椎体内部强化术后术椎塌陷的危险因素分析  

Risk factors for the collapse of cemented vertebral bodies after the minimally invasive vertebral augmentation procedures

作　　者：乐军[1] 董刚[1] 周辉[1] 项东[1] 

机构地区：[1]杭州市中医院骨伤科,浙江杭州310007

出　　处：《中国骨伤》2016年第7期625-629,共5页China Journal of Orthopaedics and Traumatology

摘　　要：目的 ：探讨椎体内部强化术,包括经皮椎体成形术（PVP）、椎体后凸成形术（PKP）,术后术椎塌陷的发生率、独立危险因素以及预防措施。方法：回顾性分析2012年1月至2013年6月经椎体内部强化术治疗并获得随访的154例单节段骨质疏松性椎体压缩骨折（OVCF）患者的临床资料,其中男65例,女89例,年龄57~90岁,平均（76.20±9.35）岁。随访时间6~30个月,平均（15.43±6.81）个月,术后随访患者均接受X线检查,部分患者接受MRI检查。分析与术椎塌陷相关的可能危险因素,包括性别、年龄、手术方式（PVP或PKP）、骨质疏松程度T评分、术椎节段水平、是否合并椎体骨坏死、术椎骨水泥填充模式、术椎前缘高度恢复率。并将可能的危险因素作为研究对象,采用多因素Logistic逐步回归分析法筛选影响术椎塌陷的独立危险因素。结果：随访周期内共发现29例发生术椎塌陷,术椎塌陷的发生率为18.83%。多因素Logistic逐步回归分析显示手术方式（OR=0.171,P=0.010）,骨质疏松程度T评分（OR=0.242,P=0.024）,是否合并椎体骨坏死（OR=12.225,P=0.003）,术椎骨水泥填充模式（OR=10.461,P=0.000）以及术椎前缘高度恢复率（OR=0.316,P=0.019）是影响术椎塌陷的独立危险因素。结论：椎体内部强化术后术椎塌陷的发生率较高,其发生率与多种因素相关,其中手术方式、骨质疏松程度T评分、是否合并椎体骨坏死、术椎骨水泥填充模式、术椎前缘高度恢复率是影响术椎塌陷的独立危险因素。术前严格筛选患者,术中注重骨水泥的对称性均匀分布,术后积极抗骨质疏松治疗,可降低术后术椎塌陷的发生率。Objective：To evaluate the incidence rate,the independent factors,and the prevention measures of the collapse of cemented vertebral bodies after minimally invasive vertebral augmentation procedures including percutaneous vertebroplasty（PVP） and percutaneous kyphoplasty（PKP）. Methods：From January 2012 to June 2013,154 patients with single segmental osteoporotic vertebral compression fractures（OVCF）were treated with PVP or PKP. There were 65 males and 89 females,ranging in age from 57 to 90 years old,with a mean of（76.20±9.35） years old. All the patients were followed up,and the duration ranged from 6 to 30 months,with a mean of（15.43±6.81） months. All the patients were arranged to perform X-ray examination,and some of the patients were arranged to do MRI examination during the follow up period. Possible risk factors were studied including gender,age,surgical approach（PVP or PKP）,lumbar spine bone mineral density,treated vertebral level,the presence of osteonecrosis in the vertebral body,filling pattern of the cement,and the restoration of anterior vertebral height. The Chi-square test and the multivariate Logistic regression model were used to analyze the risk factors. Results：The collapse of cemented vertebral bodies were found in 29 patients,and the total incidence rate of following time was 18.83%. A Multivariable Logistic Regression analysis revealed that the independent risk factors affecting the incidence rate of the collapse included surgical approach（OR=0.171,P=0.010）,lumbar spine bone mineral density（OR=0.242,P=0.024）,the presence of osteonecrosis in the vertebral body（OR=12.225,P=0.003）,filling pattern of the cement（OR=10.461,P=0.000）,and anterior vertebral height restoration（OR=0.316,P=0.019）. Conclusion：The incidence rate of the collapse was high and was associated with many risk factors. Surgical approach,lumbar spine bone mineral density,the presence of osteonecrosis in the vertebral body,filling pattern of the cement,and anterior vertebral height

关 键 词：脊柱骨折 骨质疏松 手术后并发症 椎体内部强化术 危险因素 

分 类 号：R541.4[医药卫生—心血管疾病]