背景:骨质疏松性椎体压缩性骨折(OVCF)常见于老年患者,可能由于椎体塌陷和楔入而导致局部后凸。带有聚甲基丙烯酸甲酯的球囊椎体后凸成形术(BKP)广泛用于缓解背痛并恢复被破坏的椎骨Johnell的高度和后凸(OsteoporosInt17(12):1726-33,2006);Wasnich(Bone18:179S-183S,1996);Finnern(OsteoporosInt14:429-436,2003)。然而,BKP对OVCF患者整体矢状面对齐(GSA)的影响尚不清楚.
目的:使用以下放射学参数系统地评估有关BKP对整体脊柱矢状面对准的影响的相关文献:骨盆入射(PI),骨盆倾斜(PT),腰椎前变性(LL),胸椎后凸(TK),矢状垂直轴(SVA)和脊椎角(SSA)。还记录视觉模拟评分(VAS)。
方法:使用PRISMA指南对截至2022年8月的英语文献进行了系统回顾。
结果:共548篇文章,4项研究符合纳入标准(4项III级证据)并进行分析。总的来说,201名平均年龄73.8岁(69-77)的患者患有一个或多个椎骨的急性OVCF。男女比例为51:128。骨折的数量为235(平均每个患者1.17个骨折的椎骨)。他们在站立X射线上的术前放射学参数显示平均PI为56°,PT24.1°,LL44.4°,TK42.3°,PI-LL11.7°,SVA4.9厘米,LL/TK1和SSA114.8°。平均VAS为7.6(2.6-10)。所有患者均接受BKP,术后站立X线片的放射学参数显示平均PI为55.3°,PT23.1°,LL45.1°,TK41.4°,PI-LL10.3°,SVA4.29厘米,LL/TK1.07和SSA116.8°。BPK后它们的平均VAS为2.36(0-4.8)。比较术前/术后GSA的统计分析(111例患者,3项具有标准偏差的研究)显示PT无统计学差异(24.1°与23.5°,P=0.93),TK(42.3°vs.42.4°,P=0.57),PI-LL(14.4°vs.12.4°,P=0.4),SVA(6.1厘米vs.5.5cm,P=0.19)SSA(114.8°vs.116.7°P=0.36)。BKP后VAS显着降低(7.1vs.2.5P=0.004)。
结论:在骨质疏松性椎体压缩骨折患者中,实施BKP手术对整体矢状面对齐没有显著影响。然而,在接受1级或1级以上BKP的患者中,疼痛评分显著改善.
Osteoporotic vertebral compression fractures (OVCF) are common in elderly patients and may cause local kyphosis due to the vertebral collapse and wedging. Balloon kyphoplasty (BKP) with polymethyl methacrylate is widely used to relieve back pain and restore the height and kyphosis of the destroyed vertebra Johnell (Osteoporos Int 17(12):1726-33, 2006); Wasnich (Bone 18: 179S-183S, 1996); Finnern (Osteoporos Int 14:429-436, 2003). However, the influence of BKP on global sagittal alignment (GSA) in patients with OVCF remains unclear.
To systematically evaluate the relevant literature regarding the influence of BKP on the global spinal sagittal alignment using the following radiological parameters: Pelvic Incidence (PI), Pelvic Tilt (PT), Lumbar Lordosis (LL), Thoracic Kyphosis (TK), Sagittal Vertical Axis (SVA) and Spinosacral Angle (SSA). Visual Analogue Score (VAS) was also recorded.
A systematic
review of the English language literature dating up until August 2022, was undertaken utilising the PRISMA guidelines.
Of a total of 548 articles, 4 studies met the inclusion criteria (4 level III evidence) and were analyzed. Overall, 201 patients of mean age 73.8 years (69-77) had acute OVCF of one or more vertebra. The male to female ratio was 51:128. The number of fractured vertebrae was 235 (average of 1.17 fractured vertebrae per patient). Their pre-operative radiological parameters on standing x-rays showed a mean PI of 56°, PT 24.1°, LL 44.4°, TK 42.3°, PI-LL 11.7°, SVA 4.9 cm, LL/TK 1 and SSA 114.8°. The average VAS was 7.6 (2.6-10). All the patients underwent BKP and their radiological parameters on standing x-rays post operatively showed a mean PI of 55.3°, PT 23.1°, LL 45.1°, TK 41.4°, PI-LL 10.3°, SVA 4.29 cm, LL/TK 1.07 and SSA 116.8°. Their average VAS post BPK was 2.36 (0-4.8).A statistical analysis comparing the pre/post-operative GSA (111 patients, 3 studies with standard deviations) showed no statistical difference in PT (24.1° vs. 23.5°, P = 0.93), TK (42.3° vs. 42.4°, P = 0.57), PI-LL (14.4° vs.12.4°, P = 0.4), SVA (6.1 cm vs. 5.5 cm, P = 0.19) SSA (114.8° vs. 116.7° P = 0.36). VAS was significantly reduced post BKP (7.1 vs. 2.5 P = 0.004).
Performing BKP procedures does not significantly affect the global sagittal alignment in patients with osteoporotic vertebral compression fractures. There was however, a significant improvement in pain scores in patients undergoing BKP at 1 or more levels.