椎体后凸成形术后再发骨折的相关危险因素分析  

Analysis of risk factors causing new vertebral compression fractures after percutaneous kyphoplasty

作　　者：唐政杰 侯宇[1] 张亘瑷[1] 卓成龙[1] 李宇博[1] 丁立祥[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院骨科,100038

出　　处：《中国矫形外科杂志》2015年第2期124-131,共8页Orthopedic Journal of China

基　　金：卫生部课题;应用高粘度骨水泥治疗椎体压缩性骨折术后再发骨折及邻近椎体骨折相关性的临床研究(编号:W2013ZT021)

摘　　要：[目的]探讨椎体后凸成形术治疗骨质疏松性椎体压缩骨折后不同类型再发骨折的特点和相关危险因素。[方法]回顾性研究2006年4月-2012年4月间,458例行椎体后凸成形术治疗的骨质疏松性椎体压缩骨折患者资料,根据术后再发椎体骨折情况分为原位再发骨折组36例,相邻椎体再骨折组33例,间隔椎体再骨折组35例,对照无再骨折组354例,对临床资料、影像学资料以及手术相关因素进行观察评估并分析。[结果]（1）104例患者（22.71%）PKP术后发生再发骨折,66.7%的原位组和54.5%的相邻组椎体再发骨折发生在术后半年内;（2）体重指数低、基础陈旧椎体骨折数目多、骨密度t值低是三种类型再发骨折共同的危险因素;（3）椎体内骨水泥的形态学分布是原位组和相邻组再骨折的影响因素,原位组下终板骨水泥越局限骨小梁水平,原位再骨折的风险越大（OR值,0.311;P=0.016）;相邻组上终板骨水泥越接近终板和椎间盘分布,相邻椎体再骨折的风险越大（OR值,4.831;P=0.018）;（4）术后支具佩戴时间短是相邻椎体再骨折和间隔椎体再骨折的危险因素。[结论]椎体后凸成形术后三种类型的再发骨折均与严重骨质疏松有关,椎体内骨水泥的形态学分布特点是引起术后再骨折的重要因素,规范佩戴支具和抗骨质疏松治疗能降低再骨折风险。[Objective]The purpose of this study was to evaluate the related factors that affect the different types of new vertebral compression fractures（ NVCFs） after percutaneous kyphoplasty（ PKP） in the treatment of osteoporotic vertebral compression fractures（ OVCFs）. [Method]From April 2006 to April 2012,a total of 458 patients who underwent PKP for the treatment of OVCFs were retrospectively analyzed. According to the different types of NVCFs,patients were divided into those NVCFs including the recompression of operated vertebrae（ operated fractures group,n = 36）,subsequent fracture in the adjacent vertebral bodies（ adjacent fractures group,n = 33）,subsequent fracture in the remote vertebral bodies（ remote fractures group,n =35） and those without NVCFs（ maintained group,n = 354）. The clinical parameters,spine radiographs and operation technique were evaluated to analyze the incidence and risk factors of the three types of NVCFs. [Result]1. One hundred and four patients（ 22. 71%） subsequently suffered from NVCFs. 66. 7% of the NVCFs in operated fractures group and 54. 5% of the NVCFs in adjacent fractures group developed within 6 months of the procedures. 2. For the three types of NVCFs,multivariable analysisshowed that a higher risk of NVCFs after PKP was associated with a larger number of VCFs at baseline,lower T- score and lower body mass index（ BMI）（ P〈0. 05）. 3. The risk of NVCFs in operated fractures group and adjacent fractures group after PKP was correlated with the extent of bone cement. The cement mass in the trabecula level of the vertebrae was an important factor related to inducing the subsidence of the lower endplate in operated fractures group（ OR,0. 311; P= 0. 016）. The cement mass in the endplate level and disclevel of the upper endplate caused NVCFs in adjacent fractures group（ OR,4. 831; P = 0. 018）. 4. The lack of the back brace were related to the occurrence of NVCFs in adjacent fractures group（ OR,0. 425; P = 0. 001） and remote fractures group

关 键 词：骨质疏松性椎体压缩骨折 椎体后凸成形术 再发骨折 相关危险因素 

分 类 号：R687.3[医药卫生—骨科学]