质疏松性椎体压缩骨折;骨质疏松;经皮椎体成形术;生物材料 doi:10.3969/j.issn.1673-8225.2010.25.024     

单球囊扩张与骨水泥填充矫正骨质疏松性脊柱压缩骨折椎体后凸☆

背景：椎体后凸成形技术操作时需用2个球囊在椎体内同时协调扩张，并在形成的空腔内注入骨水泥，但专用球囊价格昂贵，限制了该技术的广泛开展。采用单球囊扩张椎体后凸成形治疗骨质疏松性脊柱压缩骨折，可降低手术费用，但此干预过程中介入的骨水泥填充物生物相容性及椎体后凸成形效果需进一步观察。 目的:应用单个球囊分别在椎体两侧先后扩张，并在其形成的空腔内行骨水泥填充，观察骨水泥填充物生物相容性及治疗骨质疏松性脊柱压缩骨折的效果。 设计：前后对照观察。 单位：解放军济南军区总医院影像科。 对象：纳入2004-05/2005-05在解放军济南军区总医院医学影像科应用单球囊技术治疗的患者22例，累及椎体31个，男5例，女17例；年龄68~85岁。纳入对象均为疼痛性骨质疏松椎体压缩骨折；CT和MRI确定椎体后壁完整，脊髓无受压表现；均对治疗方案和实验知情同意。实验和治疗经医院伦理委员会批准。 方法:治疗采用冠龙公司的国产椎体后凸成形专用器械[批准文号：鲁药管械(准)字2004第2150017号]包括穿刺器械和可膨胀球囊。骨水泥为国产丙烯酸树脂骨水泥Ⅲ [批准文号：国食药监械（准）字2005第3650267号]。在X射线监测下,经双侧椎弓根穿刺伤椎,使用单球囊先后置入两侧,完成球囊扩张,改善椎体高度。 主要观察指标：①观察术中、术后骨水泥生物相容性。②观察术后72 h内疼痛缓解状况，椎体高度恢复和脊柱后凸畸形矫正情况。 结果：①骨水泥生物相容性：1例1个椎间隙发现少许骨水泥渗漏,但无临床症状，余椎体无明显骨水泥渗漏的X射线平片表现；未发现炎症和排斥反应。②疼痛缓解：22例患者术后72 h内疼痛均明显缓解。③椎体高度恢复和脊柱后凸畸形矫正情况：单球囊扩张并骨水泥填充矫正前伤椎椎体前缘和中部高度平均分别丢失（14.70±4.21）mm和（10.62±4.11）mm，矫正后平均分别丢失（10.38±4.23）mm和（6.45±4.04）mm。Cobb角由矫正前平均（21.15±6.33）°，矫正后为（11.64±4.33）°。 结论: 临床结果证实骨水泥与宿主生物相容性好，发生渗漏时无特殊宿主不良反应。应用单球囊扩张并骨水泥填充矫正老年骨质疏松脊柱压缩骨折，可有效恢复椎体高度，缓解疼痛。     

经皮椎体成形和经皮椎体后凸成形治疗国人胸腰椎压缩性骨折疗效及安全性的Meta分析★

背景：经皮椎体成形和经皮椎体后凸成形治疗胸腰椎压缩性骨折在国内外均积累了相当多的临床经验，但尚缺乏循证医学方面的依据。 目的：采用Meta分析评价经皮椎体成形和经皮椎体后凸成形治疗胸腰椎压缩性骨折的疗效以及安全性。 方法：搜集国内应用经皮椎体成形和经皮椎体后凸成形对比治疗胸腰椎压缩性骨折的文献，并追查已纳入文献的参考文献。由至少两位系统评价员做独立文献筛查、质量评价和资料提取，并交叉核对，不同意见请第三者裁决。使用统计软件RevMan 5.0完成Meta分析。 结果与结论：经筛选，最后纳入7篇文献进行Meta分析，包括受试患者398例，其基线情况一致，具有可比性。5篇文献的随访时间为6周，2篇为4周。结果提示，经皮椎体成形和经皮椎体后凸成形均是治疗国人胸腰椎压缩性骨折的有效方法，且在改善目测类比评分方面差异无显著性意义(P > 0.05)；在改善Cobb角及治疗后骨水泥渗漏发生率方面，经皮椎体后凸成形均优于经皮椎体成形(P < 0.001，P=0.05)。因纳入文献和样本量有限，建议进行大样本、长期随访的高质量临床试验，提供更佳循证证据。     

