Revista Espanola de Cirugia Ortopedica y Traumatologia最新文献_第3页

[Translated article] Osteoporotic vertebral fractures: Natural history and impact 骨质疏松性脊椎骨折：自然史和影响。

Q3 Medicine

Revista Espanola de Cirugia Ortopedica y Traumatologia

Pub Date : 2024-11-01 DOI: 10.1016/j.recot.2024.08.003

P. Checa-Betegón, R. Luque-Pérez, D. Oñate-Martínez-Olascoaga, J.L. Pérez-González, I. Domínguez-Esteban

Osteoporosis, and the consequences derived from it, such as fragility fractures, constitute a growing public health problem. Suffering from a fracture of this nature is the main risk factor for suffering a new fracture.

It is documented that vertebral compression fractures lead to significant morbidity and mortality, in the short and long term, as well as other complications, such as sagittal imbalance and hyperkyphosis of the segment. However, we have not found documentation that analyzes the medium and long-term consequences of these injuries, assessing the type of treatment used, and the economic impact they represent.

The purpose of this review is to analyse the main recent literature on the subject and make a breakdown of the consequences of these fractures in various spheres, such as economic, quality of life, sagittal balance and radiographic parameters, pain or mortality; as well as a brief analysis of epidemiology and natural history.

Conclusion

Osteoporotic fractures constitute an emerging problem, both in the medical and economic fields. The consequences and sequelae on the patient are multiple and although surgical options offer good long-term results, it is necessary to properly select the patient, through multidisciplinary teams, to try to minimise potential complications.

骨质疏松症及其引发的后果，如脆性骨折，是一个日益严重的公共健康问题。这种性质的骨折是再次发生骨折的主要风险因素。有资料显示，椎体压缩性骨折会导致严重的短期和长期发病率和死亡率，以及其他并发症，如椎节矢状不平衡和椎体后凸。然而，我们尚未发现有文献对这些损伤的中长期后果进行分析，评估所采用的治疗方式及其对经济的影响。本综述旨在分析近期有关该主题的主要文献，并对这些骨折在经济、生活质量、矢状平衡和放射学参数、疼痛或死亡率等不同领域造成的后果进行细分；同时对流行病学和自然病史进行简要分析。结论骨质疏松性骨折在医疗和经济领域都是一个新出现的问题。对患者造成的后果和后遗症是多方面的，虽然手术治疗可提供良好的长期效果，但有必要通过多学科团队对患者进行适当的选择，以尽量减少潜在的并发症。

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引用次数: 0

Diagnóstico radiográfico de pacientes con fracturas por compresión vertebral 脊椎压缩性骨折患者的诊断成像。

Q3 Medicine

Revista Espanola de Cirugia Ortopedica y Traumatologia

Pub Date : 2024-11-01 DOI: 10.1016/j.recot.2024.06.007

E. Arana

Vertebral compression fractures by osteoporosis (OVF) is usually a diagnostic problem and coincides on the age group of metastatic vertebral compression fractures (MVF). Although radiography is the first diagnostic technique, generally is not accurate for depicting demineralization and soft tissue lesions. Magnetic resonance (MRI) is the diagnostic choice. The most relevant signs are Intravertebral fluid collection or fluid signal, other vertebral deformities without edema and older age. Among the most relevant findings for diagnosis MVF are soft tissue mass and pedicle intensity signal asymmetries. However, reproducibility of these findings in clinical practice is moderate.

骨质疏松症导致的椎体压缩性骨折（OVF）通常是一个诊断问题，与转移性椎体压缩性骨折（MVF）的年龄组相吻合。虽然放射摄影是第一诊断技术，但一般不能准确描述脱矿化和软组织病变。磁共振成像（MRI）可诊断无水肿和年龄较大的椎体畸形。诊断椎体后凸畸形最重要的发现是软组织肿块和椎弓根强度信号不对称。然而，这些发现在临床实践中的再现性一般。

引用次数: 0

Estatus socioeconómico, osteoporosis y fracturas por fragilidad "社会经济地位、骨质疏松症和脆性骨折"。

Q3 Medicine

Revista Espanola de Cirugia Ortopedica y Traumatologia

Pub Date : 2024-11-01 DOI: 10.1016/j.recot.2024.06.010

G. Martínez-Díaz-Guerra, F. Hawkins Carranza, S. Librizzi

Low socioeconomic status (SES) is associated with a higher risk of fragility fractures, as well as higher mortality in the first year post-fracture. The SES variables that have the greatest impact are educational level, income level, and cohabitation status. Significant disparities exist among racial and ethnic minorities in access to osteoporosis screening and treatment.

