注入骨水泥治疗胸腰椎骨质疏松性骨折：成熟技术中的常见问题

摘要

背景：注入骨水泥是胸腰椎骨质疏松性骨折常用的固定方法之一。目的：评估注入骨水泥内固定胸腰椎骨质疏松性骨折的生物力学性能以及固定效果。方法：选取骨质疏松胸腰椎标本，测定骨密度以及最大压力载荷、位移、刚度等力学性能指标，建立骨折模型，注入骨水泥固定后，再次测定最大压力载荷、位移、刚度指标，比较注入骨水泥固定前后生物性能的变化，同时与椎弓根螺钉固定胸腰椎骨质疏松性骨折的生物学性能进行比较。对注入骨水泥固定胸腰椎骨质疏松性骨折的患者进行随访观察，通过评估患者缓解疼痛程度、胸腰椎体高度恢复程度以及骨水泥注入量和骨水泥外渗等情况，明确注入骨水泥固定治疗的效果。结果与结论：生物力学实验测定注入骨水泥固定胸腰椎骨质疏松性骨折后的最大载荷为2285 N，比骨折前承受的最大载荷1954 N强度增加了近16.9%，注入骨水泥固定胸腰椎骨质疏松性骨折后的刚度为427 N，比骨折前刚度349 N增加了近22.1%，显示出良好的生物性能。对应用注入骨水泥固定胸腰椎骨质疏松性骨折的患者以及应用闭合复位注入骨水泥固定胸腰椎骨质疏松性骨折的患者进行随访观察，结果发现2种方法均可以使患者的疼痛得到明显的缓解，而闭合复位注入骨水泥固定胸腰椎骨质疏松性骨折时骨水泥注入量、局部后凸角以及椎体高度恢复情况均更好，表明闭合复位辅助下注入骨水泥固定是胸腰椎骨质疏松性骨折安全有效的治疗方法。%　　BACKGROUND: Bone cement injection is one of the commonly used methods for the treatment of thoracolumbar osteoporotic fractures. OBJECTIVE: To evaluate biomechanical properties and fixed effects of bone cement injection for the treatment of thoracolumbar osteoporotic fractures. METHODS: The specimens of thoracolumbar osteoporotic fractures were selected, and used to measure the mechanical properties of bone mineral density, maximum pressure load, displacement and stiffness. The bone model was established, and after bone cement injection, the maximum pressure load, displacement and stiffness were measured again. The mechanical properties before and after bone cement injection were compared, and compared with those in the treatment of thoracolumbar osteoporotic fractures with pedicle screw fixation. The patients received bone cement injection for the treatment of thoracolumbar osteoporotic fractures were fol owed-up, and the treatment effect of bone cement injection was determined through evaluating the pain relief degree, thoracolumbar vertebral height restoration, amount of bone cement injection and bone cement extravasation. RESULTS AND CONCLUSION: The biomechanical experiment determined that the maximum load was 2 285 N after thoracolumbar osteoporotic fractures treated with bone cement injection, which increased almost by 16.9% than 1 954 N before fracture; the stiffness was 427 N after thoracolumbar osteoporotic fractures treated with bone cement injection, which increased almost by 22.1% than 349 N before fracture, and showed good biological properties. The thoracolumbar osteoporotic fractures patients treated with bone cement injection and closed reduction combined with bone cement injection were fol owed-up, and found that both these two methods could relieve the pain of the patients. But closed reduction combined with bone cement injection for the treatment of thoracolumbar osteoporotic fractures was better than bone cement injection in the amount of bone cement injection, local kyphosis angle and vertebral height restoration. The results indicate that closed reduction combined with bone cement injection is a safe and effective method for the treatment of thoracolumbar osteoporotic fractures.