单球囊双侧扩张后凸成形术治疗不同程度骨质疏松性椎体压缩骨折的疗效

目的:观察单球囊双侧交替扩张后凸成形术治疗老年骨质疏松性椎体压缩骨折的疗效。方法:选择我院2014年7月-2015年5月收治的老年骨质疏松性椎体压缩骨折患者60例,按照椎体塌陷程度分为重度骨折组和轻度骨折组,每组各30例。两组患者均接受单球囊双侧交替扩张后凸成形术治疗,观察治疗效果和椎体变化等。结果:与轻度骨折组比较,重度骨折组手术时间长、骨水泥注射量少,且椎体前缘高度恢复率、椎体中部高度恢复率、Cobb角矫正度高(P0.05)。治疗后,两组患者VAS评分均优于治疗前(P0.05),但两组间差异无统计学意义(P0.05)。与治疗前比较,两组治疗后椎体前缘高度、椎体中部高度、Cobb角均有所改善(P0.05),轻度骨折组的椎体前缘高度、椎体中部高度明显大于重度骨折组(P0.05),但两组Cobb角比较,差异无统计学意义(P0.05)。结论:单球囊双侧交替扩张后凸成形术治疗老年骨质疏松性椎体压缩骨折具有较好的临床疗效,可以明显纠正椎体塌陷和Cobb角度。     

MR弥散加权成像对鉴别诊断良恶性椎体压缩性骨折的临床价值研究

目的：探讨MR弥散加权成像（DWI）鉴别诊断良恶性椎体压缩性骨折的临床价值。方法：对57例经临床或病理证实的椎体良恶性压缩性骨折患者行矢状位T1M、T2WI、T2WI／FS及DWI扫描,研究其在常规序列和DWI序列上的表现,将常规MR序列和DWI序列检出率进行比较,测量正常椎体及病变椎体的表观弥散系数（ADC）值,并进行统计学分析。结果：（1）MR常规序列和DWI序列（b=500s／mm2）表现：良性椎体压缩性骨折呈长T1长或等T2改变,T2WI／FS呈高信号,DWI可以呈高信号、等信号及低信号;恶性椎体压缩性骨折呈长T1长T2信号,大部分病灶T2WUFS及DWI呈高信号,少数变现为低信号;（2）MR常规序列和DWI序列（b=500s／mm2）病灶检出率的比较：T1WI、T2WI／FS及DWI序列病灶检出率均高于T2WI序列,其间的差别有显著性意义（P〈0．01）,T1WI、T2WI／FS及DWI序列病灶检出率之间无显著性差异（P〉0．01）;（3）ADC值比较：在DWI（b=500s／mm2）上,良性组ADC值为（2．03±0．83）×10^3mm^2/s,恶性组ADC值为（1．37±0．75）×10^-3mm^2/s,正常组ADC值为（0．36±0．21）×10^-3mm^2／s,成像条件相同时,良性组高于恶性组,两组间有明显的统计学意义（P〈0．05）。结论：DWI可较好的反映椎体的弥散特征,ADC值作为量化指标可对良恶性椎体压缩性骨折进行可靠鉴别。     