In Spain, a higher risk of fractures has been described in people with a low income level, residence in rural areas during childhood and low educational level. The Civil War cohort effect is a significant risk factor for hip fracture. There is significant geographic variability in hip fracture care, although the possible impact of socioeconomic factors has not been analyzed. It would be desirable to act on socioeconomic inequalities to improve the prevention and treatment of osteoporotic fractures.

低社会经济地位（SES）与脆性骨折的高风险以及骨折后第一年的高死亡率有关。影响最大的社会经济地位变量是教育水平、收入水平和同居状况。在西班牙，收入水平低、童年时期居住在农村地区以及教育水平低的人群发生骨折的风险较高。内战队列效应是髋部骨折的一个重要风险因素。髋部骨折护理存在很大的地域差异，但尚未分析社会经济因素可能产生的影响。最好能针对社会经济不平等采取行动，以改善骨质疏松性骨折的预防和治疗。

引用次数: 0

Tips and tricks for using cement augmentation of pedicle screws and vertebral body replacements—A literature review supported by two case reports 使用骨水泥增强椎弓根螺钉和椎体置换术的技巧和窍门--文献综述，辅以两份病例报告。

Q3 Medicine

Revista Espanola de Cirugia Ortopedica y Traumatologia

Pub Date : 2024-11-01 DOI: 10.1016/j.recot.2024.07.011

V.J. Heck , M. Rauschmann , T. Prasse , J.M. Vinas-Rios , A. Slavici

Background

The prevalence of osteoporosis is escalating alongside an aging global population, increasing the demand for spinal surgeries, including those necessitating cement augmentation for enhanced construct stability.

Objective

This article delves into the nuanced application of cement augmentation techniques for pedicle screws and vertebral body replacements (VBR), aimed at optimizing surgical outcomes in osteoporotic spines.

Method

Drawing from a comprehensive literature review according to important clinical and biomechanical studies and the authors’ clinical experiences, we elucidate strategies to mitigate complications and improve surgical efficacy.

Results

Cement augmentation has shown promise in managing vertebral fractures and in securing pedicle screws within osteoporotic vertebrae, with the advent of polymethylmethacrylate (PMMA) bone cement marking a pivotal advancement in spinal surgery. We highlight intraoperative measures like the choice between pre-injecting cement and utilizing cannulated or fenestrated screws, emphasizing the importance of controlling cement viscosity to prevent leakage and embolism. Through two case reports, we demonstrate the practical application of endplate cementation following VBR.

Conclusion

While the use of cement augmentation poses certain risks, its judicious application—supported by evidence-based guidelines and surgical expertise—can substantially enhance the stability of spinal constructs in osteoporotic patients. This allows a reduction in instrumentation length by enhancing biomechanical stability concerning pullout, bending, and rotational forces. Furthermore, the incidence of endplate sintering following VBF can be significantly reduced. Future research, particularly on antibiotic-loaded PMMA, may further expand its utility and optimize its safety profile.

背景：随着全球人口老龄化的加剧，骨质疏松症的发病率也在不断上升：随着全球人口老龄化的加剧，骨质疏松症的发病率也在不断攀升，这增加了脊柱手术的需求，包括那些需要用骨水泥增强以提高结构稳定性的手术：本文深入探讨了椎弓根螺钉和椎体置换术（VBR）中骨水泥增强技术的细微应用，旨在优化骨质疏松脊柱的手术效果：方法：根据重要的临床和生物力学研究以及作者的临床经验，通过全面的文献综述，我们阐明了减少并发症和提高手术疗效的策略：结果：骨水泥增量在处理椎体骨折和固定骨质疏松椎体内的椎弓根螺钉方面显示出了良好的前景，聚甲基丙烯酸甲酯（PMMA）骨水泥的出现标志着脊柱外科手术取得了举足轻重的进步。我们重点介绍了术中措施，如选择预先注入骨水泥、使用插管螺钉还是栅栏螺钉，并强调了控制骨水泥粘度以防止渗漏和栓塞的重要性。通过两个病例报告，我们展示了VBR术后终板骨水泥的实际应用：尽管使用骨水泥增强会带来一定的风险，但在循证指南和外科专业知识的支持下，明智地应用骨水泥增强可大大提高骨质疏松患者脊柱结构的稳定性。通过增强牵拉、弯曲和旋转力方面的生物力学稳定性，可以减少器械长度。此外，VBF 还能显著降低终板烧结的发生率。未来的研究，尤其是关于抗生素负载的 PMMA 的研究，可能会进一步扩大其用途并优化其安全性。

