Pillar implantation and percutaneous balloon kyphoplasty for the treatment of thoracolumbar vertebral compression fractures

doi:10.3969/j.issn.2095-4344.2013.09.019

Abstract

Abstract:

BACKGROUND: Pillar implantation and percutaneous balloon kyphoplasty can overcome the drawbacks of “shell-like” vertebral after traditional posterior screw and rod system reset, make up the lack of traditional pedicle screw and rod system fixation, correct the deformity of the fractured vertebra with varying degrees, recover the carrying capacity and maintain the stability. But, which has the better efficacy has not been yet clear.
OBJECTIVE: To compare the clinical effects of Pillar implantation and percutaneous balloon kyphoplasty for the elderly thoracolumbar vertebral compression fractures.
METHODS: Pillar implantation was performed in 18 patients with elderly thoracolumbar vertebral compression fractures, percutaneous balloon kyphoplasty was performed in 76 patients with elderly thoracolumbar vertebral compression fractures. The operative time, blood loss, 24 hours visual analogue scale score, 7 days visual analogue scale score, anterior vertebral height and the Cobb angle were analyzed retrospectively.
RESULTS AND CONCLUSION: Both Pillar implantation in 18 patients and percutaneous balloon kyphoplasty in 76 patients were successed. The visual analogue scale score and Cobb angle after Pillar implantation were decreased, but the anterior vertebral height was increased significantly, and there was significant difference of anterior vertebral height when compared with that before implantation (P < 0.05). Compared with percutaneous kyphoplasty, the Pillar implantation showed longer operative time, more blood loss and higher 24 hours visual balloon analogue scale score, and the differences were significant (P < 0.05). However, there were no significant differences in anterior vertebral height and 7 days visual analogue scale score between Pillar implantation group and percutaneous balloon kyphoplasty group (P > 0.05). There was no adverse reaction after Pillar implantation, and cement leakage could be observed in percutaneous balloon kyphoplasty group and no neurosis could be observed. Pillar implantation and percutaneous balloon kyphoplasty for the treatment of elderly thoracolumbar vertebral compression fractures have the advantages of simple operation, shorter operative time and less blood loss, and it can improve the anterior vertebral height and relieve the pain, which is considered as the effective method for the treatment of thoracolumbar vertebral compression fractures.

Key words: bone and joint implants, basic experiment of bone injury, osteoporosis, pillar block, kyphoplasty, thoracolumbar vertebral compression fractures, balloon dilatation, anterior vertebral height, vertebral height, pain, visual analog scale, Cobb angle

CLC Number:

R318

Yu Jin-he, Sun Xian-ze, Ren Liang, Liu Yan-bing, Gu Zhen-fang, Hou Shu-bing. Pillar implantation and percutaneous balloon kyphoplasty for the treatment of thoracolumbar vertebral compression fractures[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(9): 1648-1654.

Figures/Tables 7

References

[1] Kado DM, Browner WS, Palermo L, et al. Vertebral fracture and mortality in olderwomen: a prospective study. Arch Intern Med. 1999;159(11):1215-1220.

[2] Lieberman IH, Dudeney S, ReinhardtMK, et al. Initial outcome and efficacy of“kyphoplasty”in the treatment ofpainful osteoporotic vertebral compression fractures. Spine J. 2001; 26(14):1631-1638.

[3] Qiu MC. Zhonghua Yixue Zazhi. 2001;81(14):833-835. 邱明才.骨质疏松研究的现状与展望[J].中华医学杂志,2001, 81(14):833-835.

[4] Liu ZH, Zhang L, Gao LB,et al. Zhonghua CHuangshang Guke Zazhi. 2012;14(6):507-512. 刘振华,张亮,高梁斌,等.胸腰段重度楔形骨质疏松性椎体压缩骨折的经皮椎体成形术治疗与保守治疗的近期疗效和并发症的比较[J].中华创伤骨科杂志,2012,14(6):507-512.

[5] Rampersaud YR,Annand N,Dekutoski MB. Use of minimally invasive surgical techniques in the management of thoracolumbar trauma: current concepts. Spine J.2006;31 (11 Suppl):S96-102; discussion S104.

[6] Young C, Munk PL, Heran MK, et al.Treatent of severe vertebral body compression fractures with percutaneous vertebroplasty. Skeletal Radiol. 2011;40(12):1531-1536.

