So sánh sinh học cơ học giữa việc tăng cường đốt sống với silicone và xi măng PMMA cùng hai cấp độ lấp đầy

European Spine Journal - Tập 22 - Trang 2695-2701 - 2013
Tobias L. Schulte1, Alexander Keiler2, Felix Riechelmann2, Tobias Lange1, Werner Schmoelz2
1Department of Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany
2Department of Trauma Surgery, Medical University Innsbruck, Innsbruck, Austria

Tóm tắt

Việc gia tăng đốt sống bằng PMMA là một phương pháp điều trị phổ biến đối với các gãy đốt sống do loãng xương. Các gãy tiếp theo là một biến chứng phổ biến, có thể do độ cứng tương đối cao của PMMA so với xương. Silicone với tư cách là vật liệu tăng cường có các tính chất sinh học cơ học gần hơn với xương và do đó có thể là một sự thay thế. Nghiên cứu này nhằm mục đích điều tra sự khác biệt sinh học cơ học, đặc biệt là độ cứng, của các thân đốt sống với hai vật liệu tăng cường và hai cấp độ lấp đầy. Bốn mươi đốt sống loãng xương của con người nguyên vẹn (T10–L5) đã được nghiên cứu. Các gãy hình chóp được tạo ra theo cách tiêu chuẩn hóa. Để điều trị, PMMA và silicone với hai cấp độ lấp đầy (16 và 35% lấp đầy đốt sống) được phân bổ cho bốn nhóm. Mỗi mẫu được nén 5,000 chu kỳ với một khoảng tải lớn từ 20–65% lực gãy, và độ cứng được đo. Các phép đo độ cứng với tải thấp bổ sung (100–500 N) được thực hiện cho các đốt sống nguyên vẹn và được tăng cường và sau khi nén theo chu kỳ. Kiểm tra độ cứng với tải thấp sau khi nén theo chu kỳ được chuẩn hóa theo các đốt sống nguyên vẹn cho thấy độ cứng tăng với 35 và 16% PMMA (115 và 110%) và giảm độ cứng với 35 và 16% silicone (87 và 82%). Sau khi nén theo chu kỳ (khoảng tải lớn), độ cứng chuẩn hóa theo các đốt sống không điều trị là 361 và 304% với 35 và 16% PMMA, và 243 và 222% với sự tăng cường silicone 35 và 16%. Đối với cả khoảng tải lớn và nhỏ, vật liệu tăng cường có ảnh hưởng đáng kể đến độ cứng của đốt sống được tăng cường, trong khi cấp độ lấp đầy không ảnh hưởng đáng kể đến độ cứng. Nghiên cứu này lần đầu tiên so sánh trực tiếp độ cứng của các thân đốt sống tăng cường bằng silicone và PMMA. Silicone có thể là một lựa chọn khả thi trong điều trị gãy xương do loãng xương và có tiềm năng sinh học cơ học để giảm thiểu nguy cơ gãy xương thứ phát.

Từ khóa

#đốt sống #tăng cường bằng PMMA #tăng cường bằng silicone #độ cứng #gãy xương do loãng xương