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引用次数: 0

Manejo de la deformidad espinal en el contexto de fracturas por compresión vertebral osteoporóticas 骨质疏松性椎体压缩骨折的脊柱畸形管理。

Q3 Medicine

Revista Espanola de Cirugia Ortopedica y Traumatologia

Pub Date : 2024-11-01 DOI: 10.1016/j.recot.2024.08.009

C. Mengis , N. Plais , F. Moreno , G. Cózar , F. Tomé-Bermejo , L. Álvarez-Galovich

Osteoporosis and fragility play a significant role in the treatment and planning of patients with deformity secondary to osteoporotic vertebral fracture (OVF). The resulting deformity can present significant challenges for its management, both from a medical and surgical perspective. The need for a specific classification for these deformities, including the potential for the development of artificial intelligence and machine learning in predictive analysis, is emerging as a key point in the coming years. Relevant aspects in preoperative optimization and management of these patients are addressed. A classification with therapeutic guidance for the management of spinal deformity secondary to OVF is developed, emphasizing the importance of personalized treatment. Flexibility and sagittal balance are considered key aspects. On the other hand, we recommend, especially with these fragile patients, management with minimally invasive techniques to promote rapid recovery and reduce the number of complications.

骨质疏松和脆性在骨质疏松性脊椎骨折（OVF）继发畸形患者的治疗和规划中起着重要作用。由此导致的畸形无论从内科还是外科角度来看，都会给治疗带来巨大挑战。对这些畸形进行特定分类的需求，包括人工智能和机器学习在预测分析方面的发展潜力，正在成为未来几年的一个关键点。本文探讨了这些患者术前优化和管理的相关方面。对继发于 OVF 的脊柱畸形进行了分类和治疗指导，强调了个性化治疗的重要性。灵活性和矢状平衡被认为是关键因素。另一方面，我们建议，尤其是对这些脆弱的患者，采用微创技术进行治疗，以促进快速康复并减少并发症的发生。

引用次数: 0

[Artículo traducido] Consejos y trucos para el uso de cemento óseo en tornillos pediculares y en reemplazos de cuerpos vertebrales: una revisión de la literatura respaldada por dos informes de casos 使用骨水泥增强椎弓根螺钉和椎体置换术的技巧和窍门--文献综述，辅以两份病例报告。

Q3 Medicine

Revista Espanola de Cirugia Ortopedica y Traumatologia

Pub Date : 2024-11-01 DOI: 10.1016/j.recot.2024.09.009

V.J. Heck , M. Rauschmann , T. Prasse , J.M. Vinas-Rios , A. Slavici

Background

The prevalence of osteoporosis is escalating alongside an aging global population, increasing the demand for spinal surgeries, including those necessitating cement augmentation for enhanced construct stability.

Objective

This article delves into the nuanced application of cement augmentation techniques for pedicle screws and vertebral body replacements (VBR), aimed at optimizing surgical outcomes in osteoporotic spines.

Method

Drawing from a comprehensive literature review according to important clinical and biomechanical studies and the authors’ clinical experiences, we elucidate strategies to mitigate complications and improve surgical efficacy.

Results

Cement augmentation has shown promise in managing vertebral fractures and in securing pedicle screws within osteoporotic vertebrae, with the advent of polymethylmethacrylate (PMMA) bone cement marking a pivotal advancement in spinal surgery. We highlight intraoperative measures like the choice between pre-injecting cement and utilizing cannulated or fenestrated screws, emphasizing the importance of controlling cement viscosity to prevent leakage and embolism. Through two case reports, we demonstrate the practical application of endplate cementation following VBR.

Conclusion

While the use of cement augmentation poses certain risks, its judicious application—supported by evidence-based guidelines and surgical expertise—can substantially enhance the stability of spinal constructs in osteoporotic patients. This allows a reduction in instrumentation length by enhancing biomechanical stability concerning pullout, bending, and rotational forces. Furthermore, the incidence of endplate sintering following VBF can be significantly reduced. Future research, particularly on antibiotic-loaded PMMA, may further expand its utility and optimize its safety profile.

