Lumbar-Compression-Fracture

LumbarCompressionFracturePengChenIntroductionBackground•Thelumbarvertebraearethe5largestandstrongestofallvertebraeinthespine.Thesevertebraecomprisethelowerback.Theybeginatthestartofthelumbarcurve(ie,thethoracolumbarjunction)andextendtothesacrum.Thestrongeststabilizingmusclesofthespineattachtothelumbarvertebrae.Fracturesoflumbarvertebrae,therefore,occurinthesettingofeitherseveretraumaorpathologicweakeningofthebone.Osteoporosisistheunderlyingcauseofmanylumbarfractures,especiallyinpostmenopausalwomen.Osteoporoticspinalfracturesareuniqueinthattheymayoccurwithoutapparenttrauma.However,athoroughdiagnosticworkupisalwaysrequiredtoruleoutspinalmalignancy.Theimagebelowrevealsawedgecompressionfracture.•Inthepast,treatmentoptionsforlumbarfractureswerequitelimited,withbracingandrestprescribedmostoften.Whilemanypatientsimprovedwiththisregimen,somedidnotandwereleftwithchronic,disablingpain.SuhandLylesfoundthatvertebralcompressionfractureswereassociatedwithsignificantperformanceimpairmentsinphysical,functional,andpsychosocialdomainsinolderwomen.However,medicalandsurgicaloptionsarenowavailablethatcanrelievetheseverepainanddisabilityfromthesefractures.Recentstudies•Inastudyof55patientswithvertebralcompressionfracture,Rapanetalinvestigatedchangesinpainintensityfollowingvertebroplasty(injectionofacementpolymerintothefracturedvertebralbody;seeOtherTreatment).Treatmentwasadministeredtoatotalof28thoracicand57lumbarvertebrae;patientsinthestudyhadsustainedvertebralfracturesfromspinalmetastasesorosteoporosis.椎体成形术•Priortosurgery,thepatients'averagepainscoreontheVisualAnalogScale(VAS)was8.36,while24hourspostsurgeryithadfallentoanaverageof2.23.At3-monthfollow-up,thereductionintheVASscoreremainednearlythesame.Amongthestudy'spatients,1seriouscomplication,paraparesisresultingfromcementleakageintothespinalcanal,occurred.Theauthorsconcludedthatinpatientswithvertebralcompressionfracturewhoundergovertebroplasty,thedegreeofpainreductionthatoccursby24hourspostsurgerypredictstheintensityofpainpatientswillbeexperiencing3monthslater.StabilizingMuscles稳定肌楔形压缩骨折LateralWedgeCompressionFracture侧方楔形压缩骨折InjectionofaCementPolymer胶合剂；胶接剂；水泥Pathophysiology•Thelumbarspineprovidesbothstabilityandsupport,allowinghumanstowalkupright.Properfunctionofthelumbarspinerequiresthatithaveanormalposture(ie,anormallumbarcurve).Anyinjurythatchangestheshapeofalumbarvertebrawillalterthelumbarposture,increasingordecreasingthelumbarcurve.Asthebodyattemptstocompensateforthealterationinthelumbarspineinordertomaintainanuprightposture,thiswilltendtodistortthecurvesofthethoracicandcervicalspine.•Lumbarcompressionfracturescanbeadevastatinginjury,therefore,for2reasons.First,thefractureitselfcancausesignificantpain,andthispainsometimesdoesnotresolve.Second,thefracturecanalterthemechanicsoftheposture.Mostoften,theresultisanincreaseinthoracickyphosis,sometimestothepointthatthepatientcannotstandupright.Intryingtomaintaintheirabilitytowalk,patientswithkyphosisreportsecondarypainintheirhips,sacroiliacjoints,andspinaljoints.Thesepatientsarealsoatriskforfallsandaccidents,increasingtheriskofsecondaryfracturesinthespineandelsewhere.•Fracturesinthelumbarspineoccurforanumberofreasons.Inyoungerpatients,fracturesareusuallyduetoviolenttrauma.Caraccidentsfrequentlycauseflexionandflexiondistractioninjuries.Jumpsorfallsfromheightscauseburstfractures.Thesefracturescanalsoresultinseriousneurologicalinjury.Inolderpatients,lumbarcompressionfracturesusuallyoccurintheabsenceoftrauma,orinthecontextofminortrauma,suchasafall.Themostcommonunderlyingreasonforthesefracturesingeriatricpatients,especiallywomen,isosteoporosis.Otherdisordersthatcancontributetotheoccurrenceofcompressionfracturesincludemalignancy,infections,andrenaldisease.Aburstfractureisatypeoftraumaticspinalinjuryinwhichavertebrabreaksfromahigh-energyaxialload,withpiecesofthevertebrashatteringintosurroundingtissuesandsometimesthespinalcanal.爆裂骨折BurstFracture爆裂骨折Traumaticfractures外伤骨折•Differenttypesoffracturescanoccurinthelumbar(orthoracic)spine.Classificationofthesefracturesisbasedonthe3-columnanatomictheoryofDenis,whichdescribesanterior,middle,andposteriorspinalcolumnsconsistingofaspectsofthespineandtheircorrespondingligamentsandothersoft-tissueelements.TheDenissystem,however,wascreatedtoclassifytraumaticfractures.Asimilarclassificationsystemdoesnotexistforcompressionfractures.Themainreasontousesuchaclassificationistohelpdeterminewhetherafractureisstable.InstabilityintheDenissystemimpliesthatdamagehasoccurredtoatleast2ofthecolumnsofthelumbarspine.•Wedgefracturesarethemostcommontypeoflumbarfractureandarethetypicalcompressionfractureofmalignancyorosteoporosis.Theyoccurasaresultofanaxiallydirectedcentralcompressiveforcecombinedwithaneccentriccompressiveforce.Inpureflexion-compressioninjuries,themiddlecolumnremainsintactandactsasahinge.Althoughwedgefracturesareusuallysymmetric,8-14%areasymmetricandaretermedlateralwedgefractures.Traumaticfractures外伤骨折•Fracturesinvolvingflexionanddistractionforcesareoftenduetolapbeltsinmotorvehicleaccidents.Commonly,t