Centre for Comparative and Clinical Anatomy, University of Bristol, Southwell Street, Bristol BS2 8EJ, UK.
Arch Orthop Trauma Surg. 2011 Dec;131(12):1703-10. doi: 10.1007/s00402-011-1355-9. Epub 2011 Jul 31.
Local biomechanical factors in the etiology of vertebral compression fractures are reviewed. The vertebral body is particularly vulnerable to compression fracture when its bone mineral density (BMD) falls with age. However, the risk of fracture, and the type of fracture produced, does not depend simply on BMD. Equally important is the state of degeneration of the adjacent intervertebral discs, which largely determines how compressive forces are distributed over the vertebral body. Disc height also influences load-sharing between the vertebral body and neural arch, and hence by Wolff's Law can influence regional variations in trabecular density within the vertebral body. Vertebral deformity is not entirely attributable to trauma: it can result from the gradual accumulation of fatigue damage, and can progress by a quasi-continuous process of "creep". Cement injection techniques such as vertebroplasty and kyphoplasty are valuable in the treatment of these fractures. Both techniques can stiffen a fractured vertebral body, and kyphoplasty may contribute towards restoring its height. The presence of cement can limit endplate deformation, and thereby partially reverse the adverse changes in load-sharing which follow vertebral fracture. Cement also reduces time-dependent "creep" deformation of damaged vertebrae.
探讨了局部生物力学因素在椎体压缩性骨折发病机制中的作用。随着年龄的增长，当椎体的骨密度（BMD）下降时，椎体特别容易发生压缩性骨折。然而，骨折的风险和产生的骨折类型并不仅仅取决于 BMD。同样重要的是相邻椎间盘的退变状态，它在很大程度上决定了椎体上的压缩力如何分布。椎间盘高度也会影响椎体和神经弓之间的负荷分担，因此根据 Wolff 定律，它可以影响椎体内部骨小梁密度的区域变化。椎体变形并非完全归因于创伤：它可能是由疲劳损伤的逐渐积累引起的，并且可以通过“蠕变”的准连续过程进行进展。椎体成形术和后凸成形术等水泥注射技术在这些骨折的治疗中非常有价值。这两种技术都可以使骨折的椎体变硬，后凸成形术可能有助于恢复其高度。水泥的存在可以限制终板变形，从而部分逆转椎体骨折后负荷分担的不利变化。水泥还可以减少受损椎体的时变“蠕变”变形。