背景：随着全球人口老龄化的加剧，骨质疏松症的发病率也在不断上升：随着全球人口老龄化的加剧，骨质疏松症的发病率也在不断攀升，这增加了脊柱手术的需求，包括那些需要用骨水泥增强以提高结构稳定性的手术：本文深入探讨了椎弓根螺钉和椎体置换术（VBR）中骨水泥增强技术的细微应用，旨在优化骨质疏松脊柱的手术效果：方法：根据重要的临床和生物力学研究以及作者的临床经验，通过全面的文献综述，我们阐明了减少并发症和提高手术疗效的策略：结果：骨水泥增量在处理椎体骨折和固定骨质疏松椎体内的椎弓根螺钉方面显示出了良好的前景，聚甲基丙烯酸甲酯（PMMA）骨水泥的出现标志着脊柱外科手术取得了举足轻重的进步。我们重点介绍了术中措施，如选择预先注入骨水泥、使用插管螺钉还是栅栏螺钉，并强调了控制骨水泥粘度以防止渗漏和栓塞的重要性。通过两个病例报告，我们展示了VBR术后终板骨水泥的实际应用：尽管使用骨水泥增强会带来一定的风险，但在循证指南和外科专业知识的支持下，明智地应用骨水泥增强可大大提高骨质疏松患者脊柱结构的稳定性。通过增强牵拉、弯曲和旋转力方面的生物力学稳定性，可以减少器械长度。此外，VBF 还能显著降低终板烧结的发生率。未来的研究，尤其是关于抗生素负载的 PMMA 的研究，可能会进一步扩大其用途并优化其安全性。

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引用次数: 0

Manejo rehabilitador y ortopédico de las fracturas por compresión vertebral osteoporótica 骨质疏松性脊椎压缩骨折的康复和矫形治疗。

Q3 Medicine

Revista Espanola de Cirugia Ortopedica y Traumatologia

Pub Date : 2024-11-01 DOI: 10.1016/j.recot.2024.10.003

A. Teixeira Taborda , C. De Miguel Benadiva , P. Sánchez Tarifa

Osteoporosis represents a public health problem that can be prevented and treated early through health education. Over time, screening techniques, diagnosis and treatments even conservative and surgical, have improved.

Through this publication we want to highlight the importance of the medical and orthopedic management of these fractures, describing the benefit of diet and physical exercise as the protagonists of conservative treatment but above all its indications and contraindications, emphasizing the limitations of exercise in a vertebral osteoporotic fracture. The different orthoses prescriptions are also highlighted.

骨质疏松症是一个公共卫生问题，可以通过健康教育及早预防和治疗。随着时间的推移，筛查技术、诊断和治疗（包括保守治疗和手术治疗）都在不断改进。通过本出版物，我们希望强调这些骨折的医疗和矫形管理的重要性，介绍作为保守治疗主角的饮食和体育锻炼的益处，但最重要的是其适应症和禁忌症，强调在椎体骨质疏松性骨折中锻炼的局限性。此外，还重点介绍了不同的矫形器处方。

引用次数: 0

Verdades y mentiras de las técnicas de cementación en el tratamiento de las fracturas por fragilidad "治疗脆性骨折的骨水泥技术的真相与谎言"。

Q3 Medicine

Revista Espanola de Cirugia Ortopedica y Traumatologia

Pub Date : 2024-11-01 DOI: 10.1016/j.recot.2024.04.007

S. Santiago Maniega , J. Crespo Sanjuán , F. Ardura Aragón , R. Hernández Ramajo , G.J. Labrador Hernández , M. Bragado González , D.C. Noriega González

The main event of osteoporosis is fragility fractures. Vertebral compression fractures are the most commonly fragility fracture related to osteoporosis.

Our goal is to review the available literature to confirm or deny concepts learned about spinal cementation and adapt our clinical practice according to scientific evidence.

In the complex world of spine surgery, constant innovations seek to improve the quality of life of patients. Among these, vertebral augmentation has emerged as an increasingly popular technique, but often shrouded in myths and misunderstandings. In this systematic review, we will thoroughly explore the truths behind vertebral augmentation, unraveling common myths and providing a clear insight into this technique. As specialists in the field, it is crucial to understand the reality surrounding these interventions to offer our patients the best possible information and make informed decisions.

