Percutaneous vertebroplasty combined with granulated allogeneic bone grafting for thoracolumbar compressive fractures: the completeness and stability of fractured vertebrae

doi:10.3969/j.issn.2095-4344.2017.23.011

Abstract

Abstract:

BACKGROUND: Percutaneous vertebroplasty is mainly used to treat senile osteoporotic compressive fractures, while for young patients, pedicle screw internal fixation is usually applied, but heavy trauma, nail broken, secondary surgery and other problems can be found occasionally.

OBJECTIVE: To investigate the clinical efficacy of percutaneous vertebroplasty combined with granulated allogeneic bone grafting for thoracolumbar compressive fractures.

METHODS: Twenty-one patients suffering thoracolumbar compressive fractures were recruited, and underwent percutaneous vertebroplasty combined with granulated allogeneic bone grafting. The Visual Analogue Scale scores, height ratio of fractured vertebrae and Cobb angle were detected before and after surgery.

RESULTS AND CONCLUSION: (1) Compared with baseline, the Visual Analogue Scale scores were improved significantly at 1 day and 6 months postoperatively (P < 0.05). (2) The height ratio of fractured vertebrae at 1 day and 6 months postoperatively was significantly higher than that before treatment (P < 0.05). (3) The Cobb angle of fractured vertebrae at 1 day and 6 months postoperatively was significantly less than that before treatment (P < 0.05). (4) The mean operation time was (52±12.3) minutes, and the mean blood loss was (11.5±1.5) mL. (5) These results suggest that percutaneous vertebroplasty combined with granulated allogeneic bone grafting can effectively restore the anterior fractured vertebral height, eliminate the cavity in the fractured vertebrae, renew the completeness and stabilization of the fractured vertebrae, which keep the spinal range of motion; therefore, it is a minimal invasive method in the treatment of thoracolumbar fractures.

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

Key words: Spinal Fractures, Surgical Procedures, Minimally Invasive, Tissue Engineering

CLC Number:

R318

Lin Yu-jiang, Yang Li-min, Yang Jian. Percutaneous vertebroplasty combined with granulated allogeneic bone grafting for thoracolumbar compressive fractures: the completeness and stability of fractured vertebrae [J]. Chinese Journal of Tissue Engineering Research, 2017, 21(23): 3670-3675.

Figures/Tables 1

References

[1] 叶春万,朱敏,樊道斌,等.经椎弓根打压植骨与骨水泥椎体成形术治疗胸腰椎压缩骨折的生物力学比较[J].中国骨与关节损伤杂志, 2013,28(7):610 -613.

[2] Buchbinder R,Golmohammadi K,Johnston RV,et al.Percutaneous vertebroplasty for osteoporotic vertebral compression fracture.Cochrane Database of Systematic Reviews.2015; 4(7656):1261-1262.

[3] 许正伟,贺宝荣,郝定均,等. 胸腰椎骨质疏松性骨折经皮椎体成形术后骨水泥渗漏的研究进展[J]. 中华骨科杂志, 2016, 36(17): 1142-1148.

[4] 王大寿,贺纯静,吴黔鸣,等. 经皮椎体成形术治疗重度骨质疏松性椎体压缩骨折的疗效评价[J]. 中华创伤杂志,2016,32(8): 720-723.

[5] Clarençon F, Fahed R,Gabrieli J, et al. Safety and Clinical Effectiveness of Percutaneous Vertebroplasty in the Elderly (≥80 years). European Radiology.2016; 26(7): 2352-2358.

[6] Lee DG, Park CK, Park CJ, et al. Analysis of Risk Factors Causing New Symptomatic Vertebral Compression Fractures After Percutaneous Vertebroplasty for Painful Osteoporotic Vertebral Compression Fractures: A 4-year Follow-up. J Spinal Disord Tech. 2015;28(10):E578-583.

[7] Li Q, Cai Y, Li S. Transpedicular bone grafting and pedicle screw fixation in injured vertebrae using a paraspinal approach for thoracolumbar fractures: a retrospective study. J Orthop Surg Res. 2016;11(1):115.

[8] 谢申,祝少博. 经伤椎和跨伤椎螺钉置入固定胸腰椎压缩性骨折:脊柱稳定性长期随访[J]. 中国组织工程研究, 2016, 20(4): 522-528.

[9] 文天林,孟浩,王飞,等. 经皮与开放椎弓根螺钉内固定术治疗无神经损伤胸腰段骨折的疗效对比[J]. 中国脊柱脊髓杂志, 2016, 26(5):401-407.

[10] Mcdonnell M, Shah KN, Paller DJ, et al. Biomechanical Analysis of Pedicle Screw Fixation for Thoracolumbar Burst Fractures. Orthopedics.2016;39(3):e514.

[11] Takami M,Yamada H,Nohda K,et al.A minimally invasive surgery combining temporary percutaneous pedicle screw fixation without fusion and vertebroplasty with transpedicular intracorporeal hydroxyapatite blocks grafting for fresh thoracolumbar burst fractures: prospective study. Eur J Orthop Surg Traumatol. 2014;24 Suppl 1:S159-165.

[12] 成心锟,钱邦平,邱勇.腰椎椎弓根螺钉置入对近端相邻关节突关节侵扰的影响因素研究进展[J].中国脊柱脊髓杂志,2016,26(8): 754-757.

[13] 高速,葛胜辉,权正学,等.经伤椎椎弓根螺钉内固定联合椎体成形术治疗重度胸腰椎骨质疏松性椎体压缩骨折[J].中华创伤杂志, 2016,32(9):777-782.

