Head of the Department of Oncology and Neurosurgery, Institute of Traumatology and Orthopedics Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia.
Staff Neurosurgeon, Department of Oncology and Neurosurgery, Institute of Traumatology and Orthopedics Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia.
Sovrem Tekhnologii Med. 2021;13(5):6-10. doi: 10.17691/stm2021.13.5.01. Epub 2021 Oct 29.
was to develop a new method of vertebral augmentation based on autologous and allogeneic bone chips to be used in pedicle screw fixation and to compare this method with the technique based on polymethyl methacrylate (PMMA).
This prospective non-randomized study included 164 patients with degenerative pathologies or traumatic injuries of the lumbar spine and transitional thoracolumbar segments; 153 of the operated patients were followed up for 18 months. In these patients, radiodensity of the cancellous bone tissue was below 110 HU by the Hounsfield scale. Patients with degenerative spinal disorders underwent pedicle screw fixation using transforaminal interbody fusion; patients with traumatic spinal injuries underwent intermediate pedicle screw fixation, and those with a loss of vertebral body height by >50% underwent anterior fusion.The patients were divided into three groups: in group 1 (n=39), bone tissue augmentation was performed using PMMA; in group 2 (n=21), augmentation was done with bone chips; in group 3 (n=93), no augmentation was performed (control group). The follow-up period was 12 months; cases with fixator breakage or loosening were recorded.
After augmentation with PMMA, 11 cases (28.2%) of fixator destabilization were detected. With bone chips, fixator instability developed in 2 patients (9.5%) only, whereas in patients operated without augmentation, the instability was observed in 43 cases (46.2%). With PMMA augmentation, the incidence rate of fixator destabilization did not significantly differ from that in the control group (p=0.0801), while the use of bone chips resulted in a statistically significant decrease of this index compared to the control group (p=0.0023). A logistic regression analysis confirmed the superiority of the developed method over the PMMA-based vertebral augmentation.
The use of bone chips for vertebral augmentation provides a statistically significant decrease in the incidence of pedicle screw fixator destabilization in the post-operative period. By reducing the risk of proximal loosening and eliminating the risk of bone cement drainage into the spinal canal and vascular bed, the proposed method may become especially effective in patients with impaired bone density.
开发一种基于自体和同种异体骨屑的新型椎骨增强方法，用于椎弓根螺钉固定，并将该方法与基于聚甲基丙烯酸甲酯（PMMA）的技术进行比较。
这是一项前瞻性非随机研究，纳入了 164 例退行性病变或创伤性胸腰椎段病变患者；其中 153 例接受手术的患者随访了 18 个月。这些患者的疏松骨组织的 Hounsfield 密度低于 110 HU。退行性脊柱疾病患者接受经椎间孔椎间融合椎弓根螺钉固定；创伤性脊柱损伤患者接受中间椎弓根螺钉固定，椎体高度丢失> 50%的患者接受前路融合。患者分为三组：第 1 组（n=39），采用 PMMA 进行骨组织增强；第 2 组（n=21），采用骨屑增强；第 3 组（n=93），未进行增强（对照组）。随访期为 12 个月；记录固定器断裂或松动的病例。
采用 PMMA 增强后，发现 11 例（28.2%）固定器不稳定。采用骨屑增强时，只有 2 例（9.5%）患者发生固定器不稳定，而未行增强手术的患者中，有 43 例（46.2%）发生固定器不稳定。采用 PMMA 增强时，固定器不稳定的发生率与对照组无显著差异（p=0.0801），而采用骨屑增强与对照组相比，该指标显著降低（p=0.0023）。逻辑回归分析证实了与基于 PMMA 的椎体增强相比，所开发方法的优越性。
采用骨屑进行椎骨增强可显著降低术后椎弓根螺钉固定器不稳定的发生率。通过降低近端松动的风险，并消除骨水泥流入椎管和血管床的风险，该方法在骨密度受损的患者中可能更为有效。