Tài liệu tham khảo

Blasco J, Martinez-Ferrer A, Macho J, San Roman L, Pomes J, Carrasco J, Monegal A, Guanabens N, Peris P (2012) Effect of vertebroplasty on pain relief, quality of life, and the incidence of new vertebral fractures: a 12-month randomized follow-up, controlled trial. J Bone Miner Res 27(5):1159–1166 Buchbinder R, Osborne RH, Ebeling PR, Wark JD, Mitchell P, Wriedt C, Graves S, Staples MP, Murphy B (2009) A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med 361(6):557–568 Farrokhi MR, Alibai E, Maghami Z (2011) Randomized controlled trial of percutaneous vertebroplasty versus optimal medical management for the relief of pain and disability in acute osteoporotic vertebral compression fractures. J Neurosurg Spine 14(5):561–569 Kallmes DF, Comstock BA, Heagerty PJ, Turner JA, Wilson DJ, Diamond TH, Edwards R, Gray LA, Stout L, Owen S, Hollingworth W, Ghdoke B, Annesley-Williams DJ, Ralston SH, Jarvik JG (2009) A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med 361(6):569–579 Longo UG, Loppini M, Denaro L, Brandi ML, Maffulli N, Denaro V (2010) The effectiveness and safety of vertebroplasty for osteoporotic vertebral compression fractures. A double blind, prospective, randomized, controlled study. Clin Cases Miner Bone Metab 7(2):109–113 Rousing R, Andersen MO, Jespersen SM, Thomsen K, Lauritsen J (2009) Percutaneous vertebroplasty compared to conservative treatment in patients with painful acute or subacute osteoporotic vertebral fractures: three-months follow-up in a clinical randomized study. Spine (Phila Pa 1976) 34(13):1349–1354 Rousing R, Hansen KL, Andersen MO, Jespersen SM, Thomsen K, Lauritsen JM (2010) Twelve-months follow-up in forty-nine patients with acute/semiacute osteoporotic vertebral fractures treated conservatively or with percutaneous vertebroplasty: a clinical randomized study. Spine (Phila Pa 1976) 35(5):478–482 Voormolen MH, Mali WP, Lohle PN, Fransen H, Lampmann LE, van der Graaf Y, Juttmann JR, Jansssens X, Verhaar HJ (2007) Percutaneous vertebroplasty compared with optimal pain medication treatment: short-term clinical outcome of patients with subacute or chronic painful osteoporotic vertebral compression fractures. The VERTOS study. AJNR Am J Neuroradiol 28(3):555–560 Klazen CA, Lohle PN, de Vries J, Jansen FH, Tielbeek AV, Blonk MC, Venmans A, van Rooij WJ, Schoemaker MC, Juttmann JR, Lo TH, Verhaar HJ, van der Graaf Y, van Everdingen KJ, Muller AF, Elgersma OE, Halkema DR, Fransen H, Janssens X, Buskens E, Mali WP (2010) Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet 376(9746):1085–1092 Grados F, Depriester C, Cayrolle G, Hardy N, Deramond H, Fardellone P (2000) Long-term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty. Rheumatology (Oxford) 39(12):1410–1414 Hierholzer J, Fuchs H, Westphalen K, Baumann C, Slotosch C, Schulz R (2008) Incidence of symptomatic vertebral fractures in patients after percutaneous vertebroplasty. Cardiovasc Intervent Radiol 31(6):1178–1183 Kim MH, Lee AS, Min SH, Yoon SH (2011) Risk factors of new compression fractures in adjacent vertebrae after percutaneous vertebroplasty. Asian Spine J 5(3):180–187 Kobayashi N, Numaguchi Y, Fuwa S, Uemura A, Matsusako M, Okajima Y, Ishiyama M, Takahashi O (2009) Prophylactic vertebroplasty: cement injection into non-fractured vertebral bodies during percutaneous vertebroplasty. Acad Radiol 16(2):136–143 Komemushi A, Tanigawa N, Kariya S, Kojima H, Shomura Y, Komemushi S, Sawada S (2006) Percutaneous vertebroplasty for osteoporotic compression fracture: multivariate study of predictors of new vertebral body fracture. Cardiovasc Intervent Radiol 29(4):580–585 Li YA, Lin CL, Chang MC, Liu CL, Chen TH, Lai SC (2012) Subsequent vertebral fracture after vertebroplasty: incidence and analysis of risk factors. Spine (Phila Pa 1976) 37(3):179–183 Lin H, Bao LH, Zhu XF, Qian C, Chen X, Han ZB (2010) Analysis of recurrent fracture of a new vertebral body after percutaneous vertebroplasty in patients with osteoporosis. Orthop Surg 2(2):119–123 Lin WC, Cheng TT, Lee YC, Wang TN, Cheng YF, Lui CC, Yu CY (2008) New vertebral osteoporotic compression fractures after percutaneous vertebroplasty: retrospective analysis of risk factors. J Vasc Interv Radiol 19(2 Pt 