[7] MeGirt MJ, Parker SL, Wolinsky JP, et al. Vertebroplasty and Kyphoplasty for the treatment of vertebral compression fractures: an evidenced base dreview of the literature. Spine J. 2009;9(6):501-508.

[8] Galibert P, Deramond H, Rosat P, et al. Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neurochirurgie. 1987;33(2):66-168.

[9] Xie XY,Li PS, Li YM, et al. Zhongguo Jiaoxing Waike Zazhi. 2008;16(6):467-468. 谢晓勇,李平生,李玉茂,等.骨质疏松性脊柱多发性骨折后凸成形术近期疗效分析[J].中国矫形外科杂志,2008,16(6):467-468.

[10] Yu JH, Sun XZ, Hou SB, et al. Zhongguo Jiaoxing Waike Zazhi. 2011;19(14):1158-1162. 于金河,孙先泽,侯树兵,等.过伸复位结合椎体后凸成形术治疗后壁破裂的骨质疏松性椎体骨折[J].中国矫形外科杂志,2011, 19(14):1158-1162.

[11] Hulme Pa, Krebs J, Ferguson SJ, et al. Vertebroplasty and kyphoplasty: a systematic review of 69 clinical studies. Spine J. 2006;31(17):1983-2001.

[12] Yang F, Tang M, Xu KY, et al. Shiyong Guke Zazhi. 2012; 18(6):484-485. 杨峰,唐淼,许康永,等. 椎体后凸成形术治疗骨质疏松性胸腰椎压缩性骨折[J].实用骨科杂志,2012,18(6):484-485.

[13] Li SG, Tao H, Li JJ, et al. Zhongguo Jiaoxing Waike Zazhi. 2009;17(2),98-101. 李绍刚,陶海,李建军,等.球囊扩张与Sky扩张后凸成形术的对比研究[J].中国矫形外科杂志,2009,17(2),98-101.

[14] Zhang N, Yin GY, Shen GW. SHiyong Laonian Yixue. 2010; 27(5):367-372. 张宁,殷国勇,沈国蔚.椎体内复位扩张器在经皮后凸成形术治疗中的研究现状[J].实用老年医学2010,27(5):367-372.

[15] Yin GY, Zhang ZT, Zhang N, et al. Zhongguo Jizhu Jisui Zazhi. 2012;20(9):711-715. 殷国勇,张子韬,张宁,等.应用Jack椎体扩张器行后椎体凸成形术治疗骨质疏松性胸腰椎压缩骨折[J].中国脊柱脊髓杂志,2012, 20(9);711-715.

[16] Gaitanis IN, Hadjipavlou AG, Katonis PG, et al.Balloon kyphoplasty for the treatment of pathological vertebral compression fractures. Eur Spine J. 2005; 14(3):250-260.

[17] Lin FH, Yi XB, Ren ZH, et al. Zhongguo Gu yu Guanjie Sunshang Zazhi. 2009;24(1):66-67. 蔺福辉,易小波,任志宏,等.高粘度骨水泥在经皮椎体成形术中的应用[J].中国骨与关节损伤杂志,2009,24(1):66-67.

[18] Li B, Yu Y, Zhong B, et al. Zhonghua Chuangshang Guke Zazhi. 2010;12(6):486-488. 李波,余雨,钟斌,等.高压分步注射骨水泥选择性经皮椎体成形术治疗骨质疏松性多发椎体骨折[J].中华创伤骨科杂志,2010, 12(6):486-488.

[19] Manson NA, Phillips FM. Minimally invasive techniques for the treatment of osteoporotic vertebral fractures. Instr Course Lect. 2007;56:273-285.

[20] Sun G, Jin P, Yi YH. Jieru Fangshexue Zazhi. 2006;15(7): 410-412. 孙钢,金鹏,易玉海.椎体后凸成形术治疗老年骨质疏松性椎体压缩骨折[J].介入放射学杂志,2006,15(7):410-412.

[21] Fang XH, Ding LH, Fan YL,et al. Zhongguo Jizhu Jisui Zazhi. 2011;21(11):890-894. 方晓辉,丁亮华,樊友亮,等.微创经椎弓根前柱植骨支柱快植入治疗胸腰椎压缩骨折[J].中国脊柱脊髓杂志,2011,21(11):890-894.