单侧穿刺经皮椎体注入骨水泥后凸成形治疗多椎体骨质疏松性压缩骨折

背景：经皮椎体成形和经皮椎体后凸成形是一种治疗骨质疏松症所致椎体压缩性骨折的新方法,目前已经在各大医院广泛开展,但是在临床上很多病例有多个椎体的骨折,采用经典的手术方法操作次数多,增加手术风险,射线暴露量大,医疗费用高。 目的：观察单侧穿刺经皮椎体后凸成形治疗老年多椎体骨质疏松压缩骨折的疗效。 方法：选择2007-06/2009-06巢湖市第一人民医院骨二科和皖南医学院附属弋矶山医院骨一科收治的多椎体骨质疏松压缩骨折患者12例(29椎),根据治疗前MRI信号改变判断疼痛性椎体并进行选择性单侧穿刺球囊扩张后凸成形的治疗。根据目测类比评分评价手术前后疼痛变化,观察治疗后症状改善、骨折复位情况及有无并发症发生。 结果与结论：12例穿刺均顺利完成,48 h内疼痛缓解,平均随访14个月。治疗后目测类比评分较治疗前降低(P < 0.01)。椎体前缘、中部、后缘平均高度治疗前低于治疗后,至末次随访椎体复位后前缘、中部、后缘平均高度未见明显丢失(P > 0.05)。治疗前穿刺侧与对侧椎体高度差距有显著性意义(P < 0.01),治疗后两侧差距无显著性意义(P > 0.05)。治疗前后同侧相比差异均有显著性意义(P < 0.01)。提示对多椎体压缩骨折采用选择性单侧穿刺后凸成形治疗,临床效果满意,能够缩短治疗时间、减少并发症、射线暴露和治疗费用,适于老年多椎体骨质疏松压缩骨折的治疗。 关键词：骨质疏松;脊柱;压缩骨折;后凸成形;骨水泥 doi:10.3969/j.issn.1673-8225.2010.25.025     

应用有限元对比分析椎体成形术中单侧入路退针法与双侧固定点注射骨水泥的生物力学变化

背景：要使椎体成形术单侧入路获得双侧入路的力学分布效果，需要改进单侧入路的穿刺路径及注射方法。在前期临床实践中作者设计了三维穿刺导向器，在其导引下穿刺到位理想，采用退针注射法注射骨水泥，使得骨水泥在椎体内分布更加合理，临床效果得到了提高，但是否在力学分布上与双侧相同？ 目的：应用有限元分析椎体成形过程中单侧入路退针法注射骨水泥的生物力学变化，并与双侧固定点注射骨水泥的方法对比。 方法：采用的原始影像来自一位男性患者，76岁，L1椎体骨质疏松性疼痛。患者伤椎采用单侧入路退针法注射实施椎体成形术，进针点选择左侧椎弓根近中心部位，内倾角度为24.5°，先将针穿刺到达椎体的前中1/3部位，注射骨水泥3 mL，然后缓慢向后退针至椎体的1/2部位，并停留3 min，注射2 mL，再退针到椎体的中后1/3部位注射1 mL。模拟双侧入路，每侧注入3 mL骨水泥，获取椎体L1~2节段断层图像，分别建立有限元模型，对椎体上表面分别依次施加载500，1 000， 1 500，2 000，2 500 N的轴向压缩负载，进行生物力学对比分析。 结果与结论：随着施加负载的增加，应变和应力也逐渐增加，椎体呈现弹性性质，出现了近似线性的小变形情况。双侧固定点和退针注射法注射骨水泥在轴向压缩不同负载下应力和应变差异无显著性意义(P > 0.05)。提示椎体成形过程中单侧入路退针注射法和双侧固定点注射骨水泥的生物力学分布无明显差异。     

