骨质疏松椎体压缩性骨折椎体强化术后邻椎骨折危险因素的研究进展  

Progression of the risk factors researches of adjacent vertebral fractures after vertebral augmentation for osteoporotic vertebral compression fracture

作　　者：蔡凯文 卢斌[1] 罗科锋[1] 蒋国强[1] Cai Kaiwen;Lu Bin;Luo Kefeng;Jiang Guoqiang(Department of Orthopaedics,the Affiliated Hospital of Medical School of Ningbo University,Ningbo 315020,China)

机构地区：[1]宁波大学医学院附属医院骨科,315020

出　　处：《中华骨科杂志》2019年第17期1087-1095,共9页Chinese Journal of Orthopaedics

基　　金：浙江省自然科学基金(LY17H060001);宁波市自然科学基金(A610225).

摘　　要：骨质疏松椎体压缩性骨折的椎体强化治疗临床已开展广泛,但术后强化椎体相邻椎体新发骨折的情况临床常见。为了解邻椎骨折的发生机制,多年来众多学者进行了大量的基础实验及临床研究,形成了一系列邻椎骨折发生机制的理论。其中患者的一般情况因素(年龄、性别、骨密度值、体重指数等)、骨水泥的材料学特性、骨水泥的分布模式因素(骨水泥的注射量及终板下分布、骨水泥的单或双侧分布、骨水泥的团块状分布、骨水泥的异常椎体外分布)、脊柱矢状位失衡因素、抗骨质疏松治疗及行为治疗因素、初始伤椎的节段定位因素、邻近椎间盘退变因素等,均被考虑为潜在的致病因素。然而,由于不同研究采用的方法及纳入的研究因素各异,所以得出的结论也不尽相同,甚至完全对立。针对近年来骨质疏松椎体压缩性骨折强化术后邻椎骨折的各方面研究结果,综合考虑其研究方法的可靠性及局限性进行综述,以期为椎体强化术后邻椎骨折风险的认识及治疗方案的制定提供参考。Vertebral augmentation has been widely used for treating the osteoporotic vertebral compression fractures. However, the occurrence of new fractures in adjacent vertebrae is also common. In order to understand the mechanism of adjacent vertebral fractures to prevent its happening, many scholars have carried out a lot of experiments and clinical studies by different research Methods for years. As a result, many theories about the mechanism of adjacent vertebral fracture have been formed. Including the patients' general conditions (age, gender, bone mineral density, body mass index, et al), material characteristics of bone cement, distribution of bone cement (volume of bone cement and under-endplate distribution, acentric or bilateral distribution, compact and solid cement filling pattern, bone cement leakage), factors of spinal sagittal imbalance, factors of anti-osteoporosis treatment and the behavioral therapy, the location of initial injured vertebral level, the degeneration of adjacent disc, all of above were considered as potential risk factors. However, various researches lead to diverse Conclusions because of different Methods were used and different research factors were included, some Conclusions were even opposite. Therefore, it is still controversial that whether some of the risk factors were effective. In this research, the current researches and the reliability and limitations of various research Methods were reviewed to put forward a relatively Objective interpretation, in order to provide evidences for understanding the risks of adjacent vertebral fracture after vertebral augmentation, and to provide reference for treatment.

关 键 词：椎体压缩性骨折 抗骨质疏松 椎体强化 危险因素 临床研究 强化治疗 骨水泥 椎间盘退变 

分 类 号：R687.3[医药卫生—骨科学]