经皮椎体强化术治疗骨质疏松性椎体压缩性骨折

目的探讨经皮椎体强化术（Percutaneous vertebral augmentation,PVA）治疗骨质疏松性椎体压缩性骨折的临床效果。方法对我院2004年4月至2008年1月间全部共48例应用经皮椎体强化术治疗骨质疏松性胸鹿椎压缩性骨折的临床资料进行回顾性分析。结果所有病例疼痛均得到明显缓解,无一例发生重大并发症。其中7例邻近椎体再发骨折,3例反复行3次手术。结论经皮椎体强化术是治疗骨质疏松性胸腰椎压缩性骨折的一种有效、安全和微创的方法。     

骨水泥椎体强化与保守治疗骨质疏松椎体压缩性骨折再骨折风险的Meta分析

目的 :对目前已发表的关于骨水泥椎体强化[包括经皮椎体成形术(PVP)和椎体后凸成形术(PKP)]与保守治疗骨质疏松椎体压缩性骨折(OVCF)的随机对照试验进行系统性评价,探讨椎体强化术后再发椎体骨折风险,为临床医疗和科研提供统计学依据。方法:通过计算机全面检索PubMed、Web of Science、Cochrane图书馆、EMBASE数据库,收集由建库至2018年4月发表的关于骨水泥椎体强化与保守治疗OVCF安全性和再发骨折的临床随机对照研究(randomized controlled trials,RCT)文献;遵循Cochrane协作网系统评价方法价纳入文献质量和可靠性,提取患者骨折椎体数、骨折平面、椎体压缩程度、骨密度以及再发椎体骨折相关数据;通过Review man 5.3软件行Meta分析,采用固定效应模型或随机效应模型合并数据,计算相对危险度(relative risk,RR)/标准化均数差(standardized mean difference,SMD)值和95%可信区间(confidence interval,CI),采用漏斗图对发表偏倚进行评估。结果:共纳入9篇文献,样本总量为853例,其中437例行椎体强化手术,416例接受保守治疗。2篇为高质量文献,5篇为中等质量文献,2篇为低质量文献。Meta分析结果显示:与保守治疗相比,骨水泥椎体强化术后患者再发椎体骨折的发生率[RR=1.13,95%CI(0.85,1.49),P=0.41]及相邻椎体再骨折发生率[RR=0.93,95%CI(0.48,1.82),P=0.84]均无统计学差异(P0.05)。结论:骨水泥椎体强化术是治疗OVCF的有效方法,不会增加再发椎体骨折的风险,再发椎体骨折可能同骨质疏松症的自然进程相关。     

超高龄骨质疏松性胸腰椎压缩骨折经皮椎体成形术术后邻椎再骨折的危险因素分析

目的 ：分析超高龄骨质疏松性椎体压缩骨折（osteoporosis vertebral compression fractures,OVCFs）经皮椎体成形术（percutaneous vertebroplasty,PVP）术后邻近椎体再骨折的危险因素。方法：对2012年6月至2019年6月采用PVP治疗的40例超高龄（年龄≥90岁）OVCFs患者进行回顾性分析,其中男7例,女33例;年龄90～101(94.6±1.6)岁。根据是否发生邻近椎体再骨折进行分组,其中20例患者PVP术后发生再骨折（再骨折组）,20例术后没有发生邻近椎体再骨折（对照组）。统计两组患者的一般资料、影像学数据、骨盆参数,项目包括年龄,性别,体质量指数（body mass index,BMI）,骨折部位,骨密度（bone mineral density,BMD）T值,骨折至手术时间,伤椎压缩程度,伤椎前缘恢复程度,骨水泥注入量,骨水泥是否渗漏,骨盆指数（pelvic index,PI）,骨盆倾斜角（pelvic tilt angle,PT）,骶骨角（sacral angle,SS）等。将可能与再骨折相关的因素纳入...     

