经皮椎体成形术治疗骨质疏松性椎体压缩骨折后新发椎体骨折的危险因素分析  

Risk factors of new vertebral fractures after percutaneous vertebroplasty for osteoporotic vertebralcompression fractures

作　　者：刘奕[1] 沈海敏[2] 董健[1] 

机构地区：[1]复旦大学附属中山医院骨科,复旦大学聚合物分子工程国家重点实验室,上海200032 [2]复旦大学附属华东医院骨科

出　　处：《中华创伤杂志》2016年第11期1009-1013,共5页Chinese Journal of Trauma

基　　金：国家自然科学基金（81572629,81372002）;国家高技术研究发展计划（863计划）（2015AA033703）;上海市科委医学和农业领域科技支撑项目（15411951400）

摘　　要：目的探讨骨质疏松性椎体压缩骨折（OVCF）行经皮椎体成形术（PVP）后新发椎体骨折的危险因素。方法回顾性分析2006年1月-2015年6月行PVP治疗的OVCF患者703例，其中男133例，女570例；年龄59—88岁，平均76岁。椎体分布：T65个、T73个、T819个、T916个、T10、14个、T1146个、T19 218个、L1241个、L2137个、L3108个、L455个、L，37个。根据是否新发椎体骨折，分为新发椎体骨折组（80例）和未发生新发椎体骨组（对照组，623例）。分析患者年龄、性别、身体质量指数（BMI）、腰椎骨密度、受累椎体、骨水泥注射量、椎间隙骨水泥漏、骨折椎体的前后缘高度恢复比与新发椎体骨折的相关性。根据新发椎体骨折的位置又分为相邻椎体骨折组（48例）和非相邻椎体骨折组（32例）。结果80例患者（11％）术后发生新发椎体骨折。新发骨折组平均腰椎骨密度T值为（-3．31±O．74）SD，对照组为（-2．98±0．86）SD，骨密度降低与新发椎体骨折风险显著相关（P〈0．05）。而骨水泥注射量、椎间隙骨水泥漏、骨折椎体的前后缘高度恢复比等其他因素和新发椎体骨折的发生无明显相关性（P〉0．05）。相邻椎体骨折组和非相邻椎体骨折组各项因素比较差异均无统计学意义（P〉0．05）。结论严重骨质疏松症是PVP治疗OVCF术后新发椎体骨折的重要危险因素，治疗骨质疏松症是预防术后新发椎体骨折的关键。Objective To determine the risk factors for new vertebral fractures following percutaneous vertebroplasty （PVP） for osteoporotic vertebral compression fractures （OVCF）. Methods This retrospective study included 703 patients （133 males and 570 females; 59-88 years, mean 76 years） treated with PVP for OVCF from January 2006 to June 2015. Involved vertebrae included 5 T6 , 3 T7 , 19 Ts , 16 T9 , 14 Tl0, 46 Tll, 218 T12, 241 L1, 137 L2, 108 L3, 55 L4 and 37 L5. A total of 80 patients were detected with further vertebral fractures （ new fracture group ） and 623 patients with no new vertebral fractures （control group）. Possible risk factors for new vertebral fractures were noted, including age, gender, body mass index （ BMI）, bone mineral density, involved vertebral segment, amount of cement injection, intradiscal cement leak, and anterior-posterior ratio of the fractured vertebrae. And the fracture group were subdivided into adjacent vertebral fracture group （n = 48 ） and non-adjacent vertebral fracture group（ n - 32）. Results Eighty （ 11% ） of the 703 patients had subsequent vertebral fractures after PVP. Bone mineral density differed significantly between new fracture and control groups [ （ -3.31 ± 0. 74）SD vs. （ - 2.98 ± 0.86） SD ] （ P 〈 0.05 ）, indicating the risk of new onset vertebral fractures increased as the reduction of bone mineral density （P 〈0.05）. However, the remaining factors were not significantly associated with new vertebral fractures （P 〉0. 05）. There were no significant differences in all the factors between adjacent vertebral fracture and non-adjacent vertebral fracture groups （P 〉 0. 05 ）. Conclusions Severe osteoporosis is the main risk factor of new vertebral fractures after OVCF managed with PVP. Therefore, treatment of osteoporosis is the key point to prevent postoperative new vertebral fractures.

关 键 词：脊柱骨折 椎体成形术 骨密度 

分 类 号：R580[医药卫生—内分泌] R687.3[医药卫生—内科学]