骨质疏松椎体压缩性骨折患者脊柱矢状面的失平衡

背景：国内外总结脊柱失平衡的原因包括脊柱畸形、脊柱退变性疾病、骨质疏松椎体压缩性骨折等，作者通过临床研究认为动力性因素(腰背肌)在脊柱矢状面失平衡中起关键作用。 目的：通过观察骨质疏松椎体压缩性骨折患者的临床表现和治疗效果，分析脊柱矢状面失平衡的原因。 方法：回顾性分析2012年1月至2013年5月收治的骨质疏松压缩性骨折伴脊柱矢状面失平衡患者41例，均在局麻下行经皮穿刺球囊扩张椎体成形治疗。治疗前患者均行骨密度、站立位全脊柱正侧位X射线、以伤椎为中心的CT及MR检查。于患者站立位全脊柱正侧位片中测量伤椎前缘高度、脊柱后凸Cobb角及改善角度、伤椎楔形变角度及改善角度；要求患者行负重试验及行走试验，对比治疗前后数据。 结果与结论：治疗前患者出现脊柱矢状面失平衡症状所需行走的距离显著短于治疗后(P < 0.05)；治疗前出现脊柱矢状面失平衡负重试验时间亦显著短于治疗后(P < 0.05)。在治疗前后站立位全脊柱正侧位片中，Cobb角的平均差值为(10.01±0.76)°，椎体楔形变改善的平均差值为(4.84±0.40)°，差异有显著性意义(P < 0.05)。所有患者均获随访，患者腰背部疼痛及矢状面失平衡症状明显缓解。所有患者行经皮球囊扩张椎体成形治疗后无严重并发症发生。提示骨质疏松压缩性骨折部分患者会出现脊柱矢状面失平衡症状，原因并非伤椎楔形变单一因素所致。且患者通过经皮球囊扩张后凸成形治疗后，失平衡症状往往会明显改善，提示脊柱骨折后腰痛限制腰背肌力量是导致脊柱矢状面失平衡的一个重要原因。中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程全文链接：

Spinal sagittal imbalance in patients with osteoporotic vertebral compression fractures

BACKGROUND:The reasons for spinal imbalance include spinal deformity, spinal degenerative disease osteoporotic vertebral compression fractures. We believe that the power factor (back muscle) plays a key role in spinal sagittal imbalance. OBJECTIVE:To analyze the reasons for spinal sagittal imbalance by observing clinical manifestations and therapeutic outcomes in patients with osteoporotic vertebral compression fractures. METHODS:A total of 41 patients with osteoporotic compression fractures combined with spinal sagittal imbalance were retrospectively analyzed from January 2012 to May 2013. All patients were subjected to percutaneous balloon vertebroplasty under local anesthesia. Before treatment, they received bone density, standing full-spine lateral X-ray, CT and MR imaging with injured vertebrae as the center. Using standing full-spine radiographs, the height of anterior border of the injured vertebrae, Cobb angle of kyphosis and improved angle, wedging angle of the injured vertebrae and improved angle were measured. The patients underwent weight loading test and walking test. Preoperative and postoperative data were compared. RESULTS AND CONCLUSION:The patients affected spinal sagittal imbalance symptoms, so the walking distance was significantly shorter than that postoperatively (P < 0.05). Moreover, the time of weight loading test was significantly shorter than that postoperatively (P < 0.05). In standing full-spine radiographs, the average difference of Cobb angle was (10.01±0.76)°. The mean difference of vertebral wedging improvement was (4.84±0.40)° (P < 0.05). All patients were followed up. Low back pain and sagittal imbalance symptoms were  relieved. No severe complications appeared after percutaneous balloon vertebroplasty. Results indicated that patients with osteoporosis compression fractures can affect the symptoms of spinal sagittal imbalance, which is not only induced by wedging of the injured vertebra. In addition, after percutaneous balloon vertebroplasty, imbalance symptoms are apparently improved, suggesting that back pain after spinal fracture limits back muscle strength and is an important cause for spinal sagittal imbalance.