骨水泥在骨质疏松性骨折椎体内分布状态与生物力学性能的关系

 目的 研究骨水泥在腰椎骨质疏松性骨折椎体内不同区域分布状态的生物力学特性,为经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)临床应用提供理论依据。方法 取12具福尔马林固定的老年尸体腰椎标本(包括L1~L5),共筛选49个椎体。对各椎体标本施加轴向压力负载,测量各椎体的原始强度和刚度,并建立椎体压缩骨折模型。按临床PKP手术操作要求根据不同的椎体分区灌注骨水泥,分为对照组和6个实验组,每组7个椎体。测量每组的最大压缩强度和刚度。结果 PKP术后各实验组最大压缩强度较初始强度均明显增强。单侧前2/3灌注组和单侧后2/3灌注组比较,单侧全灌注组、双侧前2/3灌注组和双侧后2/3灌注组比较差异均无统计学意义;椎体最大压缩强度双侧全灌注组>单侧全灌注组、双侧前2/3灌注组和双侧后2/3灌注组>单侧前2/3灌注组和单侧后2/3灌注组。PKP术后双侧全灌注组椎体刚度和初始刚度比较差异无统计学意义,其余各组度均明显小于初始刚度。单侧前2/3灌注组、单侧后2/3灌注组和单侧全灌注组比较,D和双侧后2/3灌注组比较差异无统计学意义;双侧全灌注组>双侧前2/3灌注组和双侧后2/3灌注组> 单侧前2/3灌注组、单侧后2/3灌注组和单侧全灌注组。结论 骨水泥分布在骨质疏松性骨折椎体的不同区域,其生物力学性能存在差异,骨水泥在椎体双侧分布较单侧分布可以获得更好的生物力学效应。骨水泥均匀分布于椎体前2/3区域是较为理想的分布状态,但仍需临床进一步验证。     

The relationship between vertebral body deformity and disc degeneration in lumbar spine of the senile

This study provides an investigation of the relationship between vertebral deformities and disc degeneration in patients with senile osteoporosis using biomechanical and medical imaging methods. The finite element analysis showed that stress concentration in the central area of the vertebral body is much decreased with disc degeneration, indicating that load transmission has been altered. Radiography and MRI suggested that vertebral deformities are related to the height and degeneration of the disc just below this vertebral body. When a disc has decreased height or degeneration, the vertebral body just above it is less likely to be deformed for patients with spinal osteoporosis. Received: 22 February 1997 Revised: 26 July 1997 Accepted: 1 August 1997     

Vertebral dimensions as risk factor of vertebral fracture in osteoporotic patients: a systematic literature review

Summary This systematic literature review studied the potential association between vertebral fracture risk and vertebral dimensions. Analysis showed that patients with vertebral fractures have smaller non-fractured vertebrae than patients without fractures. Vertebral size is an independent risk factor of vertebral fractures. Introduction Biomechanical factors such as vertebral dimensions may be a risk factor for vertebral fractures beside bone mineral density (BMD). The objective of this study was to evaluate potential association of vertebral size and shape with osteoporotic fracture risk through a systematic literature review. Methods Systematic analysis of published reports comparing vertebral dimensions of patients with and without osteoporotic fractures was performed. Data sources were electronic databases. Data extraction included methods, site, reproducibility and results of vertebral measurement, study population characteristics. It was noted if populations were matched or data were adjusted for age, height, weight and BMD. Results Of 634 reports identified by the literature search, the final review included 13 reports studying 4,428 women and 508 men; median age 64.2 years [range 51.7%–73.0%]. Measurements were performed with computed tomography scan, X-ray, or dual energy X-ray absorptiometry. Vertebral body height, width, depth, area, cross-sectional area (CSA), and volume were 5.5% to 9.5% smaller in fractured group than control group. After adjustment for confounding factors, area, CSA and volume were, respectively, 10.2% [range 7.1%–13.3%], 7.7% [range 1.2%–14.2%] and 9.5% [8.5%–10.5%] smaller in fractured group. Conclusions Vertebral size should be considered as a potential independent vertebral fracture risk factor.     