骨质疏松症的主要症状是脆性骨折。椎体压缩性骨折是与骨质疏松症有关的最常见的脆性骨折。我们的目标是回顾现有文献，确认或否认有关脊柱骨水泥的概念，并根据科学证据调整我们的临床实践。在复杂的脊柱外科领域，不断的创新寻求改善患者的生活质量。在复杂的脊柱外科领域中，不断的创新旨在提高患者的生活质量。其中，椎体增量术已成为一种日益流行的技术，但却常常被神话和误解所笼罩。在这篇系统性综述中，我们将深入探讨椎体增量术背后的真相，揭开常见的神话，为这项技术提供一个清晰的视角。作为该领域的专家，了解这些干预措施的实际情况至关重要，这样才能为患者提供尽可能好的信息并做出明智的决定。

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引用次数: 0

[Translated article] Diagnostic imaging in patients with vertebral compression fractures [椎体压缩性骨折患者的放射学诊断。

Q3 Medicine

Revista Espanola de Cirugia Ortopedica y Traumatologia

Pub Date : 2024-11-01 DOI: 10.1016/j.recot.2024.08.006

E. Arana

Vertebral compression fractures by osteoporosis (OVF) is usually a diagnostic problem and coincides on the age group of metastatic vertebral compression fractures (MVF). Although radiography is the first diagnostic technique, generally is not accurate for depicting demineralization and soft tissue lesions. Magnetic resonance (MRI) is the diagnostic choice. The most relevant signs are intravertebral fluid collection or fluid signal, other vertebral deformities without oedema and older age. Among the most relevant findings for diagnosis MVF are soft tissue mass and pedicle intensity signal asymmetries. However, reproducibility of these findings in clinical practice is moderate.

骨质疏松性椎体压缩骨折（OVF）通常会导致诊断问题，并且与转移性椎体压缩骨折（MVF）的年龄组相吻合。虽然放射摄影是第一诊断技术，但它在描述脱矿化和软组织病变方面通常并不准确。磁共振成像（MRI）是诊断的首选。椎体内积液或积液信号、无水肿的其他椎体畸形和年龄偏大是椎体内积液最相关的体征。与椎管内积液诊断最相关的发现包括软组织肿块和椎弓根强度信号不对称。然而，这些结果在临床实践中的再现性一般。

引用次数: 0

[Translated article] Anatomical and biomechanical factors of osteoporotic vertebral fracture and the occurrence of cascade fractures [译文]骨质疏松性脊椎骨折的解剖学和生物力学因素以及级联骨折的发生。

Q3 Medicine

Revista Espanola de Cirugia Ortopedica y Traumatologia

Pub Date : 2024-11-01 DOI: 10.1016/j.recot.2024.09.004

F. Tomé-Bermejo , J.F. Bartolomé Gómez

Osteoporosis weakens the structural strength of bone to such an extent that normal daily activity may exceed the capacity of the vertebra to bear this load. Vertebral fracture and deformity is a hallmark of osteoporosis. The detriment of trabecular bone properties alone cannot explain the occurrence of osteoporotic vertebral fracture. The ability of the spine to bear and resist loads depends on the structural capacity of the vertebrae, but also on loading conditions arising from activities of daily living or low-energy trauma. This review describes the mechanical properties of the vertebral bone, the structural load-bearing capacity of the various elements forming the spine, the neuromuscular control of the trunk, as well as the biomechanics of the loads to which the spine is subjected in relation to the presence of osteoporosis and the risk of vertebral fracture. A better understanding of biomechanical factors may help to explain both the high incidence of osteoporotic vertebral fractures and their mechanism of production. Consideration of these issues may be important in the development of prevention and management strategies.

骨质疏松症会削弱骨骼的结构强度，以至于正常的日常活动可能会超出椎骨承受这一负荷的能力。脊椎骨折和畸形是骨质疏松症的标志。仅凭骨小梁特性的损害并不能解释骨质疏松性脊椎骨折的发生。脊柱承受和抵抗负荷的能力取决于椎骨的结构能力，也取决于日常生活活动或低能量创伤所产生的负荷条件。本综述介绍了椎骨的机械特性、构成脊柱的各种元素的结构承载能力、躯干的神经肌肉控制，以及脊柱所承受的负荷与骨质疏松症和椎体骨折风险之间的生物力学关系。更好地了解生物力学因素可能有助于解释骨质疏松性脊椎骨折的高发病率及其产生机制。考虑这些问题可能对制定预防和管理策略非常重要。

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引用次数: 0