椎体后凸成形与椎体成形修复重建胸腰压缩性骨折患者脊柱稳定性的系统评价和Meta分析

目的：利用Meta分析方法对国内应用椎体后凸成形与椎体成形修复重建胸腰压缩性骨折的对照试验进行荟萃分析，从而在较大样本量的前提下评价并比较两种方法修复胸腰压缩性骨折的有效性和安全性。 方法：收集中国期刊全文数据库(1998/2008)、中国生物医学数据库及维普期刊网关于椎体后凸成形术与椎体成形术治疗胸腰压缩性骨折的对照文献，对结果进行Meta分析。其中，试验组行椎体后凸成形术，对照组行椎体成形术。疗效及差异评价指标以比值比、加权均数差和95%可信区间(CI)表示。统计学分析采用Review Manager4.2软件。 结果：共收集国内8个随机对照研究，Meta分析结果显示，2组病例术后目测类比疼痛评分均降低，但差异无显著性意义[比值比为-0.07，95%CI(-0.35，-0.49)，P=0.75]。2组病例手术前后Cobb角均下降，但试验组较对照组下降更明显 [比值比为-8.60，95%CI(-13.36，-3.83)，P=0.0004]。2组病例手术前后椎体前缘平均高度恢复率均升高, 但试验组较对照组升高更明显[比值比为25.08，95% CI(9.30，40.87)，P=0.002)。2组病例手术前后椎体压缩率均降低，但试验组降低更明显[比值比为-12.04，95%CI(-17.03，-7.04)，P < 0.000 01]。 结论：与椎体成形术相比，椎体后凸成形术修复重建胸腰压缩性骨折能够更好地缩小Cobb角，降低椎体压缩率，同时椎体前缘平均高度得以更好的恢复，但两者在缓解术后疼痛方面无明显差异。     

经皮椎体后凸成形术治疗严重骨质疏松性椎体压缩性骨折

目的 探讨经皮椎体后凸成形术治疗严重骨质疏松性椎体压缩性骨折的疗效。方法 2014年1月至2015年1月应用经皮椎体后凸成形术治疗严重骨质疏松性椎体压缩性骨折42例,分析手术前后Cobb's角、疼痛视觉模拟量表（VAS）评分、Oswestry功能障碍指数及骨折椎体高度变化。结果 术后椎体三柱高度显著大于术前（P<0.05）,而术后Cobb's角、VAS评分、Oswestry功能障碍指数均显著低于术前（P<0.05）。结论 经皮椎体后凸成形术治疗严重骨质疏松性椎体压缩性骨折,可以明显改善患者疼痛症状,恢复椎体高度,矫正后凸角度,有着较好的疗效。     

球囊扩张椎体后凸成形术治疗椎体压缩性骨折

随着人口的老龄化,骨质疏松症的发生率日渐增加。椎体压缩性骨折是骨质疏松症的主要并发症之一,由此引起难以忍受的背痛病例也呈上升趋势。服用药物、佩戴支具等姑息治疗效果不确切,且长期卧床会导致骨质进一步丢失,形成恶性循环;传统外科手术治疗创伤大,老年患者往往难以接受。1984年Galibert首先采用X线透视下,经皮穿刺椎体内注射骨水泥治疗侵袭性血管瘤取得满意效果。1994年Reiley在此基础上设计了通过球囊扩张来纠正后凸畸形的技术,     