椎体强化术后夹心椎体骨折的相关因素分析

目的 探讨椎体强化术后夹心椎体骨折的相关因素.方法 2006年1月至2010年10月行经皮椎体成形术或经皮椎体后凸成形术治疗且资料随访完整的患者有449例,对其中存在夹心椎现象的41例(41节)骨质疏松性椎体压缩骨折患者的临床资料进行回顾性分析,男9例,女32例;年龄54 ～85岁,平均71.1岁.根据症状、体格检查及影像学资料判断夹心椎是否骨折;以夹心椎是否骨折作为二分类因变量,选取性别、年龄、身高、体质量、体质量指数、夹心椎是否位于胸腰段、累计手术椎体节段数、夹心椎两侧强化椎体骨水泥注射入路(单侧或双侧椎弓根)、手术方式、骨水泥注射量、骨水泥椎间盘渗漏及术前、术后夹心椎局部后凸角等作为自变量进行统计学分析.结果 41例患者术后获9～44个月(平均21.6个月)随访.41例(41节)夹心椎中,9例(9节)夹心椎发生骨折.手术前、后夹心椎局部后凸角骨折组非骨折组比较差异有统计学意义(P＜0.05);进一步分析结果显示仅术前夹心椎局部后凸角是夹心椎骨折的危险因素(P=0.024).结论 术前脊柱后凸畸形严重程度对椎体骨水泥强化术后邻近椎体骨折有影响,后凸畸形越严重,骨折风险越高.     

Kyphoplasty for osteoporotic vertebral fractures with posterior wall injury

Background Context

Cement augmentation techniques are standard treatments for osteoporotic vertebral fractures. Compared with vertebroplasty, kyphoplasty is associated with lower rates of cement leak and better deformity correction; however, posterior wall fractures are relative, but not absolute; contraindications for both techniques and hence treatment practices vary among spine centers.

Load shift of the intervertebral disc after a vertebroplasty: a finite-element study

Infiltrating osteoporotic cancellous bone with bone cement (vertebroplasty) is a novel surgical procedure to stabilize and prevent osteoporotic vertebral fractures. Short-term clinical and biomechanical results are encouraging; however, so far no reports on long-term results have been published. Our clinical observations suggest that vertebroplasty may induce subsequent fractures in the vertebrae adjacent to the ones augmented. At this point, there is only a limited understanding of what causes these fractures. We have previously hypothesized that adjacent fractures may result from a shift in stiffness and load following rigid augmentation. The purpose of this study is to determine the load shift in a lumbar motion segment following vertebroplasty. A finite-element (FE) model of a lumbar motion segment (L4-L5) was used to quantify and compare the pre- and post-augmentation stiffness and loading (load shift) of the intervertebral (IV) disc adjacent to the augmented vertebra in response to quasi-static compression. The results showed that the rigid cement augmentation underneath the endplates acted as an upright pillar that severely reduced the inward bulge of the endplates of the augmented vertebra. The bulge of the augmented endplate was reduced to 7% of its value before the augmentation, resulting in a stiffening of the IV joint by approximately 17%, and of the whole motion segment by approximately 11%. The IV pressure accordingly increased by approximately 19%, and the inward bulge of the endplate adjacent to the one augmented (L4 inferior) increased considerably, by approximately 17%. This increase of up to 17% in the inward bulge of the endplate adjacent to the one augmented may be the cause of the adjacent fractures.     

Recompression of vertebral body after balloon kyphoplasty for osteoporotic vertebral compression fracture

