Mechanism of formation of intravertebral clefts in osteoporotic vertebral compression fractures: An in vitro biomechanical study
Mechanism of formation of intravertebral clefts in osteoporotic vertebral compression fractures: An in vitro biomechanical study
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骨质疏松性椎体压缩骨折椎内裂隙形成机制：体外生物力学研究。
DOI：
10.1016/j.spinee.2018.07.020
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发表时间：
2018-12-01
期刊：
影响因子：
4.5
通讯作者：
Zhao, Fengdong
中科院分区：
文献类型：
--
作者：
Wang Chongyan;Zhang, Xuyang;Zhao, Fengdong
背景信息：椎体内裂隙（IVCs）是一种类似真空的腔隙，通常与骨质疏松性椎体压缩骨折（OVCFs）相关。在椎体后凸成形术中，IVCs会促进骨水泥渗漏，这表明它与椎体基底静脉孔存在物理联系，尽管这一点并不确定。
目的：本研究旨在通过对尸体脊柱进行力学实验来制造IVCs，以阐明其发病机制、结构以及与椎体基底静脉孔的联系。
研究设计与方法：从5具年龄在68至71岁的尸体上获取共15个三节段腰椎标本，先对其施加轴向压缩过载，然后进行屈伸循环加载，以制造伴有IVC的OVCF。利用计算机断层扫描和X线片来确认结构变化，并使用微计算机断层扫描测量5个标本的骨小梁特性。随后对10个受损标本进行单侧椎弓根椎体成形术，直至透视显示骨水泥渗出。
结果：在每个标本中，加载都制造出了伴有IVC的OVCF。解剖和影像学显示，IVC总是与椎体基底静脉孔相连。包括IVC在内的椎体中央区域具有最低的连接密度、骨小梁数量和骨体积分数，以及最高的骨小梁分离度。椎体成形术导致9个标本的骨水泥通过椎体基底静脉孔渗漏，1个标本的骨水泥渗漏到相邻椎间盘。
结论：对骨折的骨质疏松性椎体施加屈伸循环加载可制造出IVC，进而导致骨水泥通过椎体基底静脉孔渗漏。（C）2018爱思唯尔公司。保留所有权利。
BACKGROUND CONTEXT: Intravertebral clefts (IVCs) are vacuum-like cavities commonly associated with osteoporotic vertebral compression fractures (OVCFs). IVCs promote cement leakage during kyphoplasty, suggesting a physical link with the basivertebral foramen, although this is uncertain.PURPOSE: The present study aims to create IVCs in mechanical experiments on cadaveric spines in order to clarify their pathogenesis, structure, and links with the basivertebral foramen.STUDY DESIGN AND METHODS: In total, 15 three-vertebra lumbar specimens from five cadavers aged 68 to 71 years were subjected to axial compressive overload followed by cyclic loading in flexion and extension to create an OVCF together with an IVC. Computed tomography scans and radiographs were used to confirm structural changes and micro-CT was used to measure trabecular bone properties in five specimens. Unipedicular vertebroplasty was then performed on 10 damaged specimens until fluoroscopy revealed extravasation of cement.RESULTS: In every specimen, loading created an OVCF with an IVC. Dissection and imaging showed that the IVC was always connected with the basivertebral foramen. The central vertebral region, including the IVC, had the lowest connectivity density, trabecular number, and bone volume fraction, and the highest trabecular separation. Vertebroplasty caused cement leakage through the basivertebral foramen in nine specimens and into an adjacent disc in one specimen.CONCLUSION: Cyclic loading in flexion and extension applied to a fractured osteoporotic vertebra can create an IVC, which then allows cement leakage via the basivertebral foramen. (C) 2018 Elsevier Inc. All rights reserved.