Voggenreiter Gregor
Department of Trauma Surgery, University Hospital Mannheim, Ruprecht-Karls-University of Heidelberg, Mannheim, Germany.
Spine (Phila Pa 1976). 2005 Dec 15;30(24):2806-12. doi: 10.1097/01.brs.0000190885.85675.a0.
A prospective radiographic analysis of deformity correction during the balloon kyphoplasty procedure.
To determine the spontaneous reduction of the deformity in prone position, the subsequent deformity correction by the inflatable bone tamp, and the overall deformity correction after deposition of the cement.
Fracture mobility has been shown to contribute to fracture reduction in vertebroplasty. Spontaneous reduction has not been taken into account in recently published series of balloon kyphoplasty, but it must be considered when performing vertebral augmentation and when reporting and interpreting the significance of vertebral height restoration.
A consecutive series of 39 osteoporotic vertebral compression fractures were treated in 30 patients. Lateral radiographs were taken and analyzed at six different time points: 1) Preoperative standing. During the kyphoplasty procedure, four consecutive radiographs were obtained: 2) after placing the patient in prone position on the operation table, 3) after inflation of the bone tamp (IBT), 4) after deflation and removal of the IBT, and 5) after deposition of the cement. 6) Standing lateral radiographs were taken after the procedure. All fractures were analyzed for improvement in sagittal alignment (Cobb angle, kyphotic angle, sagittal index, vertebral height), complications, and reduction of pain (VAS).
Placement of the patient in prone position displayed a significant spontaneous reduction in deformity of 6.5 degrees +/- 4.1 degrees Cobb angle. Inflation of the IBT demonstrated a further reduction of the fracture and a significant improvement of the Cobb angle of 3.4 degrees compared with baseline prone. After deflation and removal of the IBT and placement of the cement, no significant loss of fracture reduction was seen. Postoperative measurement of the Cobb angle by means of standing radiographs demonstrated a 3.1 degrees significant loss of reduction compared with the intraoperative measurement in prone position after cement application. Cement leaks occurred in 9 of 39 vertebral fractures. All patients subjectively reported immediate relief of their typical fracture pain. The VAS score significantly improved from 8.7 +/- 1.4 before surgery to 2.3 +/- 0.9.
The restoration of height in kyphoplasty is attributed to dynamic fracture mobility as well as to the expansion of the inserted balloon tamp.
球囊后凸成形术过程中畸形矫正的前瞻性影像学分析。
确定俯卧位时畸形的自发矫正情况、随后通过可膨胀骨填充器进行的畸形矫正以及骨水泥注入后的整体畸形矫正情况。
骨折的可动性已被证明有助于椎体成形术中骨折的复位。在最近发表的一系列球囊后凸成形术研究中，尚未考虑自发复位情况，但在进行椎体强化以及报告和解释椎体高度恢复的意义时，必须予以考虑。
对30例患者的39例骨质疏松性椎体压缩骨折进行连续观察。在六个不同时间点拍摄并分析侧位X线片：1）术前站立位。在后凸成形术过程中，连续获取四张X线片：2）将患者置于手术台上俯卧位后，3）骨填充器（IBT）充气后，4）IBT放气并取出后，5）骨水泥注入后。6）术后拍摄站立位侧位X线片。分析所有骨折在矢状位对线（Cobb角、后凸角、矢状指数、椎体高度）方面的改善情况、并发症以及疼痛减轻情况（视觉模拟评分法[VAS]）。
患者置于俯卧位时，畸形出现了6.5度±4.1度Cobb角的显著自发矫正。IBT充气显示骨折进一步复位，与俯卧位基线相比，Cobb角显著改善了3.4度。IBT放气并取出以及骨水泥注入后，未见骨折复位有明显丢失。术后通过站立位X线片测量Cobb角显示，与骨水泥注入后俯卧位的术中测量相比，复位有3.1度的显著丢失。39例椎体骨折中有9例发生骨水泥渗漏。所有患者主观报告典型骨折疼痛立即缓解。VAS评分从术前的8.7±1.4显著改善至2.3±0.9。
后凸成形术中高度的恢复归因于动态骨折可动性以及插入的球囊填充器的膨胀。