PKP治疗骨质疏松性椎体压缩骨折的预后评价及继发危险因素分析

目的:分析椎弓根入路行椎体后凸成形术(PKP)治疗骨质疏松性椎体压缩骨折的预后评价及继发危险因素分析。方法:选择2016年2月-2018年2月我院收治的骨质疏松性椎体压缩骨折患者85例纳入本次研究,采用随机数表法分为观察组(n=43)和对照组(n=42)。对照组使用经皮椎体成形术进行治疗,观察组采用PKP进行治疗。比较两组患者手术情况、术后情况、椎体前缘高度丢失率、Cobb角、继发性骨折发生情况及分析骨质疏松性椎体压缩骨折患者术后继发骨折的危险因素。结果:观察组手术时间、透视次数、骨水泥注入量、术中出血量均显著低于对照组,差异显著(P0.05);观察组疼痛缓解时间、下地时间及住院时间均显著低于对照组,差异显著(P0.05);治疗前,两组椎体前缘高度丢失率、Cobb角比较,无显著差异;治疗后,两组患者的椎体高度丢失率明显下降,但两组术后7 d、术后6月两组椎体前缘高度丢失率、Cobb角比较无显著差异;观察组术后12月椎体前缘高度丢失率、Cobb角低于对照组,差异显著(P0.05);所有患者均随访12月,其中22例(25.88%)发生继发性椎体骨折,进行单因素分析,结果发现,两组患者性别、骨折部位、局部矢状面后凸角度、骨水泥量、椎体高度恢复、术后抗骨质疏松治疗差异无统计学意义(P0.05);骨质疏松原因、骨水泥椎间隙渗漏、术后支具佩戴、原发骨折类型与骨质疏松性椎体压缩骨折患者术后发生继发骨折相关(P0.05)。多因素Logistic分析显示,骨质疏松原因、骨水泥椎间隙渗漏、术后支具佩戴、原发骨折类型均是骨质疏松性椎体压缩骨折患者术后发生继发骨折的独立危险因素(P0.05)。结论:在骨质疏松性椎体压缩骨折患者中应用PKP可有效改善手术情况,随着时间的延长,PKP更有利于维持患者椎体高度;骨质疏松原因、骨水泥椎间隙渗漏、术后支具佩戴、原发骨折类型是骨质疏松性椎体压缩骨折患者术后发生继发骨折的危险因素,临床上对于具有危险因素的患者引起重视,并采取干预措施。     

单侧PKP术对骨质疏松压缩性骨折相邻椎体高度的影响

目的：探讨单一椎体骨质疏松性压缩性骨折行单侧PKP 术后对相邻上下椎体高度的影响。方法：62 例行T12 椎体骨质疏松 性压缩性骨折单侧PKP 术后的患者,测量术前,术后2 天、6 个月、1 年T11 椎体及L1 椎体前缘、中央及后缘高度,计算椎体压缩 率,比较两椎体各时相点椎体前缘、中央及后缘椎体压缩率的变化。结果：术后2 天L1 和T11 的椎体前缘、中央及后缘压缩率比 较差异无统计学意义(P 均>0.05);术后6 个月、1 年后两椎体前缘、中央及后缘高度压缩率比较（P均<0.05）差异有统计学意义。 L1 和T11 术后2 天、6 个月、12 个月不同时相,三点压缩率越来越大,差异有统计学意义(P均<0.05)。结论：单侧PKP术后椎体相 应负荷的改变,对下位邻近椎体较上位椎体高度影响较大,可能与相邻下位椎体承受的重力高于上位相邻椎体有关。     

椎体成形术和椎弓根螺丝钉治疗胸腰椎椎体压缩性骨折的临床研究

目的:探讨胸腰椎椎体压缩性骨折采用椎体成形术和椎弓根螺丝钉固定的临床疗效。方法:按照随机数字表法将2012年2月~2014年2月我院收治的胸腰椎椎体压缩性骨折患者分为两组,观察组行经皮椎体成形术,对照组行椎弓根螺丝钉固定,术后比较两组的临床疗效及安全性。结果:观察组手术时间、术中出血量、住院时间少于对照组,差异有统计学意义(P<0.01),两组治疗前VAS评分、Cobb角、椎体前缘高度比较,差异无统计学意义(P>0.05),治疗后的VAS评分、Cobb角、椎体前缘高度较治疗前均有所改善,观察组改善程度明显优于对照组,差异有统计学意义(P<0.01);术后两组不良反应主要有伤口感染,症状复发,脊髓损伤,肺栓塞,恶心、呕吐等,观察组症状复发率,恶心、呕吐发生率低于对照组,差异有统计学意义(P<0.05)。结论:胸腰椎椎体压缩性骨折行经皮椎体成形术具有疗效好,并发症少等特点,临床有重要参考价值。     