[14] Suk SI,Kim WJ.Pedicle Screw Fixation in Thoracic or Thoracolumbar Burst Fractures.//Biomechanics and Biomaterials in Orthopedics.Springer London. 2016:440-461.

[15] Rohela H,Ravinath TM,Vasudeva J,et al.Management of fractures of thoracolumbar spine with pedicle screw fixation. 2016;3(2):55.

[16] 曾红生,陈子华,陈建威,等.经伤椎椎弓根螺钉置入内固定修复胸腰椎骨折:远期效果及生物力学分析[J].中国组织工程研究,2016, 20(4):571-576.

[17] 桂忠山,徐晓峰.椎弓根螺钉置入修复胸腰椎骨折:影响椎体高度恢复的相关因素分析[J]. 中国组织工程研究, 2015,19(39): 6315-6320.

[18] 张金山,郑勇强,林亮,等. 经椎弓根伤椎植骨结合短节段椎弓根钉内固定治疗胸腰椎骨折[J] .中国骨与关节损伤杂志,2015, 30(5):514-515.

[19] Leferink V, Zimmerman K, Veldhuis E, et al. Thoracolumbar spinal fractures. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society.2015;10(6):517-523.

[20] Nouman M A, Khan MM, Ilyas M, et al. Role of Transpedicle screw fixation in thoracolumbar spine fractures. Cambridge Review of International Affairs, 2015.

[21] 曹杰,于海洋,梁成民,等.后路椎弓根钉棒复位内固定+经伤椎椎弓根植骨治疗胸腰椎骨折[J] .中华骨与关节外科杂志,2016, 9(5):381-385.

[22] 俞伟忠,王雨辰,刘延辉,等.经伤椎椎弓根植骨与置钉在短节段固定治疗胸腰椎骨折中的疗效比较[J] .中国骨与关节损伤杂志, 2016(S1):3-4.

[23] Cavali P T M. Posterior Thoracolumbar Fixation: Overview of Implants and Surgical Techniques// Surgery of the Spine and Spinal Cord. Springer International Publishing, 2016.

[24] 敖俊,辛志军,陈方,等.两种植骨法对胸腰椎爆裂骨折复位后骨缺损空隙残存率及压缩刚度的影响[J].中国修复重建外科杂志, 2013,(8):974-979.

[25] 任永安,于圣会,顾祖超,等.人工骨复合物与经伤椎螺钉置入修复胸腰椎骨折可促进新骨形成[J].中国组织工程研究,2015, 19(16): 2461-2466.

[26] 史航,朱裕成,马军,等.微创经皮椎弓根钉内固定联合伤椎椎体植骨治疗胸腰椎骨折的疗效分析[J] .中国骨与关节损伤杂志, 2016,31(5) :513-514.

[27] 张义龙,任磊,孙志杰,等. 椎体成形后新发椎体压缩骨折:与骨质疏松及脊柱矢状位序列失衡有关[J].中国组织工程研究,2016, 20(35):5263-5269.

[28] 陈嘉裕,刘展亮,李晓彬.伤椎置钉联合经椎弓根椎体内植骨治疗胸腰椎骨折[J].骨科,2015,6(1):18-21.

[29] Baumann F, Krutsch W, Pfeifer C, et al. Posterolateral Fusion in Acute Traumatic Thoracolumbar Fractures: A Comparison of Demineralized Bone Matrix and Autologous Bone Graft. Acta Chir Orthop Traumatol Cech. 2015;82(2):119-125.

[30] Kim H, Chang BS, Lee CK. Considerations for Surgical Treatment of Osteoporotic Spinal Fracture: Surgical Indication, Approach, Fixation, and Graft Material. 2016; 23(1):41.

[31] 王骅. 经椎弓根植骨治疗腰椎骨折的生物力学研究[D].扬州大学, 2007.

[32] 尹知训,丁红梅,靳安民,等.胸腰椎骨质疏松压缩性骨折经椎弓根植骨的生物力学研究[J].中国临床解剖学杂志, 2008, 26(2): 196-198.

[33] 王健,李凯,陈博,等.胸腰椎体压缩性骨折三维有限元模型的建立和分析[J].中国矫形外科杂志, 2016, 24(16):1498-1503.

[34] Teles A R, Mattei T A. Vertebral augmentation in thoracolumbar compression fractures: a critical review on available evidence and ongoing controversies. Minerva Ortopedica E Traumatologica.2015;66(1):25-39.

[35] Iwata A, Kanayama M, Oha F, et al. Does spinopelvic alignment affect the union status in thoracolumbar osteoporotic vertebral compression fracture?. Eur J Orthop Surg Traumatol. 2017;27(1):87-92.

[36] Koh YD, Park JS. Progression of Compression and Related Factors in Conservative Management of Osteoporotic Vertebral Compression Fractures. J Korean Fract Soc. 2015, 28(2):132.

[37] Meena S, Sharma P, Chowdhury B. Management of Thoracolumbar Fractures. Ijns. 2015;4(02):56-62.

[38] 张云坤,郁忠杰,杨闻强,等.椎间盘镜下经椎弓根椎体植骨成形术治疗胸腰椎压缩性骨折[J].中华创伤杂志,2003,19(10):596-599.

[39] 贺新宁,欧晔灵,付军初,等.经皮椎体内植骨支撑成形术治疗中青年胸腰椎骨折[J]. 中华创伤骨科杂志, 2010, 12(4):393-395.