The purpose of this retrospective clinical study was to evaluate the factors that affect recompression of operated vertebrae after percutaneous balloon kyphoplasty (PKP) for osteoporotic vertebral compression fractures (VCFs) and assess their clinical importance. PKP has been used for VCFs with satisfactory results. Several studies about subsequent VCFs adjacent to cemented vertebrae have been reported after PKP. However, the presence and significance of recompression of operated vertebrae have not been adequately described. In total, 80 patients treated with PKP for single thoracolumbar VCFs were reviewed. The follow-up period was at least 1 year. Patients were divided into those without recompression (maintained group, n = 70) and those with recompression (recompressed group, n = 10). Plain roentgenography (preoperative, operative, and last), preoperative BMD, and preoperative MRI were checked. Age, gender, T-score in BMD, duration of symptom, compression rate (CR) of VCF, reduction rate, kyphotic angle (KA), reduction angle, intervertebral cleft (IVC), and non-PMMA-endplate-contact (NPEC) were evaluated. To evaluate the clinical results, we checked the VAS score at each follow-up period. All data were analyzed statistically. The CR for the recompressed group increased significantly after surgery and decreased at the last follow-up (p < 0.05). The last CR was not significantly different from the preoperative CR. The KA showed the same pattern. The preoperative, postoperative, and last VAS scores were significantly different from one another in both groups (p < 0.05). Between the groups, preoperative KA, postoperative KA, last KA, IVC, and NPEC were significantly different (p < 0.05). In particular, last KA, IVC, and NPEC showed highly significant differences (p < 0.001). In a correlation test for the evaluated factors, IVC (r = 0.557) and NPEC (r = 0.496) were the most significant. The presence of IVC and NPEC may play an important role in inducing recompression of treated vertebrae after PKP. Careful observation of patients with these conditions is necessary to prevent deterioration of their clinical course.     

Thoracal flat back is a risk factor for lumbar disc degeneration after scoliosis surgery

Background contextLumbar segments below fused scoliotic spines are thought to be exposed to extraordinary stress. Although positive sagittal imbalance has come into focus, reports about factors influencing the outcome of these segments remain inconclusive.PurposeOur study aimed at identifying spinal risk factors for the development of lumbar degenerative disc disease (DDD) in surgically treated patients with adolescent idiopathic scoliosis (AIS).Study design/settingRetrospective comparative prognostic study (Level III) was conducted. Thirty-three patients were seen at an average follow-up of 7.5 years after either isolated selective anterior (n=18) or long combined anterior-posterior fusion (n=15) for AIS.Outcome measuresSelf-reported Scoliosis Research Society 22 questionnaire, physical examination including the detection of segmental pain and unspecific back pain, preoperative and postoperative whole-spine standing radiographs, and magnetic resonance imaging were obtained.MethodsRadiographic evaluation included the measurement of regional, coronal, and sagittal curve parameters and the assessment of spinal balance. Magnetic resonance imaging evaluation was done for preoperative and postoperative lumbar discs, according to the classification of Pfirrmann.ResultsPatients with low DDD (Pfirrmann grading <3) had a significantly higher thoracal kyphosis angle (mean 28°) than patients with advanced DDD (mean 15°). There was a trend toward a more flat-type lumbar lordosis in patients with severe DDD. Positive sagittal imbalance was associated with advanced DDD. Follow-up coronal parameters, trunk imbalance, instrumentation length, and lowest instrumented vertebra selection had no influence on DDD. Specific segmental pain could be attributed to a significantly higher coronal trunk imbalance (21 vs. 11 mm).ConclusionsThis study establishes thoracal flat back as a risk factor for lumbar DDD after spinal fusion and supports the pathogenetic role of positive sagittal imbalance in this process.     