骨质疏松椎体压缩性骨折患者经皮椎体成形术后再次骨折的危险因素分析

目的:探讨骨质疏松椎体压缩骨折患者接受椎体成形术后再次新发骨折的危险因素。方法:选取2009年1月到2015年1月就诊于我院诊断为骨质疏松椎体压缩性骨折且行经皮椎体成形术的患者,收集患者的诊疗信息及影像学资料。收集患者的年龄、性别等基本资料及基于定量CT测量的骨矿物含量、骨水泥注射占椎体体积的比、骨水泥的分布及骨水泥的渗漏情况。将单椎体骨折且在随访时间内再次新发椎体骨折的患者分为A组,未骨折的患者分为B组,对比分析两组之间的参数的差异,并利用二项Logistic回归分析分析再次骨折的危险因素。结果:共有287例患者纳入研究,平均随访时间为34.7±17.8个月,压缩性骨折最常见的椎体依次为L1(29.1%)、T12(20.8%)及L2(13.5%)。在随访时间内共有32例患者再次发生椎体骨折。252例单椎体骨折患者中,26例(A组)再次发生骨折,226例(B组)未发生骨折。A组骨矿物含量低于B组(P0.001),骨水泥分布较B组差(P0.001),年龄高于B组(P0.001)且骨水泥渗漏发生率(34.6%)高于B组(13.7%)(P=0.006),两组在骨水泥占椎体的比、后凸程度、性别比例没有统计学差异。回归分析显示骨矿物含量(OR=1.092,P0.001)、年龄(OR=1.091,P0.001)及骨水泥渗漏(OR=1.200,P=0.002)均是再次骨折的危险因素,骨水泥的均匀分布是保护因素(OR=0.922,P0.001)。结论:年龄较大且骨质较差的患者容易再次发生椎体骨折,在行椎体成形术过程中应尽量使骨水泥均匀分布并避免骨水泥的渗漏。     

椎体后凸成形术治疗老年骨质疏松脊柱压缩骨折的临床分析

目的分析老年骨质疏松脊柱压缩骨折行椎体后凸成形术的治疗方法及临床效果,为临床提供依据。方法回顾性分析我院2014年10月~2015年10月收治的老年骨质疏松脊柱压缩骨折患者40例的临床资料,全部患者均为椎体后壁完整疼痛性骨质疏松脊柱压缩骨折,均接受椎体后凸成形术治疗,经双侧椎弓根、椎弓根旁置入可扩张球囊,将骨折塌陷椎体进行复位,采取骨水泥填充球囊扩张产生的椎体内空腔,术后观察患者症状改善和骨折复位情况。结果 40例患者手术均顺利完成,术后48h内患者疼痛显著缓解,骨折椎体前缘以及中部高度丢失,从手术前的(12.5±2.2)mm、(9.1±1.3)mm减少到手术后的(4.6±1.4)mm、(3.3±1.0)mm;后凸畸形Cobb角从手术前的(22.2±5.1)°矫正到手术后的(9.1±4.6)°,其中1例患者术后出现少量骨水泥渗漏,1例患者手术过程中一侧穿刺管中出现脑脊液,即停止该侧手术。结论老年骨质疏松脊柱压缩骨折行椎体后凸成形术治疗效果显著,可以快速缓解患者的疼痛,使患者脊柱序列得到恢复,值得临床推广使用。     

Lésion vertébrale froide en TEP/TDM au FNa-(18F) : n’oubliez pas l’ostéonécrose vertébrale (ou maladie de Kümmell) !

A 75-year-old woman presented with a history of severe backache and spinal cord compression syndrome. MRI revealed a well-circumscribed, homogeneous, wedge-shaped lesion involving T11 vertebral body, which was hypointense on T1- and hyperintense on T2-weighted images with bulging posterior border. Patient benefited from a decompressive T10–T12 laminectomy. Four months later, a new vertebral collapse of T10 was evidenced on plain X-rays. A second MRI exam displayed worrisome diffuse signal abnormalities of T10 pointing to a space-occupying lesion. A (18F)-NaF PET/CT was ordered and disclosed an hypometabolic (“cold”) activity of T10 and T11 vertebral bodies with a partial postero-lateral hypermetabolic rim. Twined low dose CT evidenced fracture sequelae and air-filled cleft within vertebral bodies. Histopathologic examination of the biopsy specimen of T10 revealed thinned out trabeculae surrounded by hyalinized fatty marrow cells and fibrovascular tissue, thus ascertaining the diagnosis of avascular necrosis of the vertebra. The radiographic and CT sine qua non for Kümmell's disease is intraosseous vacuum phenomenon. That is to say, vacuum clefts (VCs) of the vertebral bodies are radiographically recognized as a vacuum or air-filled cleft within the collapsed vertebrae. This sign is felt to be suggestive of ischemic necrosis but not specific as VCs of the vertebral bodies have also been associated with delayed union or non-union of osteoporotic fractures. Because of often misleading MRI abnormalities, integrative interpretation of (18F)-NaF PET/CT pattern should be undertaken in order to suspect Kümmell's disease and to discard some of the differentials.     