1):225–231 Lin WC, Lee YC, Lee CH, Kuo YL, Cheng YF, Lui CC, Cheng TT (2008) Refractures in cemented vertebrae after percutaneous vertebroplasty: a retrospective analysis. Eur Spine J 17(4):592–599 Lu K, Liang CL, Hsieh CH, Tsai YD, Chen HJ, Liliang PC (2012) Risk factors of subsequent vertebral compression fractures after vertebroplasty. Pain Med 13(3):376–382 Movrin I, Vengust R, Komadina R (2010) Adjacent vertebral fractures after percutaneous vertebral augmentation of osteoporotic vertebral compression fracture: a comparison of balloon kyphoplasty and vertebroplasty. Arch Orthop Trauma Surg 130(9):1157–1166 Rho YJ, Choe WJ, Chun YI (2012) Risk factors predicting the new symptomatic vertebral compression fractures after percutaneous vertebroplasty or kyphoplasty. Eur Spine J 21(5):905–911 Trout AT, Kallmes DF, Kaufmann TJ (2006) New fractures after vertebroplasty: adjacent fractures occur significantly sooner. AJNR Am J Neuroradiol 27(1):217–223 Tseng YY, Yang TC, Tu PH, Lo YL, Yang ST (2009) Repeated and multiple new vertebral compression fractures after percutaneous transpedicular vertebroplasty. Spine (Phila Pa 1976) 34(18):1917–1922 Voormolen MH, Lohle PN, Juttmann JR, van der Graaf Y, Fransen H, Lampmann LE (2006) The risk of new osteoporotic vertebral compression fractures in the year after percutaneous vertebroplasty. J Vasc Interv Radiol 17(1):71–76 Yen CH, Teng MM, Yuan WH, Sun YC, Chang CY (2012) Preventive vertebroplasty for adjacent vertebral bodies: a good solution to reduce adjacent vertebral fracture after percutaneous vertebroplasty. AJNR Am J Neuroradiol 33(5):826–832 Klazen CA, Venmans A, de Vries J, van Rooij WJ, Jansen FH, Blonk MC, Lohle PN, Juttmann JR, Buskens E, van Everdingen KJ, Muller A, Fransen H, Elgersma OE, Mali WP, Verhaar HJ (2010) Percutaneous vertebroplasty is not a risk factor for new osteoporotic compression fractures: results from VERTOS II. AJNR Am J Neuroradiol 31(8):1447–1450 Mudano AS, Bian J, Cope JU, Curtis JR, Gross TP, Allison JJ, Kim Y, Briggs D, Melton ME, Xi J, Saag KG (2009) Vertebroplasty and kyphoplasty are associated with an increased risk of secondary vertebral compression fractures: a population-based cohort study. Osteoporos Int 20(5):819–826 Wang HK, Lu K, Liang CL, Weng HC, Wang KW, Tsai YD, Hsieh CH, Liliang PC (2010) Comparing clinical outcomes following percutaneous vertebroplasty with conservative therapy for acute osteoporotic vertebral compression fractures. Pain Med 11(11):1659–1665 Wardlaw D, Cummings SR, Van Meirhaeghe J, Bastian L, Tillman JB, Ranstam J, Eastell R, Shabe P, Talmadge K, Boonen S (2009) Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial. Lancet 373(9668):1016–1024 Chosa K, Naito A, Awai K (2011) Newly developed compression fractures after percutaneous vertebroplasty: comparison with conservative treatment. Jpn J Radiol 29(5):335–341 Baroud G, Heini P, Nemes J, Bohner M, Ferguson S, Steffen T (2003) Biomechanical explanation of adjacent fractures following vertebroplasty. Radiology 229(2):606–607 Author reply 607–608 Boger A, Heini P, Windolf M, Schneider E (2007) Adjacent vertebral failure after vertebroplasty: a biomechanical study of low-modulus PMMA cement. Eur Spine J 16(12):2118–2125 Chiang CK, Wang YH, Yang CY, Yang BD, Wang JL (2009) Prophylactic vertebroplasty may reduce the risk of adjacent intact vertebra from fatigue injury: an ex vivo biomechanical study. Spine (Phila Pa 1976) 34(4):356–364 Wilcox RK (2006) The biomechanical effect of vertebroplasty on the adjacent vertebral body: a finite element study. Proc Inst Mech Eng H 220(4):565–572 Pickhardt PJ, Lee LJ, del Rio AM, Lauder T, Bruce RJ, Summers RM, Pooler BD, Binkley N (2011) Simultaneous screening for osteoporosis at CT colonography: bone mineral density assessment using MDCT attenuation techniques compared with the DXA reference standard. J Bone Miner Res 26(9):2194–2203 Ruger M, Schmoelz W (2009) Vertebroplasty with high-viscosity polymethylmethacrylate cement facilitates vertebral body restoration in vitro. Spine (Phila Pa 1976) 34(24):2619–2625 Liebschner MA, Rosenberg WS, Keaveny TM (2001) Effects of bone cement volume and distribution on vertebral stiffness after vertebroplasty. Spine (Phila Pa 1976) 26(14):1547–1554 Molloy