Moura Diogo Filipe Lino, Gabriel Josué Pereira
Centro Hospitalar e Universitário de Coimbra, Orthopedics Department, Spine Unit, Coimbra, Portugal.
Universidade de Coimbra, Faculty of Medicine, Coimbra, Portugal.
Acta Ortop Bras. 2022 May 23;30(3):e245117. doi: 10.1590/1413-785220223003e245117. eCollection 2022.
Current scientific evidence enhances the importance of the anatomic restauration of vertebral bodies with compression fractures aiming, as with other human body joints, to obtain a biomechanic and functional spine as close as the one prior to the fracture as possible. We consider that anatomic reduction of these fractures is only completely possible using intravertebral expandable implants, restoring vertebral endplate morphology, and enabling a more adequate intervertebral disc healing. This enables avoiding disc and osteodegenerative changes to that vertebral segment and its adjacent levels, as well as the anterior overload of adjacent vertebral bodies in older adults - a consequence of post-traumatic vertebral flattening - thus minimizing the risk of adjacent vertebral fractures. The ability of vertebral body fracture reduction and height maintenance over time and its percutaneous transpedicular application make the intra-vertebral expandable implants a very attractive option for treating these fractures. The authors show the direct and indirect reduction concepts of vertebral fractures, review the biomechanics, characteristics and indications of intravertebral expandable implants and present a suggestion for updating the algorithm for the surgical treatment of vertebral compression fractures which includes the use of intravertebral expandable implants.
当前的科学证据凸显了对压缩性骨折椎体进行解剖复位的重要性，与人体其他关节一样，其目标是尽可能使脊柱的生物力学和功能恢复到骨折前的状态。我们认为，只有使用椎体内可膨胀植入物才能完全实现这些骨折的解剖复位，恢复椎体终板形态，并促进椎间盘更充分地愈合。这有助于避免该椎体节段及其相邻节段出现椎间盘退变和骨质退变，以及避免老年人因创伤后椎体扁平导致相邻椎体的前负荷增加，从而将相邻椎体骨折的风险降至最低。椎体内可膨胀植入物能够随着时间推移实现椎体骨折复位和高度维持，且可经皮椎弓根置入，这使其成为治疗这些骨折极具吸引力的选择。作者展示了椎体骨折的直接和间接复位概念，回顾了椎体内可膨胀植入物的生物力学、特点和适应证，并提出了更新椎体压缩性骨折手术治疗算法的建议，其中包括使用椎体内可膨胀植入物。
