Department of Orthopedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People' Republic of China.
Department of Orthopedic surgery, Singapore General Hospital, Singapore.
Spine (Phila Pa 1976). 2017 Aug 15;42(16):E939-E948. doi: 10.1097/BRS.0000000000002073.
A prospective study on cadaver specimens.
To explore why cement leakage from basivertebral foramen (BF) easily occurs during vertebral augmentation procedures.
Type B (through BF, basivertebral foramen) cement leakage is the most common type after vertebral augmentation, but the mechanism of this is still controversial. The contribution of vertebral trabecular bone orientation and trabecular damage during compression fracture to cement leakage is still unknown.
In this study, 12 fresh-frozen human lumbar spines (T12-L5) were collected and divided into 24 three-segment units. Mechanical testing was performed to simulate a compression fracture. MicroCT were performed on all segments before and after mechanical testing, and trabecular microstructure of the superior, middle (containing BF), and inferior 1/3 of each vertebral body was analyzed. The diameter variation of intertrabecular space before and after compression fracture was used to quantify trabecular injury. After mechanical testing, vertebral augmentation, and imaging-based diagnosis were used to evaluate cement leakage.
Trabecular bone microstructural parameters in middle region (containing BF) were lower than those of the superior or inferior regions (P < 0.01). After compressive failure, 3D-reconstruction of the vertebral body by MicroCT demonstrated that intertrabecular distance in the middle region was markedly increased. Type B cement leakage was the most common type after vertebral augmentation, as found previously in Wang et al. (Spine J 2014;14: 1551-1558).
The presence of the BF and the relative sparsity of trabecular bone make the middle region of the vertebral body the mechanically weakest region. Trabecular bone in middle region suffered the most severe damage during compressive failure of the vertebral body, which resulted in the greatest intervertebral spacing, and subsequently the highest percentage of type B cement leakage. These data suggest specific mechanisms by which cement may leak from the BF, and the contribution of trabecular microstructure and trabecular injury.
一项针对尸体标本的前瞻性研究。
探索椎体增强过程中为何骨水泥容易从基底静脉孔（BF）漏出。
椎体增强后最常见的骨水泥渗漏类型为 B 型（经 BF），但该机制仍存在争议。在压缩性骨折过程中，椎体小梁骨方向和小梁损伤对骨水泥渗漏的影响尚不清楚。
本研究共收集 12 个新鲜冷冻人腰椎（T12-L5），分为 24 个三节段单元。进行力学测试以模拟压缩性骨折。对所有节段在力学测试前后均进行 microCT 检查，并分析每个椎体上、中（包含 BF）和下 1/3 的小梁微观结构。压缩性骨折前后 intertrabecular 空间直径变化用于量化小梁损伤。力学测试后，进行椎体增强和基于影像学的诊断以评估骨水泥渗漏。
中间区域（包含 BF）的小梁骨微观结构参数低于上、下区域（P ＜ 0.01）。经 microCT 三维重建椎体压缩性骨折后，中间区域的 intertrabecular 距离明显增加。Wang 等人先前发现，椎体增强后最常见的骨水泥渗漏类型为 B 型（Spine J 2014；14: 1551-1558）。
BF 的存在和小梁骨的相对稀疏使椎体中间区域成为力学上最薄弱的区域。在椎体压缩性骨折过程中，中间区域的小梁骨受到最严重的损伤，导致椎间间距最大，随后 B 型骨水泥渗漏率最高。这些数据表明了骨水泥可能从 BF 漏出的具体机制，以及小梁微观结构和小梁损伤的作用。
4 级。