Prevalence of vertebral compression fractures due to osteoporosis in ankylosing spondylitis.

OBJECTIVE--To determine the prevalence of vertebral compression fractures due to osteoporosis in patients with ankylosing spondylitis. DESIGN--Prospective study of 111 consecutive patients; patients with vertebral compression fractures were entered into a case-control study. SETTING--Outpatient clinic at the centre for rheumatic diseases, Glasgow. PATIENTS--111 Consecutive patients with ankylosing spondylitis. Patients with compression fractures were matched for age and sex with two controls selected from the rest of the group. Patients with biconcave vertebral fractures were also studied. MAIN OUTCOME MEASURES--Assessments of spinal deformity and mobility and analysis of lateral radiographs of spines for presence of syndesmophytes. RESULTS--Fifteen patients with compression fractures and five with biconcave fractures were studied. Compared with the controls the patients with compression fractures had increased formation of syndesmophytes in the lumbar spine, whereas those with biconcave fractures had increased formation throughout the spine. Patients with compression fractures also had a greater degree of spinal deformity (distance from wall to tragus 24.5 cm v 12.7 cm in controls), less spinal mobility (20 v 45.6 degrees of flexion), and reduced chest expansion (2 cm v 3cm). CONCLUSION--Vertebral compression fractures due to osteoporosis are a common but frequently unrecognised complication of ankylosing spondylitis and may contribute to the pathogenesis of spinal deformity and back pain.     

椎体成形术治疗脊柱压缩骨折的临床疗效

目的:探讨脊柱压缩骨折患者的椎体成形术应用方法与效果。方法:脊柱压缩骨折患者150例根据随机抽签法分为治疗组与对照组各75例,对照组给予传统开放性手术,治疗组给予椎体成形术。通过比较两组手术时间,术中出血量,术后住院时间,术后疼痛评分,术后局部Cobb角的差异评价治疗效果,其中,疼痛评分采用VAS量表,局部Cobb角通过脊椎侧围X片测定。结果:所有患者都顺利完成手术,无严重并发症发生,治疗组的术中出血量与术后住院时间明显少于对照组(P0.05)。两组术前疼痛评分对比差异无统计学意义,术后疼痛评分都呈现明显下降的趋势(P0.05),同时术后治疗组的疼痛评分明显低于对照组(P0.05)。两组术前局部Cobb角对比差异无统计学意义,术后局部Cobb角都明显下降(P0.05),同时术后治疗组的局部Cobb角都明显低于对照组(P0.05)。结论:脊柱压缩骨折患者的椎体成形术应用能有效缓解疼痛程度,改善椎体前中部高度脊柱后凸情况,对于患者的创伤比较少,有很好的推广应用价值。     

Percutaneous Stabilization System Osseofix? for Treatment of Osteoporotic Vertebral Compression Fractures - Clinical and Radiological Results after 12 Months

Study Design

A prospective consecutive cohort study (follow-up study).

Objective

Our study investigated whether implantation of an expandable titanium mesh cage (Osseofix®) is a successful and safe minimally invasive therapy for osteoporotic vertebral compression fractures (VCF). Our experiences, clinical and radiological findings after 12 months follow-up are presented. Kypho- and vertebroplasty are well-established minimally invasive procedures for the treatment of osteoporotic VCF. The main complications associated with both procedures are uncontrolled bone cement leakage. Therefore a suitable alternative has been investigated.