骨水泥材料在经皮椎体成形中的应用

背景：1987年首次报道经皮椎体成形应用于临床,目前该技术已广泛应用于治疗老年骨质疏松椎体压缩性骨折以及椎体肿瘤并取得良效,但仍有一些问题需关注和探讨。 目的：对国内外骨水泥材料在经皮椎体成形中的临床应用进展进行综述,了解椎体成形的主要理论观点及存在的争议问题。 方法：应用计算机检索2008-01/2011-01 PubMed数据库相关文章,检索词为“vertebroplasty”,并限定文章语言种类为English。同时计算机检索2006-01/2011-01 CNKI数据库相关文章,检索词为“椎体成形”,并限定文章语言种类为中文。共检索到文献725篇,最终纳入符合标准的文献28篇。 结果与结论：经皮椎体成形应用于临床治疗老年骨质疏松椎体压缩性骨折以及椎体肿瘤取得良效,它既可以消除或缓解疼痛症状,又能够加固和强化椎体从而防止进一步塌陷。但如何选择病椎,单侧还是双侧穿刺,经皮椎体成形还是经皮椎体后凸成形,骨水泥的注入时机和注入量,如何避免穿刺损伤以及骨水泥的渗漏等仍需进一步研究。     

注射型磷酸钙人工骨椎体后凸成形固化治疗骨质疏松性胸腰椎压缩骨折

背景：椎体后凸成形目前常用的注射型聚甲基丙烯酸甲酯骨水泥椎体增强剂可达到增加椎体强度、稳定椎体、止痛的目的,但其组织相容性差,无生物降解性,容易造成使临近椎间盘或椎体发生变性、甚至骨折。 目的：观察注射型磷酸钙人工骨椎体后凸成形固化治疗骨质疏松性椎体压缩骨折的效果。 方法：选择2007-12/2010-06哈尔滨医科大学附属第四医院骨外科收治的骨质疏松性胸腰椎压缩性骨折患者20例,均采用经双侧椎弓根球囊扩张注射型磷酸钙人工骨行椎体后凸成形固化治疗。手术前后行疼痛目测类比评分,胸(腰)椎正侧位X射线片及椎体前缘高度、Cobb角检测。 结果与结论：术后病椎前缘椎体平均高度较术前平均高度恢复(3.38±1.44) mm (P < 0.05)。术后Cobb角较术前平均恢复(7.63±2.52)° (P < 0.05),后凸矫正率为(38.90±11.28)%。术后3d及3周目测类比评分均较术前明显降低(P < 0.01)。说明经双侧椎弓根球囊扩张注射型磷酸钙人工骨行椎体后凸成形可以有效增加椎体强度、稳定椎体、明显缓解患者疼痛,是治疗骨质疏松性胸腰椎压缩骨折的有效方法。     

单侧椎弓根外入路椎体后凸成形术治疗胸椎骨质疏松性椎体压缩骨折38例

目的:评价单侧椎弓根外入路经皮椎体后凸成形术（PKP）治疗胸椎骨质疏松性椎体压缩骨折(OVCFs)的临床效果。方法:2004年7月～2008年5月采用行单侧经椎弓根外穿刺入路PKP治疗胸椎骨质疏松性VCFs患者38例;年龄55-72岁,平均60.3岁。结合体检、MRI及X线片确定责任椎体,骨折部位为T4-T12。手术前后进行视觉模拟评分（VAS）以及X线片测定,观察患者疼痛、病椎高度的恢复以及后凸畸形的矫正情况。结果：38例患者均安全完成手术,平均骨水泥注入量为3.2±1.4ml,随访6-24个月,平均9.5个月。术后背痛明显缓解,36例（95%）VAS评分获明显改善;椎体中线高度矫正率为50.9%,冠状位X线未发现椎体侧方楔形变增加。有3例共5个椎体出现骨水泥渗漏,但均未出现临床症状。结论：经椎弓根外入路单侧椎体后凸成形术是治疗胸椎骨质疏松性VCFs安全有效的方法,可有效恢复椎体高度、迅速缓解疼痛,提高患者生活质量。     

Comparison of unilateral versus bilateral balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures

Thirty-one patients with osteoporotic vertebral compression fractures (OVCF) were treated with unilateral balloon kyphoplasty (BKP), and 31 patients were treated with bilateral BKP. The efficacy of unilateral and bilateral BKP was assessed by comparing operation time, X-ray exposure times, incidence of complications, vertebral height restoration, and improvement of the visual analogue scale (VAS) scores. The mean operative time and the exposure time to X-rays in the unilateral BKP group was less than that of the bilateral BKP group (p<0.05). No statistically significant differences were observed in the cement leakage rate, VAS score, or vertebral height restoration between the two groups (p>0.05). Unilateral and bilateral BKP are safe and effective treatments for OVCF. Compared with bilateral BKP, patients undergoing unilateral BKP have shorter operations and receive lower X-ray radiation doses.     