[22] Jiang ST, Ding LH, Zhu XG, et al. Zhongguo Yishi Jinxiu Zazhi. 2010;33(32):50-52. 姜世涛,丁亮华,朱小广,等.联合椎弓根钉椎体支柱块治疗胸腰椎骨折20例短期疗效分析[J].中国医师进修杂志,2010,33(32): 50-52.

[23] Jiang ST,Zhang LZ, Ding LH, et al. Zhongguo Gu yu Guanjie Sunshang Zazhi. 2012;27(3):241-242. 姜世涛,张洛舟,丁亮华,等.支柱块治疗胸腰椎骨折24例临床疗效分析[J].中国骨与关节损伤杂志,2012,27(3):241-242.

[24] Jiang ST, Ding LH, Zhang LZ, et al. Zhongguo Jizhu Jisui Zazhi. 2012;22(5):470-471. 姜世涛,丁亮华,张洛舟,等.椎体内置入支柱块联合椎弓根螺钉固定治疗胸腰椎爆裂骨折[J].中国脊柱脊髓杂志,2012,22(5): 470-471.

[25] Hu YS, Ma Y, Tian HZ,et al. Zhongguo Jiaoxing Waike Zazhi. 2007;15(18):1392-1394. 胡永胜,马原,田慧中,等.经皮椎体成形术的临床应用[J]. 中国矫形外科杂志,2007,15(18):1392-1394.

[26] Yu W. Zhonghua Guzhi Susong He Gukuangyan Jibing Zazhi. 2010;3(2):141-148. 余卫.国际临床骨测量学会2007年骨测量文件简介[J].中华骨质疏松和骨矿盐疾病杂志,2010,3(2):141-148.

[27] Yang HL, Wang GL, Niu GQ, et al. Zhonghua Chuangshang Guke Zazhi. 2007;9(8):760-762. 杨惠林,王根林,牛国旗,等.球囊扩张椎体后凸成形术治疗骨质疏松椎体骨折骨不愈合[J].中华创伤骨科杂志,2007,9(8):760-762.

[28] Lin WC, Lee YC, Lee CH, et al.Refractures in cemented vertebrate after percutaneous vertebroplasty: a retrospective analysis. Eur Spine J. 2008;17(4):592-599.

[29] Ledlie JT, Renfro MB. kyphoplasty treatment of vertebral fractures：2-year outcomes show sustained benefits. 2006; 31(1):57-64.

[30] Baroud G, Nemes J, Heini P, et al. Load shift of the intervertebral disc after a vertebroplasty: a finite-element study. Eur Spine J. 2003;12(4):421-426.

[31] Liv HZ, Zhao F, Cao J, et al. ZHongguo Xiufu Chongjian Waike Zazhi. 2012;26(12):1419-1421. 吕辉照,赵枫,曹杰,等.椎间盘镜下后路椎管减压联合椎体支柱块治疗胸腰椎陈旧性骨折[J].中国修复重建外科杂志,2012,26(12): 1419-1421.

[32] Tian HZ. Zhongguo Jiaoxing Waike Zazhi. 2003;11(18): 1231-1234. 田慧中.椎体间撑压系统加立柱植骨治疗胸腰椎压缩骨折失稳[J].中国矫形外科杂志,2003,11(18):1231-1234.

[33] Liu XJ, WangJ, Liu YZ, et al. Zhongguo Guy u Guanjie Sunshang Zazhi. 2012;27(1):41-42. 刘喜俊,王健,刘颖赵,等. Pillar结合后路椎弓根内固定治疗胸腰段椎体骨折[J]. 中国骨与关节损伤杂志,2012,27(1):41-42.

[34] Nieuwenhuijse MJ, Putter H, van Erkel AR, et al. New Vertebral Fractures after Percutaneous Vertebroplasty for Painful Osteoporotic Vertebral Compression Fractures: A Clustered Analysis and the Relevance of Intradiskal Cement Leakage. Radiology. 2012 Nov 30.

[35] Yoo CM, Park KB, Hwang SH, et al. The analysis of patterns and risk factors of newly developed vertebral compression fractures after percutaneous vertebroplasty. J Korean Neurosurg Soc. 2012;52(4):339-345.

[36] Fernández-Baíllo N, Sánchez Márquez JM, Sánchez Pérez-Grueso FJ, et al. Proximal junctional vertebral fracture-subluxation after adult spine deformity surgery. Does vertebral augmentation avoid this complication? A case report. Scoliosis. 2012;7(1):16.