椎体后凸成形后相邻椎体生物力学的有限元分析

背景：椎体后凸成形后相邻椎体新发骨折的发生率为2.4%~23%,并且6个月内2/3骨折发生于邻近椎体,其原因是骨质疏松的发展,还是骨水泥强化的结果,目前存有争论。 目的: 应用脊柱有限元分析方法分析生理载荷作用下,椎体后凸成形后相邻椎体终板的应力变化与相邻椎体新发骨折的相关性。 方法: 收集老年骨质疏松女性胸腰椎CT扫描资料,利用一系列计算机辅助设计软件构造相对应的T12-L1-L2骨质疏松性椎体的三维有限元模型。模拟L1椎体为楔形压缩骨折椎体(前缘高度较正常降低60%),模拟经皮椎体后凸成形模型,复位骨折椎体(L1椎体高度较正常降低10%,代表骨折椎体复位),在L1椎体内置入2个对称的圆柱体PMMA骨水泥块共约4 mL。分析轴向压缩、前屈和后伸3种加载状态下正常椎体、手术前后相邻椎体的应力变化情况。 结果与结论:与正常椎体比较,L1压缩性骨折模型和椎体后凸成形后模型相邻椎体终板最大应力值分别增高76%和27%;椎体后凸成形模型后部结构的应力水平较正常椎体平均增加13.2%,其中椎弓根增加4.5%,峡部增加6.15%和关节点增加25.6%。与 L1椎体压缩性骨折模型相比,L1椎体后凸成形后椎弓根、峡部和关节突应力均有所降低。结果说明椎体后凸成形后,T12椎体下位终板和L2椎体上位终板的应力值在各种状态下均较正常椎体增加,应力增加可能导致终板骨折可能性增加,进而导致相邻椎体骨折的风险性增加,这一观点尚需进一步研究的支持。     

单侧与双侧入路脊柱行后凸成形治疗骨质疏松性椎体压缩骨折的Meta分析

背景：椎体后凸成形明显改善了骨质疏松性椎体压缩骨折的治疗过程,但临床上对于单侧入路还是双侧入路还存在一定争议。 目的：对比单侧与双侧入路脊柱后凸成形治疗骨质疏松性椎体压缩骨折的疗效。 方法：全面收集椎体单侧与双侧入路脊柱后凸成形治疗骨质疏松性椎体压缩骨折的随机对照研究,由两个研究者独立评价文献,并采集数据,在严格文献质量评价的基础上,进行Meta系统评价。 结果与结论：共纳入5篇文献,241例患者。在止痛及骨水泥渗漏方面,两种脊柱入路差异无显著性意义(P=0.99,P=0.56);在改善后凸角度方面,双侧入路优于单侧入路(P=0.05);在手术时间方面,单侧入路优于双侧入路(P < 0.000 01)。表明单侧入路与双侧入路均能明显减轻疼痛,二者差异无显著性意义;二者骨水泥渗漏率差异无显著性意义;双侧入路可更好地改善脊柱后凸角度,但手术时间较长;鉴于纳入的文献质量不高,结论尚需更多设计严谨的随机对照研究加以证实。     

经皮椎体成形术治疗椎体压缩性骨折与血管瘤

目的总结经皮椎体成形术治疗疼痛性椎体压缩性骨折和症状性椎体血管瘤的临床经验,评估其治疗疗效。方法回顾性分析35例疼痛性椎体压缩性骨折和7例症状性椎体血管瘤的椎体成形术治疗,其中腰椎30例,胸椎10例,颈椎2例,40例采用单侧或双侧椎弓根入路,2例颈椎血管瘤采用颈椎前外侧入路。注射13%～20%的骨水泥,使骨水泥在椎体内分布、铸形。结果42例治疗都获得成功,注射骨水泥0.5～7mL。42例随访3～15个月,33例患者术后3个月疼痛完全缓解,7例明显缓解,2例有所缓解。42例疼痛评分和自理生活能力评分术后均显著下降(P<0.01)。无复发迹象。结论采用经皮椎体成形术治疗疼痛性椎体压缩性骨折及症状性椎体血管瘤是一种微创、安全、有效的治疗手段。     