椎体成形穿刺注射骨水泥防止灾难性并发症：87例137个椎体资料分析

背景：椎体成形治疗老年骨质疏松椎体压缩性骨折效果确切,但一些热点问题仍无定论。 目的：探讨椎体成形技术治疗老年骨质疏松椎体压缩性骨折过程中穿刺损伤、骨水泥注射剂量、多椎体成形及骨水泥渗漏等问题的解决方案。 方法：回顾性分析经皮穿刺椎体成形技术治疗骨质疏松椎体压缩性骨折87例137个椎体。全部经单侧椎弓根穿刺,骨水泥稀薄期注射,骨水泥注射量为3~7.5 mL,胸椎3 mL以上,腰椎4.5 mL以上,平均4.8 mL,多椎体者均一次手术完成。 结果与结论：随访6~30个月,治疗后第2天和最终随访时患者目测类比疼痛评分及Oswestry功能障碍指数评分均显著低于治疗前(P < 0.01)。所有患者胸腰背疼痛明显缓解,其中58例疼痛完全消失;1例术中出现骨水泥单体中毒症状,28例出现不同程度骨水泥渗漏,但未出现临床症状。137个椎体中骨水泥渗透达到和超过中线119个,占87.2%。提示椎体成形技术是治疗老年骨质疏松椎体压缩性骨折的有效方法。骨水泥稀薄期注射能够获得良好的渗透效果;在局麻药限量范围内,一次可完成3个以上椎体成形;严格正规的操作技术是预防骨水泥渗漏灾难性并发症最重要的方法。     

The Role of Bone Cement Augmentation in the Treatment of Chronic Symptomatic Osteoporotic Compression Fracture

Objective

Bone cement augmentation procedures such as percutaneous vertebroplasty and balloon kyphoplasty have been shown to be effective treatment for acute or subacute osteoporotic vertebral compression fractures. The purpose of this study was to determine the efficacy of bone cement augmentation procedures for long standing osteoporotic vertebral compression fracture with late vertebral collapse and persistent back pain.

Methods

Among 278 single level osteoporotic vertebral compression fractures that were treated by vertebral augmentation procedures at our institute, 18 consecutive patients were included in this study. Study inclusion was limited to initially, minimal compression fractures, but showing a poor prognosis due to late vertebral collapse, intravertebral vacuum clefts and continuous back pain despite conservative treatment for more than one year. The subjects included three men and 15 women. The mean age was 70.7 with a range from 64 to 85 years of age. After postural reduction for two days, bone cement augmentation procedures following intraoperative pressure reduction were performed. Imaging and clinical findings, including the level of the vertebra involved, vertebral height restoration, injected cement volume, local kyphosis, clinical outcome and complications were analyzed.

Results

The mean follow-up period after bone cement augmentation procedures was 14.3 months (range 12-27 months). The mean injected cement volume was 4.1 mL (range 2.4-5.9 mL). The unipedicular approach was possible in 15 patients. The mean pain score (visual analogue scale) prior to surgery was 7.1, which decreased to 3.1 at 7 days after the procedure. The pain relief was maintained at the final follow up. The kyphotic angle improved significantly from 21.2 ± 4.9° before surgery to 10.4 ± 3.8° after surgery. The fraction of vertebral height increased from 30% to 60% after bone cement augmentation, and the restored vertebral height was maintained at the final follow up. There were no serious complications related to cement leakage.

Conclusion

In the management of even long-standing osteoporotic vertebral compression fracture for over one year, bone cement augmentation procedures following postural reduction were considered safe and effective treatment in cases of non-healing evidence.     

Segmental Deformity Correction after Balloon Kyphoplasty in the Osteoporotic Vertebral Compression Fracture

Objective

Balloon kyphoplasty can effectively relieve the symptomatic pain and correct the segmental deformity of osteoporotic vertebral compression fractures. While many articles have reported on the effectiveness of the procedure, there has not been any research on the factors affecting the deformity correction. Here, we evaluated both the relationship between postoperative pain relief and restoration of the vertebral height, and segmental kyphosis, as well as the various factors affecting segmental deformity correction after balloon kyphoplasty.

