Matsuyama Yukihiro, Goto Manabu, Yoshihara Hisatake, Tsuji Taichi, Sakai Yoshihito, Nakamura Hiroshi, Sato Koji, Kamiya Mitsuhiro, Ishiguro Naoki
Orthopedic Department, Nagoya University School of Medicine, Aichi 466-8550, Japan.
J Spinal Disord Tech. 2004 Aug;17(4):291-6. doi: 10.1097/01.bsd.0000097253.54459.a6.
To assess the efficacy of posterior instrumentation and vertebral reconstruction with biodegradable calcium phosphate cement (CPC) in the treatment of osteoporotic vertebral compression fracture with neurologic deficit.
Vertebroplasty consists of the injection of polymethylmethacrylate (PMMA) cement into the vertebral body. While PMMA has high mechanical strength, it cures fast and thus allows only a short handling time. Other potential problems of using PMMA injection may include damage to surrounding tissues due to the high polymerization temperature or by the toxic unreacted monomer and the lack of long-term biocompatibility. Bone mineral cements such as calcium carbonate and CPCs have a longer working time and low thermal effect. They are also biodegradable while providing good mechanical strength. However, the viscosity of injectable mineral cements is high, and the infiltration of these cements into the vertebral body has been questioned. Recently, the infiltration properties of CPC have been significantly improved, making it more suitable for injection into the vertebral bodies for vertebral reconstruction.
Five patients were included in this open prospective study. Inclusion criteria were delayed collapsed vertebral compression fractures responsible for severe pain and neurologic dysfunction necessitating posterior decompression surgery. Of five patients, two were male and three were female with an average age at surgery of 80.4 years (71-85 years) and an average duration of follow-up of 2.5 years (2-3.5 years). Evaluation of clinical data was based on x-ray, Japanese Orthopaedic Association (JOA) score for low back pain (full score is 29 points), and Visual Analog Scale (VAS).
The levels of the delayed collapsed vertebrae were T10, L1, and L2 (for one patient each) and L4 (two patients). All patients were in poor condition, for example, renal failure, heart failure, and chronic hepatitis. The average operative time was 2 hours (1 hour 36 minutes to 2 hours 16 minutes), and intraoperative bleeding was 181 mL (85-236 mL). As for clinical symptoms, preoperative JOA score averaged 17.8 points and was improved to 26 points postoperatively, while the preoperative VAS score of 8.6 points improved to 2 points postoperatively. Morphologic evaluation showed preoperative vertebral compression ratio averaged 41% and improved to 74% immediately after the operation and finally settled at 68%. Just one of five cases experienced late vertebral collapse 3 months after the operation.
Vertebral reconstruction with biodegradable CPC in the treatment of osteoporotic vertebral compression fracture using instrumentation was a safe and useful surgical treatment.
评估后路内固定及使用可生物降解磷酸钙骨水泥（CPC）进行椎体重建治疗伴有神经功能缺损的骨质疏松性椎体压缩骨折的疗效。
椎体成形术是将聚甲基丙烯酸甲酯（PMMA）骨水泥注入椎体。虽然PMMA具有较高的机械强度，但其固化快，因此操作时间短。使用PMMA注射的其他潜在问题可能包括由于高聚合温度或有毒未反应单体对周围组织的损伤以及缺乏长期生物相容性。诸如碳酸钙和CPCs等骨矿物水泥具有更长的工作时间和低热效应。它们在提供良好机械强度的同时也是可生物降解的。然而，可注射矿物水泥的粘度较高，这些水泥向椎体内的渗透受到质疑。最近，CPC的渗透性能有了显著改善，使其更适合注入椎体进行椎体重建。
本开放性前瞻性研究纳入5例患者。纳入标准为延迟塌陷的椎体压缩骨折导致严重疼痛和神经功能障碍，需要进行后路减压手术。5例患者中，2例为男性，3例为女性，手术平均年龄为80.4岁（71 - 85岁），平均随访时间为2.5年（2 - 3.5年）。临床资料评估基于X线、日本骨科学会（JOA）下腰痛评分（满分29分）和视觉模拟评分（VAS）。
延迟塌陷椎体的节段为T10、L1和L2（各1例）以及L4（2例）。所有患者病情均较差，例如，肾衰竭、心力衰竭和慢性肝炎。平均手术时间为2小时（1小时36分钟至2小时16分钟），术中出血量为181 mL（85 - 236 mL）。至于临床症状，术前JOA评分平均为17.8分，术后提高到26分，而术前VAS评分为8.6分，术后提高到2分。形态学评估显示术前椎体压缩率平均为41%，术后立即提高到74%，最终稳定在68%。5例患者中仅1例在术后3个月出现晚期椎体塌陷。
使用器械辅助，采用可生物降解CPC进行椎体重建治疗骨质疏松性椎体压缩骨折是一种安全有效的手术治疗方法。