Methods

During June 2010 to May 2011 24 patients were included with 32 osteoporotic VCF (T6 to L4). All of them were stabilized with the Osseofix® system. Preinterventionally we performed X-ray, MRI, and bone density measurements (DXA). Clinical and radiological results were evaluated preop., postop. and after 12 months postop. based on the Oswestry Disability Index (ODI) and the Visual Analogue Scale (VAS), X-ray (Beck Index, Cobb-angle) and CT.

Results

There was a significant improvement in the mean ODI (70,6% to 30,1%) as well as a significant reduction in pain intensity (VAS) (7,7 to 1,4) after 12 month. The mean kyphotic angle according to Cobb showed significant improvements (11,7° to 10,4°) after 12 months. Postinterventional imaging showed only one case of loss of height in a stabilized vertebral body (3.1%). We saw no changes in posterior vertebral wall or adjacent fractures. Except for one pronounced postoperative hematoma we saw no surgical complications including no cement leakage.

Conclusions

Stabilization of symptomatic osteoporotic VCF with Osseofix® system is a safe and effective procedure, even in fractures with posterior wall involvement. The clinical mid-term results are good at a very low complication rate. The Osseofix® system is an interesting alternative to the established procedures of cement augmentation.     

The relation between forearm and vertebral mineral density and fractures in postmenopausal women

Vertebral and forearm mineral density (VMD and FMD, respectively) were determined in 124 postmenopausal women with no crushed vertebrae or peripheral fractures, 51 who had sustained peripheral fractures only since the menopause, 62 with vertebral compression(s) only and 75 with both types of fracture.There was a very significant correlation between the two measurements in the whole set. The scatter could not be accounted for by methodological error but was partly accounted for by body weight, since VMD was related to body weight and FMD was not. Whatever criterion was used for the diagnosis of osteoporosis (whether fracture or density) the percentage of misclassified cases was very similar by the two methods. However, VMD was relatively more reduced than FMD in vertebral fracture cases and FMD was marginally more reduced than VMD in peripheral fracture cases.There is little to choose between vertebral and forearm density in the diagnosis of osteoporosis but vertebral densitometry is slightly superior to forearm densitometry in describing the severity of osteoporosis in vertebral fracture patients.     

Tassements vertébraux chez le petit enfant : présentation d’un cas et discussion étiologique

Vertebral compression fractures among children are less common and described than among adults. We report a case of a 3-year-old boy presenting with low back pain. The bone scan revealed multiple vertebral compression fractures. This case leads us to discuss the main etiologies of vertebral compression fractures in pediatric population: traumatic causes, secondary osteoporosis and its many underlying etiologies, and primary osteoporosis (mainly osteogenesis imperfecta and idiopathic juvenile osteoporosis).     

椎体静脉稀疏区注入骨水泥对PVP术中骨水泥渗漏的影响

目的:探讨椎体静脉稀疏区注入骨水泥对骨质疏松椎体压缩性骨折患者行经皮穿刺椎体成形术(percutaneous vertebroplasty,PVP)术中骨水泥渗漏的影响。方法:选择西安交通大学第二附属医院2014年1月至2018年6月收治的61例骨质疏松椎体压缩性骨折患者,根据骨水泥注入区域的不同,将所有患者分为A组(30例)及B组(31例),A组骨水泥注入区域为椎体静脉密集区(椎体中1/3平面处),B组骨水泥注入区域为椎体静脉稀疏区(椎体上1/3及下1/3平面处),对比两组的骨水泥渗漏率,术前、术后6个月时的视觉模拟评分(Visual analogue scale,VAS),治疗中的骨水泥用量、椎体高度恢复率及cobb角恢复度数。结果:B组的骨水泥渗漏率及骨水泥用量均明显低于A组(P0.05)。两组的VAS评分、椎体高度恢复率、cobb角恢复情况对比差异无统计学意义(P0.05)。结论:与椎体静脉密集区相比,在椎体静脉稀疏区注入骨水泥可显著降低骨质疏松椎体压缩性骨折患者PVP术中骨水泥渗漏率,椎体静脉稀疏区可作为PVP术中骨水泥注射的一个相对安全区域。     