肌少症对经皮椎体强化术治疗骨质疏松性胸腰椎压缩骨折疗效的影响

【摘要】 目的：探讨肌少症对经皮椎体强化术（percutaneous vertebral augmentation,PVA）治疗骨质疏松性胸腰椎压缩骨折（osteoporotic thoracolumbar vertebral compression fracture,OTLVCF）疗效的影响。方法：回顾性分析2020年1月~2022年12月在空军军医大学第二附属医院和西安交通大学附属红会医院行PVA治疗的270例OTLVCF患者的临床资料,男性109例,女性161例;骨折椎体：T10 37例,T11 52例,T12 68例,L1 72例,L2 41例。依据欧洲老年人肌少症工作组（European Working Group on Sarcopenia in Older People,EWGSOP）的诊断标准,以男性优势手握力<28.0kg且L3水平骨骼肌指数（skeletal muscle index,SMI）<45.4cm2/m2、女性优势手握力<18.0kg且L3水平SMI<34.4cm2/m2作为诊断阈值,将患者分为肌少症组（52例）和非肌少症组（218例）。收集并记录两组患者的一般资料（性别、年龄、身高、体重、身体质量分数、骨折节段、握力和骨骼肌指数）、手术资料（手术方法、手术时间、术中出血量、骨水泥注入量和术中透视次数）和并发症（骨水泥渗漏、伤椎再骨折、邻椎再骨折和远端椎体再骨折）发生情况;记录并比较两组患者术前和术后1d、1个月、6个月、1年时的疼痛视觉模拟评分（visual analogue scale,VAS）、Oswestry功能障碍指数（Oswestry disability index,ODI）。结果：两组患者性别、身高、体重、手术方法、手术时间、出血量、骨水泥注入量、术中透视次数以及术前VAS评分和ODI均无统计学差异（P＞0.05）,肌少症组患者年龄较非肌少症组大（80.3±7.9岁 vs 75.7±6.8岁,P＜0.05）,而身体质量指数（body mass index,BMI）较非肌少症组小（24.4±2.2kg/m2 vs 26.2±2.4kg/m2,P＜0.05）;两组术后1d、1个月、6个月、1年时的VAS评分及ODI与术前比较均有显著性改善（P＜0.05）,肌少症组患者术后1d、1个月、6个月、1年的VAS评分及ODI均显著高于同时间点非肌少症组（P＜0.05）。两组骨水泥渗漏的发生率无统计学差异（9.65% vs 7.34%,P＞0.05）,肌少症组患者术后1年内伤椎、邻椎和远端椎体再骨折发生率及总发生率均显著性高于非肌少症组（9.62% vs 2.75%、13.46% vs 5.05%、11.54% vs 4.13%及33.61% vs 11.93%,P＜0.05）。结论：肌少症OTLVCF患者行PVA的临床疗效较非肌少症患者差,1年内椎体再骨折发生率较高。     

体位复位结合高黏骨水泥椎体成形术治疗椎体压缩性骨折疗效观察

目的 探讨体位复位结合高黏骨水泥在椎体成形术中治疗椎体压缩性骨折的临床疗效。方法 回顾性分析2012年3月～2015年10月接受治疗的单椎体压缩骨折患者159例,其中经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗的56例患者纳入PVP组,经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗的51例患者纳入PKP组,经体位复位结合高黏骨水泥椎体成形术治疗的52例患者纳入高黏骨水泥组,通过术前术后视觉模拟疼痛评分（VAS）、椎体后凸Cobb角的改变以及术后椎体高度恢复率、骨水泥渗漏率,比较3组临床疗效。结果 3组术后VAS评分较各组术前评分均有显著性改善（P<0.05）。椎体高度恢复率PVP组为36%,PKP组75%（χ2=30.792,P=0.021）,高黏骨水泥组79%（χ2=37.831,P=0.016）,PKP组及高黏骨水泥组较PVP组差异具有统计学意义（P<0.05）。椎体后凸Cobb角PVP组手术前后分别为23.6±1.3、23.0±2.7（t=1.498, P=0.182）,PKP组及高黏骨水泥组术前分别为25.7±1.7、26.2±2.3,术后分别为12.8±2.1（t=34.096, P=0.001）、13.3±1.6（t=33.201, P=0.001）。经X线证实PVP组发生骨水泥渗漏8例（14.3%）,PKP组发生渗漏3例（5.9%）,高黏骨水泥组渗漏3例（5.8%）,PKP组及高黏骨水泥组骨水泥渗漏率与PVP组比较具有显著性差异（t=3.886、3.996, P=0.012、0.008）。结论 体位复位结合高黏骨水泥椎体成形术治疗椎体压缩性骨折,可以取得与PKP相同的临床疗效,因其不需使用昂贵的球囊,因而有着良好的临床推广应用前景。     

椎体加强术在骨质疏松性椎体压缩骨折的临床应用

正椎体压缩骨折(vertebral compression fractures,VCF)通常由骨质疏松症、椎体肿瘤或脊柱外伤等原因造成,其正逐渐成为一种严重危害老年人健康的疾病。临床上骨质疏松症乃是VCF常见的病因。据文献报道,70岁以上的老年人群中VCF的发病率约为20%,而绝经后妇女中的发病率约为16%~([1])。全美每年约有70万的骨质疏松性椎体压缩骨折(OVCF)患者,其     

