Korovessis Panagiotis, Mpountogianni Eva, Syrimpeis Vasileios, Baikousis Andreas, Tsekouras Vasileios
Orthopaedics Department, General Hospital of Patras, Tsertidou Str. 1, 26224 Rio, Greece.
Adv Orthop. 2018 Mar 5;2018:6365472. doi: 10.1155/2018/6365472. eCollection 2018.
Polymethacrylate (PMMA) is commonly used in vertebroplasty and balloon kyphoplasty, but its use has been associated with complications. This study tests three hypotheses: (1) whether strontium hydroxyapatite (Sr-HA) is equivalent to PMMA for restoring thoracolumbar vertebral body fractures, (2) whether the incidence of PMMA leakage is similar to that of Sr-HA leakage, and (3) whether Sr-HAis is resorbed and substituted by new vertebral bone.
Two age- and sex-matched groups received short percutaneous pedicle screw fixation plus PEEK implant (Kiva, VCF Treatment System, Benvenue Medical, Santa Clara, CA, USA) filled with either Sr-HA (Group A) or PMMA (Group B) after A2- and A3/AO-type thoracolumbar vertebral body fractures. The Visual Analog Scale (VAS) score and imaging parameters, which included segmental kyphosis angle (SKA), vertebral body height ratios (VBHr), spinal canal encroachment (SCE), bone cement leakage, and Sr-HA resorption, were compared between the two groups.
The average follow-up was 28 months. No differences in VAS scores between Groups A and B were observed at baseline. Baseline back pain in both groups improved significantly three months postoperatively. Anterior, middle, and posterior VBHr did not differ between the two groups at any time point. SKA was improved insignificantly in both groups. SCE decreased insignificantly in both groups on 12-month follow-up using computed tomography (CT). PMMA leakage was observed in one patient, while no Sr-HA paste leakages occurred. Sr-HA resorption and replacement with vertebral bone were observed, and no new fractures were observed.
As all hypotheses were confirmed, the authors recommend the use of Sr-HA instead of PMMA in traumatic spine fractures, although more patients and longer follow-up will be needed to strengthen these results. This trial is registered with NCT03431519.
聚甲基丙烯酸甲酯（PMMA）常用于椎体成形术和球囊后凸成形术，但其使用与并发症相关。本研究检验了三个假设：（1）羟基磷灰石锶（Sr-HA）在恢复胸腰椎椎体骨折方面是否等同于PMMA；（2）PMMA渗漏的发生率是否与Sr-HA渗漏的发生率相似；（3）Sr-HA是否会被新的椎体骨吸收并替代。
两组年龄和性别匹配的患者在发生A2型和A3/AO型胸腰椎椎体骨折后，接受短节段经皮椎弓根螺钉固定加聚醚醚酮（PEEK）植入物（Kiva，VCF治疗系统，美国加利福尼亚州圣克拉拉市的Benvenue Medical公司），植入物填充Sr-HA（A组）或PMMA（B组）。比较两组之间的视觉模拟评分（VAS）以及影像学参数，包括节段后凸角（SKA）、椎体高度比（VBHr）、椎管侵占（SCE）、骨水泥渗漏和Sr-HA吸收情况。
平均随访时间为28个月。A组和B组在基线时的VAS评分无差异。两组的基线背痛在术后3个月均有显著改善。两组在任何时间点的前、中、后VBHr均无差异。两组的SKA均有轻微改善。在12个月随访时，使用计算机断层扫描（CT）观察到两组的SCE均有轻微下降。观察到1例患者发生PMMA渗漏，但未发生Sr-HA糊剂渗漏。观察到Sr-HA被吸收并被椎体骨替代，且未观察到新的骨折。
由于所有假设均得到证实，作者建议在创伤性脊柱骨折中使用Sr-HA而非PMMA，尽管需要更多患者和更长时间的随访来强化这些结果。本试验已在ClinicalTrials.gov上注册，注册号为NCT03431519。