椎体成形术和椎体后凸成形术治疗椎体压缩性骨折的研究进展

绝大多数椎体压缩性骨折由骨质疏松或椎体肿瘤引起,其导致骨折部位的疼痛以及椎间高度丢失。经皮椎体成形术和经皮椎体后凸成形术是近二十年来兴起用于治疗椎体压缩性骨折的微创手术方法,能够迅速缓解病人的疼痛、恢复伤椎畸形。经皮椎体成形术通过小切口将骨水泥注入骨折部位,而椎体后凸成形术将球囊注入骨折部位,通过球囊扩张和收缩形成空腔,并在腔中注入填充材料,接着取出球囊,注入骨水泥。本文从经皮椎体成形术和经皮椎体后凸成形术的发展、两种手术的疗效和安全性、骨水泥的研究现状和两种技术的临床应用结果、当前和未来的研究方向等进行综述。     

Micromechanics of the human vertebral body for forward flexion

To provide mechanistic insight into the etiology of osteoporotic wedge fractures, we investigated the spatial distribution of tissue at the highest risk of initial failure within the human vertebral body for both forward flexion and uniform compression loading conditions. Micro-CT-based linear elastic finite element analysis was used to virtually load 22 human T9 vertebral bodies in either 5° of forward flexion or uniform compression; we also ran analyses replacing the simulated compliant disc (E=8 MPa) with stiff polymethylmethacrylate (PMMA, E=2500 MPa). As expected, we found that, compared to uniform compression, forward flexion increased the overall endplate axial load on the anterior half of the vertebra and shifted the spatial distribution of high-risk tissue within the vertebra towards the anterior aspect of the vertebral body. However, despite that shift, the high-risk tissue remained primarily within the central regions of the trabecular bone and endplates, and forward flexion only slightly altered the ratio of cortical-to-trabecular load sharing at the mid-vertebral level (mean±SD for n=22: 41.3±7.4% compression; 44.1±8.2% forward flexion). When the compliant disc was replaced with PMMA, the anterior shift of high-risk tissue was much more severe. We conclude that, for a compliant disc, a moderate degree of forward flexion does not appreciably alter the spatial distribution of stress within the vertebral body.     

Damage accumulation in vertebral trabecular bone depends on loading mode and direction

Osteoporotic vertebral fractures constitute a major clinical problem in ageing societies. A third of all vertebral fractures is caused by falls, 15% by lifting heavy loads or traffic accidents and over 50% are not relatable to a traumatic event. In the latter case vertebrae show sinter processes which indicate the accumulation of damage and permanent deformation. Accumulated damage may not be visible on radiographs but increases the risk of fracture and could lead to vertebral collapse. Clear understanding of the accumulation of damage and residual strains and their dependence on loading mode and direction is important for understanding vertebral fractures. Altogether, 251 cylindrical samples (8×18-25mm) were obtained from 50 male and 54 female fresh frozen human vertebrae (T1-L3) of 65 (21-94) years. Vertebrae were randomly assigned to three groups cranial-caudal, anterior-posterior and latero-lateral. Specimens were mechanically loaded in compression, tension or torsion in five load steps at a strain rate of 0.2%/s. Three conditioning cycles were driven per load step. Stress-strain curves were reconstructed from the force-displacement or from the moment-twist angle curves. Damage accumulated from 0 to 86% in compression, from 0 to 76% in tension and from 0 to 86% in torsion through the five load steps. Residual strains accumulated from 0 to -0.008mm/mm in compression, 0 to 0.006mm/mm in tension and 0 to 0.026rad/rad in torsion. Significantly less damage (p<0.05) but not residual strains accumulated in transverse directions. This study provides detailed experimental insights into the damage behaviour of vertebral trabecular bone under various loads occurring in vivo. Damage but not residual strain evolution seems to be anisotropic. Both seem to evolve differently under different loading modes. The results could be of importance in understanding vertebral fractures.     

