Trabecular Microstructure and Damage Affect Cement Leakage From the Basivertebral Foramen During Vertebral Augmentation
Trabecular Microstructure and Damage Affect Cement Leakage From the Basivertebral Foramen During Vertebral Augmentation
复制标题
小梁微观结构和损伤影响椎体增强过程中基椎孔骨水泥渗漏
DOI：
10.1097/brs.0000000000002073
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发表时间：
2017-08-15
期刊：
影响因子：
3
通讯作者：
Zhao, Fengdong
中科院分区：
文献类型：
--
作者：
Li, Shengyun;Wang, Chongyan;Zhao, Fengdong
研究设计.尸体标本的前瞻性研究。Objective.探讨椎体强化手术中骨水泥容易从椎基底孔（BF）泄漏的原因。背景数据总结。B型（通过BF，椎基底孔）骨水泥泄漏是椎体强化后最常见的类型，但其机制仍有争议。压缩性骨折时椎体骨小梁方向和骨小梁损伤对骨水泥渗漏的影响尚不清楚。方法.本研究收集了12个新鲜冷冻的人腰椎（T12-L5），并将其分为24个三段单元。进行力学测试以模拟压缩断裂。在力学测试前后对所有节段进行MicroCT，并分析每个椎体的上级、中间（含BF）和下1/3的小梁显微结构。以压缩性骨折前后小梁间隙的直径变化来量化小梁损伤。在机械测试后，使用椎体增强和基于成像的诊断来评价骨水泥泄漏。结果中段（含BF）的骨小梁显微结构参数低于上级和下级（P <0.01）。 压缩失败后，通过MicroCT对椎体进行三维重建，显示中间区域的小梁间距明显增加。B型骨水泥泄漏是椎体加固后最常见的类型，如Wang等人之前所发现的（Spine J 2014;14：1551-1558）。结论BF的存在和松质骨的相对稀疏使得椎体的中间区域是机械最弱的区域。椎体压缩破坏时中部骨小梁损伤最严重，导致椎间间距最大，B型骨水泥渗漏率最高。这些数据表明骨水泥可能从BF中泄漏的特定机制，以及小梁微结构和小梁损伤的作用。证据等级：4
Study design. A prospective study on cadaver specimens. Objective. To explore why cement leakage from basivertebral foramen (BF) easily occurs during vertebral augmentation procedures. Summary of Background Data. Type B (through BF, basivertebral foramen) cement leakage is the most common type after vertebral augmentation, but the mechanism of this is still controversial. The contribution of vertebral trabecular bone orientation and trabecular damage during compression fracture to cement leakage is still unknown. Methods. In this study, 12 fresh-frozen human lumbar spines (T12-L5) were collected and divided into 24 three-segment units. Mechanical testing was performed to simulate a compression fracture. MicroCT were performed on all segments before and after mechanical testing, and trabecular microstructure of the superior, middle (containing BF), and inferior 1/3 of each vertebral body was analyzed. The diameter variation of intertrabecular space before and after compression fracture was used to quantify trabecular injury. After mechanical testing, vertebral augmentation, and imaging-based diagnosis were used to evaluate cement leakage. Results. Trabecular bone microstructural parameters in middle region (containing BF) were lower than those of the superior or inferior regions (P < 0.01). After compressive failure, 3D-reconstruction of the vertebral body by MicroCT demonstrated that intertrabecular distance in the middle region was markedly increased. Type B cement leakage was the most common type after vertebral augmentation, as found previously in Wang et al. (Spine J 2014;14: 1551-1558). Conclusion. The presence of the BF and the relative sparsity of trabecular bone make the middle region of the vertebral body the mechanically weakest region. Trabecular bone in middle region suffered the most severe damage during compressive failure of the vertebral body, which resulted in the greatest intervertebral spacing, and subsequently the highest percentage of type B cement leakage. These data suggest specific mechanisms by which cement may leak from the BF, and the contribution of trabecular microstructure and trabecular injury. Level of Evidence: 4