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。     

经椎弓根椎体楔形截骨治疗胸腰椎陈旧性骨折伴后凸畸形23例

背景：迟发性创伤后胸腰椎后凸畸形常引起下腰痛及椎管骨性压迫。为了消除疼痛及改善神经功能,常需手术治疗,其目标是矫正畸形,稳定脊柱。但究竟采取何种手术入路仍存在争论。 目的：观察经椎弓根椎体楔形截骨治疗胸腰椎陈旧性骨折伴后凸畸形的疗效。 方法：回顾性分析2004-01/2006-12南华大学附属第一医院脊柱外科收治的胸腰椎陈旧性骨折并后凸畸形患者23例,男14例,女9例;年龄18~60岁,平均36岁;术前腰椎功能损伤程度按照JOA评分标准评定为(11.02±1.24)分,胸腰段后凸畸形Cobb角为(37.43±3.76)°。23例患者均采用经椎弓根椎体截骨、椎管减压及重建矢状面矫形方法,比较截骨前后腰椎功能恢复、骨愈合情况及有无并发症发生。 结果与结论：23例患者均获得随访,随访时间6~28个月,平均12.5个月。术后腰椎功能及后凸畸形均有明显改善,末次随访JOA评分为(14.04±2.12)分,Cobb角为(11.02±3.58)°,与术前相比差异均有显著性意义(P < 0.05)。截骨面均于术后6个月骨性愈合,无假关节形成及矫正丢失等并发症。提示经椎弓根椎体楔形截骨可获得满意的后凸畸形矫正和神经减压,可促使腰椎功能恢复。     

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     

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。     

A meta-analysis of balloon kyphoplasty compared to percutaneous vertebroplasty for treating osteoporotic vertebral compression fractures

A meta-analysis was conducted to assess the safety and efficacy of balloon kyphoplasty (KP) compared to percutaneous vertebroplasty (VP) in the treatment of osteoporotic vertebral compression fractures (OVCF). Ten studies, encompassing 783 patients, met the inclusion criteria. Overall, the results of the meta-analysis indicated that there were significant differences between the two groups in the long-term kyphosis angle (mean difference [MD] = –2.64, 95% confidence interval [CI] = –4.66 to –0.61; p = 0.01), the anterior height of the vertebral body (MD = 3.67, 95% CI = 1.40 to 5.94; p = 0.002), and the cement leakage rates (risk ratio [RR] = 0.70, 95% CI = 0.52 to 0.95; p = 0.02). However, there were no significant differences in the short-term visual analog scale (VAS) scores (MD = –0.57, 95% CI –1.33 to 0.20; p = 0.15), the long-term VAS scores (MD = –0.99, 95% CI = –2.29 to 0.31; p = 0.14), the short-term Oswestry Disability Index (ODI) scores (MD = –6.54, 95% CI = –14.57 to 1.48; p = 0.11), the long-term ODI scores (MD = –2.01, 95% CI = –11.75 to 7.73; p = 0.69), the operation time (MD = 4.47, 95% CI = –0.22 to 9.17; p = 0.06), the short-term kyphosis angle (MD = –2.25, 95% CI = –5.14 to 0.65; p = 0.13), or the adjacent-level fracture rates (RR = 1.52, 95% CI = 0.76 to 3.03; p = 0.24). This meta-analysis demonstrates that KP and VP are both safe and effective surgical procedures for treating OVCF. Compared with VP, KP can significantly relieve a long-term kyphosis angle, improve the height of the vertebral body, and reduce the incidence of bone cement leakage. However, because of the limitations of this meta-analysis, a large randomized controlled trial is required to confirm our findings.     

Percutaneous vertebroplasty: an emerging therapy for vertebral compression fractures

Osteoporosis is a debilitating disease that occurs in epidemic proportions in Western societies and has a large economic impact. Percutaneous vertebroplasty is successful in alleviating subacute and chronic pain caused by osteoporotic compression fractures and pathological vertebral fractures from tumor infiltration. The technique is safe and can be performed on an outpatient basis utilizing high-resolution fluoroscopy.     

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.     

Current status of percutaneous vertebral augmentation techniques for vertebral compression fractures

Vertebral compression fracture (VCF) is a common and debilitating problem that occurs in patients with osteoporosis and osteolytic tumors. Standard conservative management with narcotic analgesics, bracing, and immobilization is often ineffective, and major reconstructive surgery is poorly tolerated by this frail patient population. The limitations of conventional treatments stimulated the development of minimally invasive, percutaneous vertebral augmentation techniques, including vertebroplasty and kyphoplasty, which have become established as safe and effective treatments for VCF. This report reviews the current status of vertebroplasty and kyphoplasty in the management of acute VCF.