Gu Chenxi, Huang Anquan, Wang Yefeng, Liang Dongzhu, Sun Peidong, Zhang Zhenfeng, Cai Xiaoqiang, Shen Jun, Ou-Yang Jun, Zou Tianming, Yu Xiao
Department of Orthopedics, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital Suzhou, Jiangsu, China.
Key Laboratory of Medical Biomechanics, Southern Medical University Guangzhou, Guangdong, China.
Am J Transl Res. 2022 May 15;14(5):3448-3455. eCollection 2022.
Percutaneous vertebroplasty (PVP) via the unilateral posterosuperior approach has achieved good clinical results for the treatment of osteoporotic vertebral compression fractures. This study compared the biomechanical performance of a single vertebral body after PVP by the unilateral posterosuperior, unipedicular, and bipedicular approaches. Twenty-one vertebral bodies from the osteoporotic spine segments (T11-L1) of seven older female cadavers were randomly assigned to the unipedicular (group A), bipedicular (group B), or unilateral posterosuperior approach group (group C). After constructing the fracture compression model, PVP was performed by the different approaches. CT scans showed symmetrical, evenly distributed bone cement in groups B and C and unilaterally distributed cement in group A. The recovery rates of the anterior vertebral body height in groups B and C were significantly higher than those in group A after PVP (P<0.05). The left curvature elastic moduli after PVP were significantly higher in group A than in groups B and C; however, the right curvature moduli in group A were lower than in the other groups (P<0.05). The flexion, extension, and vertical compression elastic moduli were lowest in group B (P<0.05). After PVP, failure strength and stiffness in groups B and C were comparable (P>0.05) and higher than those in group A (P<0.05). PVP through the unilateral posterosuperior approach was superior to the unipedicular approach and comparable to the bipedicular approach based on the biomechanical performance of a single vertebral body. Due to its safety, simplicity, and efficacy, the unilateral posterosuperior approach is recommended for clinical application.
经单侧后上方入路的经皮椎体成形术（PVP）在治疗骨质疏松性椎体压缩骨折方面取得了良好的临床效果。本研究比较了经单侧后上方、单椎弓根和双椎弓根入路进行PVP后单个椎体的生物力学性能。从7具老年女性尸体的骨质疏松性脊柱节段（T11-L1）获取21个椎体，随机分为单椎弓根组（A组）、双椎弓根组（B组）或单侧后上方入路组（C组）。构建骨折压缩模型后，采用不同入路进行PVP。CT扫描显示，B组和C组骨水泥分布对称、均匀，A组骨水泥单侧分布。PVP后，B组和C组椎体前缘高度恢复率显著高于A组（P<0.05）。PVP后，A组左侧弯曲弹性模量显著高于B组和C组；然而，A组右侧弯曲模量低于其他组（P<0.05）。B组的前屈、后伸和垂直压缩弹性模量最低（P<0.05）。PVP后，B组和C组的破坏强度和刚度相当（P>0.05），且高于A组（P<0.05）。基于单个椎体的生物力学性能，经单侧后上方入路的PVP优于单椎弓根入路，与双椎弓根入路相当。由于其安全性、简便性和有效性，推荐单侧后上方入路用于临床应用。
