Li Xigong, Lou Xianfeng, Lin Xiangjin, Du Junhua
Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhejiang University, Qingchun Road 79, Hangzhou, 310003, Zhejiang Province, China.
Osteoporos Int. 2014 May;25(5):1647-50. doi: 10.1007/s00198-014-2626-4. Epub 2014 Feb 20.
Kyphoplasty has been shown to provide symptomatic relief of vertebral compression fractures refractory to medical therapy. However, few reports have focused on refracture of cemented vertebrae after kyphoplasty. The presence of cemented vertebrae refracture concurrent with cement fragmentation is an extremely rare condition. We reported an 86-year-old man with a T12 osteoporotic compression fracture undergoing the kyphoplasty treatment. The patient postoperatively continued to have back pain at the same level. The solid lumped polymethylmethacrylate (PMMA) mass and inadequate use and insufficient filling of PMMA cement were observed in postoperative radiographs and magnetic resonance image (MRI) examination. He refused to receive the surgical intervention, but had not strict compliance with oral anti-osteoporotic medications. Ten months postoperatively, refracture of osteoporotic vertebral body concurrent with cement fragmentation occurred at the previously kyphoplasty-treated vertebral level. Bone mineral analysis showed severe osteoporosis with a T-score of -4.0. The patient finally obtained therapeutic benefit of pain relief and bony union of T12 vertebral body by consistently adhering to anti-osteoporotic medication treatment. This case illustrated that patients who underwent kyphoplasty to treat osteoporotic vertebral compression fractures with intravertebral fracture should be strictly followed up and supervised in their anti-osteoporotic medication treatment. The interdigitation injection pattern of PMMA and sufficient PMMA filling with trabeculae in the kyphoplasty procedure also might prevent refracture of the cemented vertebrae concurrent with PMMA fragmentation.
椎体后凸成形术已被证明能有效缓解药物治疗无效的椎体压缩性骨折所带来的症状。然而，很少有报告关注椎体后凸成形术后骨水泥强化椎体的再骨折情况。骨水泥强化椎体再骨折并伴有骨水泥碎裂是一种极其罕见的情况。我们报告了一名86岁男性，因T12骨质疏松性压缩骨折接受了椎体后凸成形术治疗。术后患者在同一部位仍持续存在背痛。术后X线片和磁共振成像（MRI）检查发现了固态块状聚甲基丙烯酸甲酯（PMMA）团块以及PMMA骨水泥使用不当和填充不足的情况。他拒绝接受手术干预，且未严格遵医嘱口服抗骨质疏松药物。术后十个月，在先前接受椎体后凸成形术治疗的椎体水平发生了骨质疏松性椎体再骨折并伴有骨水泥碎裂。骨矿物质分析显示严重骨质疏松，T值为 -4.0。患者最终通过持续坚持抗骨质疏松药物治疗获得了疼痛缓解和T12椎体骨愈合的治疗效果。该病例表明，接受椎体后凸成形术治疗伴有椎体内骨折的骨质疏松性椎体压缩骨折的患者，应在抗骨质疏松药物治疗方面进行严格的随访和监督。椎体后凸成形术中PMMA的交叉指状注射模式以及向骨小梁充分填充PMMA也可能预防骨水泥强化椎体再骨折并伴有PMMA碎裂的情况。