Finite element analyses of human vertebral bodies embedded in polymethylmethalcrylate or loaded via the hyperelastic intervertebral disc models provide equivalent predictions of experimental strength

Quantitative computer tomography (QCT)-based finite element (FE) models of vertebral body provide better prediction of vertebral strength than dual energy X-ray absorptiometry. However, most models were validated against compression of vertebral bodies with endplates embedded in polymethylmethalcrylate (PMMA). Yet, loading being as important as bone density, the absence of intervertebral disc (IVD) affects the strength. Accordingly, the aim was to assess the strength predictions of the classic FE models (vertebral body embedded) against the in vitro and in silico strengths of vertebral bodies loaded via IVDs. High resolution peripheral QCT (HR-pQCT) were performed on 13 segments (T11/T12/L1). T11 and L1 were augmented with PMMA and the samples were tested under a 4° wedge compression until failure of T12. Specimen-specific model was generated for each T12 from the HR-pQCT data. Two FE sets were created: FE-PMMA refers to the classical vertebral body embedded model under axial compression; FE-IVD to their loading via hyperelastic IVD model under the wedge compression as conducted experimentally. Results showed that FE-PMMA models overestimated the experimental strength and their strength prediction was satisfactory considering the different experimental set-up. On the other hand, the FE-IVD models did not prove significantly better (Exp/FE-PMMA: R²=0.68; Exp/FE-IVD: R²=0.71, p=0.84). In conclusion, FE-PMMA correlates well with in vitro strength of human vertebral bodies loaded via real IVDs and FE-IVD with hyperelastic IVDs do not significantly improve this correlation. Therefore, it seems not worth adding the IVDs to vertebral body models until fully validated patient-specific IVD models become available.     

PKP 在治疗多节段胸腰椎骨质疏松压缩性骨折方面的应用

目的:探讨经皮椎体后凸成形术(PKP)治疗多节段骨质疏松性椎体压缩性骨折(OVCF)的疗效和安全性。方法:应用PKP治疗37例共112节胸腰椎多节段骨质疏松性椎体压缩骨折,分析患者术前、术中、术后的临床及影像学资料,采用模拟视觉评分(VAS)及Oswesty功能障碍指数(ODI)评价术前、术后疼痛缓解及日常活动功能恢复情况。结果:13例一次手术完成1节椎体,12例一次手术完成2～3节段椎体,12例两次手术完成3～4个节段椎体。1例术中出现一过性血压降低和呛咳。VAS评分术前为(8.55±1.22)分,术后1周为(2.12±1.09)分,术后3个月为(2.01±1.07)分;ODI值术前为83.02±11.14,术后1周为25.23±7.17,术后3个月为27.45±9.67,疼痛缓解及日常活动功能恢复明显。结论:初步的临床结果显示PKP是多节段骨质疏松性椎体压缩性骨折的有效治疗方法,单椎体信号改变者治疗效果好于多椎体信号改变者。多椎体信号改变者只选择第一责任椎的单节段PKP可能获得更好的效果;多节段患者同时选择第一和第二责任椎一次完成PKP术效果可能好于分次完成。一次治疗多椎体病变更为经济、适用。     

经伤椎椎弓根螺钉固定治疗脊柱骨折的疗效及对患者疼痛、Cobb角的影响

目的:探讨经伤椎椎弓根螺钉固定治疗脊柱骨折的疗效及对患者疼痛、Cobb角的影响。方法:选择2013年2月至2018年2月我院接诊的脊柱骨折患者80例作为研究对象,以随机数表法分为观察组(n=41)和对照组(n=39)。对照组采用跨伤椎固定治疗,观察组采用经伤椎椎弓根螺钉固定治疗。比较两组患者临床手术指标、日本骨科协会评估治疗(JOA)评分、视觉模拟评分(VAS)、椎体压缩率、Cobb角水平及伤椎椎体高度。结果:观察组患者手术时间、术中出血量及住院时间均显著低于对照组(P0.05);治疗后,两组患者JOA评分、VAS评分均明显改善(P0.05),且观察组患者VAS评分显著低于对照组(P0.05);治疗后,两组患者椎体压缩率、Cobb角水平均明显改善(P0.05),且观察组患者椎体压缩率、Cobb角水平显著低于对照组(P0.05);两组患者治疗前椎体前、后缘高度无明显差异;治疗后,两组患者椎体前、后缘高度均明显改善(P0.05),且观察组患者椎体前、后缘高度显著高于对照组(P0.05)。结论:脊柱骨折患者采用经伤椎椎弓根螺钉固定治疗栓效果显著,可改善患者疼痛、Cobb角水平,值得临床推广。