Anterior vertebroplasty of adjacent levels after vertebral body replacement

The aim of this study was to evaluate the feasibility of a new method, which should help to avoid cage subsidence after vertebrectomy in short fusions. After implantation of an extendable vertebral body replacement (VBR) the two adjacent endplates to the fractured or destroyed vertebra were augmented with bone cement using the anterior approach in 20 patients with short circumferential fusion. All patients were followed up for 2 years clinically and radiographically. X-rays were reviewed for kyphosis, cage subsidence, presence of a solid fusion mass and instrumentation failure. Changes in every day activities (Oswestry Disability Index-ODI) and visual analogue scale (VAS), pain score, as well as technique-related complications were examined. The mean amount of kyphosis correction was 12.8° (±6.4°) and changed by only 0.3° (±0.4°) until last follow-up. Pain (VAS) and ODI scores were significantly improved and did not change until last follow-up. In all but two cases, the authors observed solid union with incorporation of the cage. No surgery-related complications were recorded. In one case revision was advised because of non-union due to septic loosening. The augmentation of the adjacent vertebras after anterior VBR provides an enhancement of the interface between cage and vertebra in cases with poor bone quality and in revision surgery. The technique is simple and safe, as the needles can be placed under visual control. Cement augmentation of the endplates may reduce interbody device subsidence.     

Lordoplasty: report on early results with a new technique for the treatment of vertebral compression fractures to restore the lordosis

Cement augmentation using PMMA cement is known as an efficient treatment for osteoporotic vertebral compression fractures with a rapid release of pain in most patients and prevention of an ongoing kyphotic deformity of the vertebrae treated. However, after a vertebroplasty there is no chance to restore vertebral height. Using the technique of kyphoplasty a certain restoration of vertebral body height can be achieved. But there is a limitation of recovery due to loss of correction when deflating the kyphoplastic ballon and before injecting the cement. In addition, the instruments used are quite expensive. Lordoplasty is another technique to restore kyphosis by indirect fracture reduction as it is used with an internal fixateur. The fractured and the adjacent vertebrae are instrumented with bone cannulas bipediculary and the adjacent vertebrae are augmentated with cement. After curing of the cement the fractured vertebra is reduced by applying a lordotic moment via the cannulas. While maintaining the pretension the fractured vertebra is reinforced. We performed a prospective trial of 26 patients with a lordoplastic procedure. There was a pain relief of about 87% and a significant decrease in VAS value from 7.3 to 1.9. Due to lordoplasty there was a significant and permanent correction in vertebral and segmental kyphotic angle about 15.2° and 10.0°, respectively and also a significant restoration in anterior and mid vertebral height. Lordoplasty is a minimal invasive technique to restore vertebral body height. An immediate relief of pain is achieved in most patients. The procedure is safe and cost effective.     

Clinical application of a pedicle nail system with polymethylmethacrylate for osteoporotic vertebral fracture

The instrumentation of the osteoporotic spine may sometimes result in failure due to the loosening or pullout of the conventional pedicle screw. Moreover, augmentation of screws with polymethylmethacrylate (PMMA) has risks of complications. We developed a new and original pedicle nail system with PMMA for osteoporotic vertebral fractures. A clinical evaluation of this novel pedicle nail system utilized in patients with an osteoporotic vertebral collapse was performed to determine the effectiveness and safety of this technique. Thirty-four elderly patients who suffered from osteoporotic compression fractures were treated by posterolateral fusion using the pedicle nail system. The mean follow-up period was 37 months. Of the 25 patients with neurological symptoms, two patients improved two stages at the Frankel level. Fifteen patients improved one stage at the Frankel level, and eight other patients improved, however, their improvement did not exceed a Frankel level. Nine cases with neuralgia symptoms improved from 4.4 to 2.2 points on average on the Denis pain scale (p < 0.01). The fusion rate was 94% as determined by X-rays of flexion and extension, and the correction of the compression fracture site was maintained well. A pedicle nail system stabilizes the spinal column with osteoporosis and reduces the instrumentation failure. The technique for the insertion of the pedicle nail reduces complication from cement augmentation. The authors speculate that the strategy using the pedicle nail system for osteoporotic spine may be effective and safe when the surgery is performed through a posterior approach.     

