骨质疏松性压缩骨折椎体成形术后再发椎体骨折  

New Vertebral Compression Fractures after Percutaneous Vertebroplasty

作　　者：张宇鹏[1] 吴叶[1] 任东风[1] 商卫林[1] 吴闻文[1] 侯树勋[1] 

机构地区：[1]解放军总医院第一附属医院骨科,北京100048

出　　处：《实用骨科杂志》2012年第10期865-868,共4页Journal of Practical Orthopaedics

摘　　要：目的研究椎体骨质疏松性压缩骨折行椎体成形术后再发骨折的规律及相关危险因素。方法 2005年12月至2009年8月,收治外伤所致胸腰椎骨质疏松性压缩骨折行PVP治疗并资料完整的病例218例,其中男44例,女174例;年龄48～82岁,平均72.1岁。收集术前、术后1d、末次随访(至少18个月)时影像资料,对新发骨折情况进行统计分析。结果 218例(286个椎体)患者中,有22例患者进行2次以上PVP治疗,60.7%的新发椎体骨折为相邻椎体骨折;相邻椎体新发骨折较非相邻椎体新发骨折发生更快(P<0.001);在椎体骨折2次以上的病例,高龄、低骨密度的病例再发椎体骨折比例较大(P<0.005);将单次及多次骨折(2次以上)两组病例比较,性别和骨水泥注入量无明显差异(P>0.05)。结论椎体成形术后数年内易新发椎体骨折,其中相邻椎体骨折所占比例更大,且发生更快;高龄、低骨密度的患者再发骨折可能性更大。椎间盘骨水泥渗漏亦对相邻椎体骨折的发生起重要影响。Objective To investigate the characteristics and associated risk factors of new-onset vertebral compression fractures after percutaneous vertebroplasty.Methods We retrospectively reviewed patients with osteoporotic compression fractures from December 2005 to August 2009.There were 218 patients,including 44 males and 174 females.The age ranged from 48 years to 82 years,with an average of 72.1 years.The patients received percutaneous vertebroplasty with bone cement augmentation.Long-term radiographical follow-up identified the occurrence of vertebral fracture（minimum follow-up for 18 months） after the initial vertebral fracture.Results In 218 patients（286 vertebrae）,60.7% of new compression fractures after vertebroplasty were adjacent vertebral compression fractures.Adjacent fractures occurred much sooner than nonadjacent fractures（P0.001）.In patients who experienced vertebral compression fractures 2 or more times,older age and lower baseline bone mineral density（BMD） were demonstrated in this study（P0.005）.The gender and amount of cemented polymethyl methacrylate were not statistically different between Groups A（1 vertebral compression fracture） and B（vertebral compression fracture≥2 times）.Conclusion New-onset vertebral compression fractures occur repeatedly within a few years after vertebroplasty.New-onset adjacent-level fractures occur sooner and are more predominate than nonadjacent level fractures.The results of this study suggest that older patient age and lower baseline BMD are risk factors for multiple vertebral compression fractures.Postvertebroplasty disc space bone cement leakage also plays an important role in the onset of new adjacent fractures.

关 键 词：相邻椎体骨折 骨质疏松 压缩骨折 椎体成形术 骨密度 

分 类 号：R683.2[医药卫生—骨科学]