经皮椎体后凸成形术后球囊扩张过程中微创椎体支架对降低球囊瘪陷效应的作用：一项生物力学研究。
The Role of Minimally Invasive Vertebral Body Stent on Reduction of the Deflation Effect After Kyphoplasty: A Biomechanical Study.
机构信息
Department of Orthopaedic surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
出版信息
Spine (Phila Pa 1976). 2018 Mar 15;43(6):E341-E347. doi: 10.1097/BRS.0000000000002317.
STUDY DESIGN
Biomechanical investigation using cadaver spines.
OBJECTIVE
The aim of the present study was to assess the magnitude of the deflation effect after balloon kyphoplasty (BKP) or use of minimally invasive vertebral body stent (MIVBS) in in vitro biomechanical condition.
SUMMARY OF BACKGROUND DATA
BKP is a well-established minimally invasive treatment option for osteoporotic vertebral compression fractures. However, this technique can lead to a secondary height loss-known as the "deflation effect"-causing intrasegmental kyphosis and an overall alignment failure.
METHODS
The study was conducted on 24 human cadaveric vertebral bodies (T12-L5). After creating a compression fracture model, the fractured vertebral bodies were reduced by BKP (n = 12) or by MIVBS (n = 12) and then augmented with polymethyl methacrylate bone cement. Each step of the procedure was performed under fluoroscopic guidance and the results were analyzed quantitatively. Finally, the strength and stiffness of augmented vertebral bodies were measured by biomechanical tests.
RESULTS
Complete initial reduction of the fractured vertebral body height was achieved by both systems. Secondary loss of reduction after balloon deflation was significantly greater in the BKP group (2.36 ± 0.63 mm vs. 0.34 ± 0.43 mm in the MIVBS group; P < 0.05). Height gain was significantly higher in the MIVBS group (77.68% ± 11.46% vs. 34.87% ± 13.16% in the BKP group; P < 0.05). Increase in the kyphotic angle gain (relative to the preoperative kyphotic angle) was significantly more in the MIVBS group (95.60% ± 6.12% vs. 77.0% ± 4.94% in the BKP group; P < 0.05). Failure load was significantly higher in the MIVBS group (189% ± 16% vs. 146% ± 14%; P < 0.05). However, stiffness was not significantly different between the two groups.
CONCLUSION
The deflation effect after BKP can be significantly decreased with the use of the MIVBS technique.
LEVEL OF EVIDENCE
N/A.
研究设计
使用尸体脊柱进行生物力学研究。
目的
本研究旨在评估球囊后扩张椎体成形术（BKP）或微创椎体支架（MIVBS）在体外生物力学条件下的膨胀效果。
背景资料概要
BKP 是治疗骨质疏松性椎体压缩性骨折的一种成熟的微创治疗选择。然而，这种技术会导致继发性高度损失，即“膨胀效应”，导致节段性后凸和整体排列失败。
方法
本研究在 24 个人体尸体脊柱（T12-L5）上进行。在创建压缩骨折模型后，通过 BKP（n=12）或 MIVBS（n=12）使骨折椎体复位，然后用聚甲基丙烯酸甲酯骨水泥进行增强。每个步骤都在透视引导下进行，结果进行了定量分析。最后，通过生物力学测试测量增强椎体的强度和刚度。
结果
两种系统均能完全实现初始骨折椎体高度的复位。BKP 组的球囊膨胀后，复位的二次损失明显更大（2.36±0.63mm 比 MIVBS 组的 0.34±0.43mm；P<0.05）。MIVBS 组的高度增益明显更高（77.68%±11.46%比 BKP 组的 34.87%±13.16%；P<0.05）。MIVBS 组的后凸角度增益（相对于术前后凸角）增加更为明显（95.60%±6.12%比 BKP 组的 77.0%±4.94%；P<0.05）。MIVBS 组的失效载荷明显更高（189%±16%比 BKP 组的 146%±14%；P<0.05）。然而，两组之间的刚度没有显著差异。
结论
使用 MIVBS 技术可以显著减少 BKP 后的膨胀效应。
证据水平
无。
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