Methods

Between January 2004 and December 2006, 137 patients (158 vertebral levels) underwent balloon kyphoplasty. We analyzed various factors such as the age and sex of the patient, preoperative compression ratio, kyphotic angle of compressed segment, injected PMMA volume, configuration of compression, preoperative bone mineral density (BMD) score, time interval between onset of symptom and the procedure, visual analogue scale (VAS) score for pain rating and surgery-related complications.

Results

The mean postoperative VAS score improvement was 4.93±0.17. The mean postoperative height restoration rate was 17.8±1.57% and the kyphotic angle reduction was 1.94±0.38°. However, there were no significant statistical correlations among VAS score improvement, height restoration rate, and kyphotic angle reduction. Among the various factors, the configuration of the compressed vertebral body (p=0.002) was related to the height restoration rate and the direction of the compression (p=0.006) was related with the kyphotic angle reduction. The preoperative compression ratio (p=0.023, p=0.006) and injected PMMA volume (p<0.001, p=0.035) affected both the height restoration and kyphotic angle reduction. Only the preoperative compression ratio was found to be as an independent affecting factor (95% CI : 1.064-5.068).

Conclusion

The two major benefits of balloon kyphoplasty are immediate pain relief and local deformity correction, but segmental deformity correction achieved by balloon kyphoplasty does not result in additional pain relief. Among the factors that were shown to affect the segmental deformity correction, configuration of the compressed vertebral body, direction of the most compressed area, and preoperative compression ratio were not modifiable. However, careful preoperative consideration about the modifiable factor, the PMMA volume to inject, may contribute to the dynamic correction of the segmental deformity.     

Comparison of unilateral and bilateral puncture percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fractures

Objectives:To compare the clinical efficacy of unilateral and bilateral puncture PKP in the treatment of OVCFs and explored whether there is a difference in the efficacy of unilateral and bilateral puncture PKP after surgery.Methods:A total of 98 patients with OVCFs treated by PKP from August 2016 to June 2018 were selected. There were 62 cases in the unilateral puncture group and 36 cases in the bilateral puncture group. The operation time, the amount of bone cement injection, the height of the anterior edge of the vertebral body and the visual analog scale (Visual Analog Scale, VAS) scores before and after the operation were analyzed, and whether the differences between the 2 groups were statistically significant was analyzed.Results:All patients were followed up completely. The operation time and the number of X-ray fluoroscopies of the unilateral puncture group were significantly reduced compared to those of the bilateral group, and the difference was statistically significant (p<0.05). In terms of the bone cement injection volume, the average injection volume of the bilateral group was greater than that of the unilateral group, and the difference was statistically significant (p<0.05); the postoperative VAS scores of the 2 groups of patients were significantly improved, and the difference was statistically significant compared with that before surgery (p<0.05) but that of the unilateral group was not statistically significant compared with that of the bilateral group (p>0.05). The height of the anterior edge of the vertebral body in both groups was significantly improved compared with that before the operation, and the difference was statistically significant (p<0.05).Conclusion:Unilateral and bilateral puncture PKP can achieve good clinical efficacy in the treatment of osteoporotic vertebral compression fractures, but unilateral PKP has the advantages of short operation time and low X-ray exposure.

