骨水泥增强对胸腰脊柱后路长节段固定手术的影响

Effect of bone cement augmentation on posterior long-segment fixation surgery of the thoracolumbar spine

临床研究表明,不同节段骨水泥增强椎体能够有效预防近端交界性后凸(Proximal Junctional Kyphosis,PJK),然而其中的生物力学影响尚不清楚。针对这一现象,本研究基于正常人体脊柱计算机断层扫描(Computed Tomography,CT)数据,通过临床手术方案构建了T10-S1骨质疏松症胸腰脊柱后路固定(Posterior Thoracolumbar Spinal Fixation,PTSF)T11-S1及PTSF分别联合T10、T11或T10&T11节段椎体骨水泥增强(Vertebral Body Cement Augmentation,VBCA)构建的PTSF+T10VBCA,PTSF+T11VBCA,PTSF+T10&T11VBCA 4种手术有限元模型。通过有限元分析发现骨水泥增强椎体对于预防PJK有明显效果,单节段椎体增强会产生较大的松质骨骨折风险,因此,双节段椎体增强术对PJK的预防效果更好。

Clinical studies have shown that different segmental bone cement augmentation of the vertebral body is effective in preventing proximal junctional kyphosis(PJK).However,the biomechanical effects of this are not known.In response to this phenomenon,based on the computed tomography(CT)data of normal human spine,through a clinical surgical protocol,constructed T10-S1 osteoporosis posterior thoracolumbar spinal fixation(PTSF)T11-S1 and PTSF combined with T10,T11 or T10&T11 segment vertebral bone cement augmentation(VBCA),four surgical finite element models,PTSF+T10VBCA,PTSF+T11VBCA,PTSF+T10&T11VBCA,are established.The finite element analysis reveales that cemented vertebral body augmentation is significantly effective for the prevention of PJK,and single-segment vertebral body augmentation produces a greater risk of cancellous fracture;therefore,double-segment vertebral body augmentation is more effective for the prevention of PJK.