S, Mathis JM, Belkoff SM (2003) The effect of vertebral body percentage fill on mechanical behavior during percutaneous vertebroplasty. Spine (Phila Pa 1976) 28(14):1549–1554 Galibert P, Deramond H, Rosat P, Le Gars D (1987) Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neurochirurgie 33(2):166–168 Lapras C, Mottolese C, Deruty R, Lapras C Jr, Remond J, Duquesnel J (1989) Percutaneous injection of methyl-metacrylate in osteoporosis and severe vertebral osteolysis (Galibert’s technic). Ann Chir 43(5):371–376 Lieberman IH, Dudeney S, Reinhardt MK, Bell G (2001) Initial outcome and efficacy of “kyphoplasty” in the treatment of painful osteoporotic vertebral compression fractures. Spine (Phila Pa 1976) 26(14):1631–1638 Laredo JD, Hamze B (2004) Complications of percutaneous vertebroplasty and their prevention. Skeletal Radiol 33(9):493–505 Han IH, Chin DK, Kuh SU, Kim KS, Jin BH, Yoon YS, Cho YE (2009) Magnetic resonance imaging findings of subsequent fractures after vertebroplasty. Neurosurgery 64(4):740–744 Discussion 744–745 Berlemann U, Ferguson SJ, Nolte LP, Heini PF (2002) Adjacent vertebral failure after vertebroplasty. A biomechanical investigation. J Bone Joint Surg Br 84(5):748–752 Polikeit A, Nolte LP, Ferguson SJ (2003) The effect of cement augmentation on the load transfer in an osteoporotic functional spinal unit: finite-element analysis. Spine (Phila Pa 1976) 28(10):991–996 Aquarius R, Homminga J, Verdonschot N, Tanck E (2011) The fracture risk of adjacent vertebrae is increased by the changed loading direction after a wedge fracture. Spine (Phila Pa 1976) 36(6):E408–E412 Ahn Y, Lee JH, Lee HY, Lee SH, Keem SH (2008) Predictive factors for subsequent vertebral fracture after percutaneous vertebroplasty. J Neurosurg Spine 9(2):129–136 Chen WJ, Kao YH, Yang SC, Yu SW, Tu YK, Chung KC (2010) Impact of cement leakage into disks on the development of adjacent vertebral compression fractures. J Spinal Disord Tech 23(1):35–39 Sun YC, Teng MM, Yuan WS, Luo CB, Chang FC, Lirng JF, Guo WY, Chang CY (2011) Risk of post-vertebroplasty fracture in adjacent vertebral bodies appears correlated with the morphologic extent of bone cement. J Chin Med Assoc 74(8):357–362 Lee KA, Hong SJ, Lee S, Cha IH, Kim BH, Kang EY (2011) Analysis of adjacent fracture after percutaneous vertebroplasty: does intradiscal cement leakage really increase the risk of adjacent vertebral fracture? Skeletal Radiol 40(12):1537–1542 Rohlmann A, Boustani HN, Bergmann G, Zander T (2010) A probabilistic finite element analysis of the stresses in the augmented vertebral body after vertebroplasty. Eur Spine J 19(9):1585–1595 Chen LH, Hsieh MK, Liao JC, Lai PL, Niu CC, Fu TS, Tsai TT, Chen WJ (2011) Repeated percutaneous vertebroplasty for refracture of cemented vertebrae. Arch Orthop Trauma Surg 131(7):927–933 Heo DH, Chin DK, Yoon YS, Kuh SU (2009) Recollapse of previous vertebral compression fracture after percutaneous vertebroplasty. Osteoporos Int 20(3):473–480 Wang JL, Chiang CK, Kuo YW, Chou WK, Yang BD (2012) Mechanism of fractures of adjacent and augmented vertebrae following simulated vertebroplasty. J Biomech 45(8):1372–1378 Colas A, Curtis J (2004) Silicone biomaterials: history and chemistry. In: Ratner BD, Hoffman AS, Schoen FJ, Lemons JE (eds) Biomaterials science: an introduction to materials in medicine, 2nd edn. Elsevier Academic Press, San Diego, pp 80–86 Colas A, Curtis J (2004) Medical applications of silicones. In: Ratner BD, Hoffman AS, Schoen FJ, Lemons JE (eds) Biomaterials science: an introduction to materials in medicine, 2nd edn. Elsevier Academic Press, San Diego, pp 697–707 Heide C (1999) Silicone rubber for medical device applications. Medical device and diagnostic industry magazine, Nov, pp 38–44 Nouda S, Tomita S, Kin A, Kawahara K, Kinoshita M (2009) Adjacent vertebral body fracture following vertebroplasty with polymethylmethacrylate or calcium phosphate cement: biomechanical evaluation of the cadaveric spine. Spine (Phila Pa 1976) 34(24):2613–2618 Luo J, Daines L, Charalambous A, Adams MA, Annesley-Williams DJ, Dolan P (2009) Vertebroplasty: only small cement volumes are required to normalize stress distributions on the vertebral bodies. Spine (Phila Pa 1976) 34(26):2865–2873