椎体后凸成形术治疗周壁破损的骨质疏松性椎体骨折

目的探讨周壁破损的骨质疏松性椎体骨折采用椎体后凸成形术治疗的个体化手术方案及其可行性与安全性。方法对35例39椎周壁破损的骨质疏松性椎体骨折患者施行椎体后凸成形术,男8例,女27例;年龄48￣85岁,平均68.3岁。术中采用个体化手术方法:对前壁破损的患者采用骨水泥分次灌注的方法,以防骨水泥向前方渗漏;对后壁或侧壁破损的患者采用全程动态“C”型臂X线机监测下灌注骨水泥,以防骨水泥向后方或侧方渗漏。术后观察症状改善、骨折复位及并发症情况。结果全部病例均顺利完成手术,无症状性并发症发生。术后椎体高度平均恢复率68.46%。后凸畸形Cobb角平均矫正8.6°,术前与术后比较差异有统计学意义(t=9.8872,P<0.01)。27例31椎获得随访6￣41个月,平均20.1个月。术后疼痛明显减轻或消失,VAS评分由术前8.7分降至2.6分。结论椎体后凸成形术治疗周壁破损的骨质疏松性椎体骨折,采用个体化手术方法防止骨水泥渗漏有一定的可行性与安全性。椎体前壁破损者采用骨水泥分次灌注,椎体后壁或侧壁破损者采用术中全程动态“C”型臂X线机监测,有助于防止骨水泥渗漏。     

Early results after vertebral body stenting for fractures of the anterior column of the thoracolumbar spine

Introduction

Vertebroplasty and balloon kyphoplasty have shown to improve pain and functional outcome in cases with symptomatic vertebral fractures. Although restoration of the vertebral body height and kyphosis seemed to be easier with balloon kyphoplasty, it became clear that some of the correction achieved by the balloon is lost once it was deflated. Vertebral body stent was developed to eliminate this phenomenon. To our knowledge this is the first study in describing this technique in clinical settings.

Materials and methods

Seventeen patients with 20 fractured vertebral bodies were included. All fractures were Type A1.3 or A3.1 (incomplete burst). Information about pain (visual analogue scale-VAS) and function (Oswestry disability index-ODI) and vertebral body deformity (vertebral angle-VA) was recorded in a prospective way at regular intervals. Patients were classified into osteoporotic group (7 patients) and traumatic groups (10 patients, younger than 60 years).

Results

There were 6 male and 11 female patients with mean age of 58.1 years (31–88 years). Mean follow up was 12 months. The preoperative pain level showed a mean VAS score of 8.9 in osteoporotic group and 9.7 in traumatic group. Postoperatively, in osteoporotic group, mean VAS was 4.8 at 6 weeks, 4.0 at 6 months and 2.5 at 12 months compared with traumatic fracture group where it was 2.7 at 6 weeks, 2.2 at 6 months and 1.6 at 12 months. Mean ODI in osteoporotic group was 41.7% (14–58%) and in traumatic group it was 20.4% (6–33%). Mean vertebral body angle prior to surgery in osteoporotic group was 9.7 whilst postoperatively it was 5.2°; so the mean correction achieved was 4.5°. In traumatic group preoperative VA was 13° whilst postoperatively it was 5.7°; therefore the mean correction achieved was 7.3°. None of the patients lost reduction at their last follow up.

Conclusion

Vertebral body stenting leads to satisfactory improvement in pain, function and kyphosis correction in the treatment of osteoporotic and traumatic fractures. Anterior spinal column, especially the fragmented superior endplate is nicely reconstructed by the stent provided it is inserted accurately. With addition of posterior transpedicular instrumentation, indications for this technique may be wider covering some Type B and C fractures with similar vertebral body damage.