Gumpert Rainer, Bodo Koppany, Spuller Ekkehard, Poglitsch Thomas, Bindl Ronny, Ignatius Anita, Puchwein Paul
Department of Traumatology, Medical University Graz (MUG), Auenbruggerplatz 5, 8036, Graz, Austria.
Eur Spine J. 2014 Jun;23(6):1361-8. doi: 10.1007/s00586-014-3239-5. Epub 2014 Feb 25.
Balloon kyphoplasty (BKP) with calcium phosphate cement (CPC) is increasingly being used for spinal surgery in younger patients. In routinely performed follow-up CT scans we observed considerable areas of demineralization in CPC processed vertebrae in several patients. To rule out infections or inflammations histological examinations were planned for these patients.
Ten patients (23-54 years; six men) with significant demineralization areas in CT scans after CPC balloon kyphoplasty were selected. Punch biopsies from these areas were taken in local anesthesia using a biopsy needle. One half of the specimen was decalcified and embedded in paraffin, and sections were examined histologically using hematoxylin and eosin, Van Gieson, and trichrome staining. The second half of the specimen was cast directly in methyl methacrylate and sections were examined by Paragon and von Kossa/Safranin staining. Stained slides were viewed under light microscopy.
Bone-punch specimens were taken at 17.5 months (mean) after BKP with CPC. In most cases, the cement was well surrounded by newly formed lamellar bone with very tight connections between the cement and new bone. Unmineralized areas were observed sporadically at the cement surface and adjacent to the implant. There were no pronounced signs of inflammation or osteolysis of adjacent bone. No complications were observed during or following patients' biopsy procedures.
CPC demonstrated good biocompatibility and osseointegration in clinical use, with no evidence of inflammation or osteonecrosis. Demineralized areas in CT scans could be a result of remodeling of the cancellous bone in vertebral bodies.
使用磷酸钙骨水泥（CPC）的球囊后凸成形术（BKP）越来越多地用于年轻患者的脊柱手术。在常规进行的随访CT扫描中，我们在几名患者的经CPC处理的椎骨中观察到相当大的脱矿质区域。为排除感染或炎症，计划对这些患者进行组织学检查。
选择10例（23 - 54岁；6例男性）在CPC球囊后凸成形术后CT扫描中有明显脱矿质区域的患者。在局部麻醉下使用活检针从这些区域获取穿刺活检组织。标本的一半进行脱钙并嵌入石蜡，切片用苏木精和伊红、Van Gieson和三色染色进行组织学检查。标本的另一半直接铸入甲基丙烯酸甲酯，切片用Paragon和von Kossa/番红染色进行检查。染色玻片在光学显微镜下观察。
在使用CPC进行BKP后平均17.5个月获取骨穿刺标本。在大多数情况下，骨水泥被新形成的板层骨很好地包围，骨水泥与新骨之间连接紧密。在骨水泥表面和植入物相邻处偶尔观察到未矿化区域。没有明显的炎症迹象或相邻骨的骨溶解。在患者活检过程中及之后未观察到并发症。
CPC在临床应用中表现出良好的生物相容性和骨整合性，没有炎症或骨坏死的证据。CT扫描中的脱矿质区域可能是椎体松质骨重塑的结果。
