经皮椎体成形术对相邻和非相邻椎体新发骨折发生率的影响及危险因素分析  

Effect of percutaneous vertebroplasty on the incidence of new fractures in adjacent and non-adjacent vertebral bodies and its risk factors

作　　者：马伟民 付爱军 MA Weimin;FU Aijun(Department of Orthopaedics,Zhengzhou No.7 People's Hospital,Zhengzhou 450000;Department of Neurosurgery,Affiliated Hospital of North China University of Science and Technology,Tangshan 063000,Hebei,China)

机构地区：[1]郑州市第七人民医院骨一科,郑州450000 [2]华北理工大学附属医院神经外科,河北唐山063000

出　　处：《中华骨与关节外科杂志》2020年第8期630-635,共6页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:目前还不清楚椎体再发骨折风险增加是经皮椎体成形术(PVP)引起,还是仅是骨质疏松症自然发展的结果。目的:分析PVP和保守治疗后相邻和非相邻椎体再发骨折的发生率和危险因素。方法:选取2013年12月至2017年12月我院收治的290例PVP治疗患者和277例保守治疗患者,分为PVP组和保守组。定期进行电话随访,随访时间2~6年,平均(4.1±1.1)年。根据有无新发骨折分为新发组和无新发组。根据再发骨折与原始节段的位置,分为邻椎组和远椎组。收集年龄、性别、体重指数、VAS评分、椎体前缘高度、初始骨折节段、腰椎骨矿物质密度(BMD)、新发骨折节段、椎体压缩率和后凸角,并进行统计学比较。结果:PVP组术后290例患者中36例患者发生40个新发骨质疏松性椎体压缩骨折(OVCFs),保守组治疗后277例患者中31例患者发生34个新发OVCFs。PVP组中新发骨折的发生率略高于保守组,但差异无统计学意义(P=0.51)。新发组的BMD低于无新发组(P<0.01)。邻椎组发病率较远椎组低,但差异无统计学意义(P>0.05)。与保守组比较,PVP组末次随访VAS评分更低,椎体前缘高度、椎体压缩率、后凸角改善更显著(P<0.001)。末次随访PVP组椎体压缩率和后凸角较术前显著改善(P<0.001)。结论:与保守治疗相比,PVP椎体强化不仅可迅速缓解疼痛,还可改善椎体压缩和后凸角,恢复椎体部分高度,术后并未增加OVCFs的发生率,尤其与治疗椎体相邻的OVCFs。OVCFs最重要的危险因素是骨质疏松症。Background: It is not clear whether the increased risk of new vertebral fractures is caused by PVP or is simply the result of a natural progression of osteoporosis. Objective: To analyze the incidence of new vertebral compression fractures(OVCFs) and risk factors affecting adjacent and non-adjacent segmental vertebral fractures after percutaneous vertebroplasty(PVP) or conservative treatment. Methods: A total of 290 patients treated with PVP and 277 patients treated with conservative treatment admitted to our hospital from December 2013 to December 2017, which were divided into PVP group and conservative group respectively. Telephone follow-up was conducted every month for 2-6 years, with an average of(4.1±1.1) years. According to the presence or absence of new fractures, the patients were divided into new group and non-new group. According to the location between the recurrent fracture and the original segment, it was divided into adjacent vertebral group and distal vertebral group. Statistical comparisons were made based on age, gender, body mass index, initial fracture segment, spinal bone mineral density(BMD), VAS score, vertebral anterior margin height, vertebral compression rate, kyphosis angle and new fracture segment. Results: Totally 36 of 290 patients after PVP surgery had 40 new OVCFs, and 31 of 277 patients with conservative treatment had 34 new OVCFs. The incidence of new fractures in the PVP group was slightly higher than in the conservative group, but the difference was not statistically significant(P=0.51). The BMD of the new group was significantly lower than that of the non-new group(P<0.01). The incidence of the adjacent vertebral group was lower than that of the distal vertebral group, but the difference was not statistically significant(P>0.05). Compared with the conservative group, VAS score was lower, and the anterior vertebral height, the compression rate and kyphosis angle were significantly improved at the last follow-up in the PVP group(P<0.001). At the final follow-up, the compression

关 键 词：骨质疏松性椎体压缩骨折 椎体成形术 邻椎 骨密度 骨质疏松症 

分 类 号：R687.3[医药卫生—骨科学]