骨质疏松性椎体压缩骨折经皮椎体强化术后椎体内骨水泥分布类型的研究进展

The distribution of bone cement in the vertebral body after percutaneous vertebral augmentation for osteoporotic vertebral compression fractures

经皮椎体强化术是治疗骨质疏松性椎体压缩骨折有效且安全的方法,包括经皮椎体成形术和经皮椎体后凸成形术。经皮椎体强化术通过将骨水泥注入骨折椎体内以增加椎体强度,从而减轻症状。术中注入的骨水泥根据位置可分为椎体外(渗漏)和椎体内两部分。椎体外骨水泥(渗漏)或可导致肺栓塞、脊髓神经损伤等并发症;椎体内骨水泥分布情况,或与临床结果、影像学结果、手术并发症及生物力学性能等密切相关。截止目前,椎体内骨水泥分布类型的研究数量众多、分类标准不一,尚缺乏系统归纳。骨水泥分布类型是经皮椎体强化术中非常重要的参数,几乎不可忽视;根据术后X线片分类居多,根据术后CT扫描分类次之,根据术后MR检查分类少见;根据骨水泥形态的分类标准趋于一致,而根据骨水泥范围的分类标准趋于混乱;无论是形态分类还是范围分类,不同研究者的结论均有相同、相似或相佐;单一现有的分类方法,尚不能完好的描述骨水泥分布情况。对分类系统进行综述,总结分类系统的临床意义及生物力学相关结论,归纳分类系统的可靠性和局限性,以期为骨水泥椎体分布情况分类的进一步研究提供思路。

Percutaneous vertebral augmentation,including percutaneous vertebroplasty and percutaneous kyphoplasty,has been considered as an effective and safe option in treating osteoporotic vertebral compression fractures.The fractured vertebrae were strengthened by the bone cement injected,thus reducing the symptoms related to fracture.Bone cement injected intraoperatively can be divided into extraspinal(leakage)and intraspinal part,depending on its final location.The former may lead to pulmonary embolism,spinal cord or nerve injury,or some other sequelae;the latter may closely relate to the clinical outcome,radiological outcomes,surgical complications and biomechanical properties.To date,there were a large number of studies on term of the distribution type of bone cement.However,the classification criteria varied and there was lack of literature review on this issue.According to the literature reviewed,the distribution type of bone cement was a critical parameter in percutaneous vertebral augmentation;most classification systems were based on the postoperative X-ray,some based on the postoperative CT,and only a few based on postoperative MRI;in different classification systems,criteria on bone cement morphology tends to be consistent,however,criteria on bone cement range tends to be inconsistent,consistency,similarity and controversy all exited among conclusions between various studies on the morphology and range of bone cement;any single classification system can not describe the distribution of bone cement thoroughly.In this study,classification systems were reviewed,clinical significance and biomechanical conclusions of different classification systems were documented,and the reliability and limitations of classification systems were summarized,hence providing an insight for further research on classifications of the bone cement distribution.