Osteoporosis (OP) is caused by a decrease in bone mass for a variety of reasons, especially a decrease in the amount of cancellous bone in the vertebral body and damage to the microstructure of bone tissue, bone mineral composition and bone matrix per unit volume. Osteoporosis is one of the diseases with high morbidity and mortality in the world and has become an important disease that endangers the health of middle-aged and elderly people.¹ Osteoporotic vertebral compression fractures (OVCFs) are one of the major complications of osteoporosis, which often cause stubborn waist and back aches. Severe thoracolumbar osteoporotic vertebral body compression fractures may lead to cardiopulmonary and other multisystem dysfunctions, seriously affecting the patient’s quality of life.²For the treatment of OVCFs, the current recommendations are conservative treatment and surgical treatment. Conservative treatment may cause various complications due to long-term bed rest, including bedsores, delayed fracture healing, deformity healing or nonunion, respiratory and urinary tract infections, and lower extremity venous thrombosis, which can threaten the life of the patient.^3,4 Therefore, patients with OVCFs who have early out-of-bed activity requirements and surgical indications are more likely to undergo surgical treatment.The traditional surgical treatment for OVCFs is posterior laminectomy and decompression pedicle screw internal fixation, but due to the higher degree of osteoporosis in older patients, the long-term screw internal fixation effect is poor, and surgical trauma has a greater impact on patients; thus, the long-term efficacy is not ideal.⁵ In recent years, with the improvement of minimally invasive spine technology, percutaneous vertebralplasty (PVP) and percutaneous balloon dilatation kyphoplasty (Percutaneous kyphoplasty, PKP) have achieved satisfactory results in the treatment of OVCF. Compared with PVP, PKP uses a balloon or other expansion system to expand the compressed vertebral body to form a relatively low-pressure vertebral body space, followed by low-pressure injection of bone cement, which can better correct kyphosis and reduce the penetration of bone cement leakage.^6,7The PKP surgical puncture consists of a bilateral pedicle approach or a unilateral pedicle approach. While the advantages of the transdermal bilateral pedicle approach include better diffusion of bone cement and reduced risk of puncture, there are shortcomings, such as long operation time, large radiation exposure and high hospitalization costs.⁸ At present, there is no unified conclusion as to which PKP approach is better for use to treat OVCFs. Therefore, it is of great clinical significance to clarify the difference between unilateral and bilateral PKP in the treatment of OVCFs.The OVCFs are one of the common diseases that cause lumbago and kyphosis in the elderly. At present, PKP is one of the common methods for the treatment of OVCFs. Bilateral puncture of the pedicle approach is the classic operation method of PKP, but some scholars believe that unilateral puncture bone cement injection can achieve the same surgical effect. This record-based case–control study retrospectively analyzed patients with OVCFs treated in our hospital from August 2016 to June 2018, performed an in-depth analysis and comparison of the unilateral and bilateral PKP treatment of OVCFs, and provided a reference for the clinical approach to PKP treatment of OVCFs.     

Osteoporotic burst fracture with spinal canal compromise treated with percutaneous vertebroplasty

Objective

There has been minimal literature reporting on results of osteoporotic burst fracture with spinal canal compromise treated with percutaneous vertebroplasty. Vertebroplasty for treatment of osteoporotic burst fracture is controversial. We want to clarify whether the osteoporotic burst fracture with spinal canal compromise is a contraindication to percutaneous vertebroplasty. To compare the clinical and radiological results between osteoporotic burst and compression fractures treated with percutaneous vertebroplasty.

Patients and methods

From 2005 through 2006, 23 osteoporotic burst fracture patients with asymptomatic spinal canal compromise and 41 osteoporotic compression fracture patients underwent percutaneous vertebroplasty. Pre- and post-operative pain scores, functional and radiographic results and complications were analyzed.

Results

The average canal compromise in study group was 15% (5–49%). The mean post-operative Oswestry Disability Index (ODI), Visual Analogue Score (VAS), kyphotic angle, vertebral body height measurement from the anterior, central and posterior part of the body are all significantly improved in both the study and control groups when compared to pre-operative data. However, there was no significant difference between study and control groups in pre- and post-operative ODI, VAS, kyphotic angle and improvement of body height. There were no significant differences (P = 0.3797) in cement leakage rate between burst and compression groups (47.8% vs 36.6%). All the leakages were minor and without neurological deficit. The percentage of adjacent fractures in both groups also had no significant differences (39.1% in burst and 41.5% in compression group).

Conclusions

Osteoporotic burst fracture with asymptomatic spinal canal compromise is not a contraindication for percutaneous vertebroplasty. This procedure is suitable for both osteoporotic burst and compression fracture with careful surgical technique.     

Post-traumatic osteoporotic vertebral osteonecrosis treated using balloon kyphoplasty

Nineteen patients with post-traumatic osteoporotic vertebral osteonecrosis were treated using percutaneous balloon kyphoplasty. The anterior and middle vertebral heights, as well as the kyphotic angle, were measured using a standing lateral radiograph before surgery, 2 days after surgery and at the final follow-up. At the same time points, a visual analog scale and the Oswestry Disability Index were used to evaluate pain status and functional activity, respectively. The mean follow-up was 24.7 months (range: 7-36 months). Statistically significant improvements were observed between the preoperative and postoperative assessments for each evaluated measure (p < 0.05). There were no statistically significant differences between the postoperative and final follow-up assessments (p > 0.05). Asymptomatic cement leakage into the intervertebral disc occurred in three patients. This study suggests that balloon kyphoplasty is a safe and effective procedure for treating this disease entity.