Budapest University of Technology and Economics, Műegyetem rkp. 3, H-1111 Budapest, Hungary.
AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos Platz, Switzerland.
Med Eng Phys. 2019 Mar;65:46-56. doi: 10.1016/j.medengphy.2019.01.004. Epub 2019 Feb 4.
Vertebroplasty and kyphoplasty are alternative augmentation techniques of osteoporotic vertebral compression fractures. However, shortly after augmentation, new vertebral compression fractures may occur, mostly in the adjacent vertebrae. To prevent this, prophylactic cement injection can be applied to the neighboring vertebral bodies. Although there are many evidence-based clinical studies on the potential hazards of vertebroplasty and kyphoplasty, there are only few studies comparing the prophylactic potential of the two treatments. In this matched-pair experimental biomechanical study, the two treatments were compared via destructive compressive testing of 76 non-fractured osteoporotic human lumbar vertebral bodies from 24 cadavers, augmented pair-wise with vertebroplasty or kyphoplasty. Strength, stiffness and deformability were analyzed in terms of donor age, CT-based bone density, vertebral morphometry, and cement-endplate contacts. These were investigated in a paired analysis and also in terms of the number of cement-endplate contacts. Vertebroplasty resulted in significantly, but only 19% larger stiffness, approximately equal failure load and smaller failure displacement compared to kyphoplasty. Cement-endplate contacts affect augmentation differently for the two techniques, namely, strength significantly increased with increasing number of contacts in vertebroplasty, but decreased in kyphoplasty. The reasons for these contrasting behavior included the fundamentally different augmentation method, the resulting different construction and location of cement clouds and the different form and location of failure. These results indicate that both prophylactic vertebroplasty and kyphoplasty of non-fractured adjacent vertebrae may be advantageous to avoid subsequent fractures after post-fracture vertebroplasty and kyphoplasty, respectively. However, cement bridging in vertebroplasty and central cement placement in kyphoplasty are advantageous in prevention.
椎体成形术和后凸成形术是骨质疏松性椎体压缩性骨折的两种可供选择的增强技术。然而，在增强后不久，新的椎体压缩性骨折可能会发生，主要发生在相邻的椎体。为了预防这种情况，可以在相邻的椎体上预防性地注入水泥。虽然有许多关于椎体成形术和后凸成形术潜在危害的基于证据的临床研究，但比较这两种治疗方法的预防潜力的研究很少。在这项配对实验生物力学研究中，通过对 24 具尸体的 76 个非骨折骨质疏松性人腰椎体进行破坏性压缩试验，比较了这两种治疗方法。对供体年龄、基于 CT 的骨密度、椎体形态计量学和水泥-终板接触进行了分析。这些在配对分析中以及在水泥-终板接触次数方面进行了研究。与后凸成形术相比，椎体成形术的刚度显著增加，但仅增加了 19%，失效载荷大致相等，失效位移较小。水泥-终板接触对两种技术的增强效果不同，即椎体成形术中接触次数的增加显著增加了强度，但在后凸成形术中则降低了强度。造成这种对比行为的原因包括根本不同的增强方法、由此产生的水泥云的不同结构和位置，以及不同形式和位置的失效。这些结果表明，预防性椎体成形术和非骨折相邻椎体的后凸成形术可能有利于分别避免骨折后椎体成形术和后凸成形术后的后续骨折。然而，椎体成形术中的水泥桥接和后凸成形术中的中央水泥放置在预防方面是有利的。
