Larsson S
Department of Orthopedics, Uppsala University Hospital, Uppsala, Sweden.
Scand J Surg. 2006;95(2):111-8. doi: 10.1177/145749690609500206.
Surgical treatment of fractures close to joints, especially in osteoporotic patients, is often associated with problems to obtain adequate strength of the bone-implant construct as well as sufficient purchase for screws in the weak bone. One way to address this increasing problem is through the development of new metal implants specifically designed for fixation of fractures in osteopenic bone. An alternative strategy is to develop methods for augmentation of the weak bone that surrounds the metal implant. In most instances augmentation is achieved by using injectable cement to reinforce the bone. Conventional PMMA provides good strength but due to several drawbacks it has never gained general acceptance for fracture augmentation. More recently several injectable cements based on calcium-phosphate, calcium-sulphate or bioglass has been developed for augmentation of fractures in the extremities as well as for vertebral compressive fractures in the spine. On the basis of biomechanical studies and the clinical experience so far, cement augmentation will enable faster rehabilitation, as the strength of the cement makes it possible to allow full weight-bearing earlier than conventional metal implants alone. More clinical studies are needed in order to refine the surgical technique, develop cement types aimed for fracture treatment and define the most appropriate indications and limitations of augmentation for fracture repair. The purpose of this article is to review the possible use of augmentation as a technique in the treatment of fractures in the extremities as well as in the spine.
关节附近骨折的手术治疗，尤其是在骨质疏松患者中，常常伴随着诸多问题，比如难以获得骨植入物结构的足够强度，以及在脆弱骨质中螺钉难以获得足够的把持力。解决这一日益严重问题的一种方法是研发专门用于固定骨质减少患者骨折的新型金属植入物。另一种策略是开发增强金属植入物周围脆弱骨质的方法。在大多数情况下，增强是通过使用可注射骨水泥来强化骨质实现的。传统的聚甲基丙烯酸甲酯（PMMA）骨水泥具有良好的强度，但由于存在一些缺点，它从未被广泛接受用于骨折增强。最近，已经开发出几种基于磷酸钙、硫酸钙或生物玻璃的可注射骨水泥，用于治疗四肢骨折以及脊柱椎体压缩性骨折。基于目前的生物力学研究和临床经验，骨水泥增强能够实现更快的康复，因为骨水泥的强度使得患者能够比仅使用传统金属植入物更早地完全负重。为了完善手术技术、开发针对骨折治疗的骨水泥类型以及确定骨折修复增强最合适的适应症和局限性，还需要更多的临床研究。本文的目的是综述增强技术在治疗四肢骨折以及脊柱骨折中的可能应用。
