终板骨折与椎体强化后伤椎高度丢失、后凸畸形及慢性疼痛的相关性  

Correlation of endplate fractures with height loss of injured vertebral body,kyphosis and chronic pain after vertebral augmentation

作　　者：马日吉 宋文慧[1] 刘昌文[1] 梁凯恒[1] 王子奡 史帆 Ma Riji;Song Wenhui;Liu Changwen;Liang Kaiheng;Wang Ziao;Shi Fan(Department of Orthopedics,the Second Hospital of Shanxi Medical University,Taiyuan 030001,Shanxi Province,China)

机构地区：[1]山西医科大学第二医院骨科,山西省太原市030001

出　　处：《中国组织工程研究》2021年第30期4857-4862,共6页Chinese Journal of Tissue Engineering Research

基　　金：山西省应用基础研究项目(201801D121324),项目负责人:宋文慧。

摘　　要：背景:椎体强化虽能迅速稳定骨折,缓解疼痛症状,纠正后凸畸形,但随着病例数的不断增加,临床中发现部分患者术后远期后凸畸形及慢性疼痛问题也日渐突出。目的:探究终板骨折对椎体强化(经皮椎体成形/经皮椎体后凸成形)后伤椎高度丢失、后凸畸形及慢性疼痛的影响。方法:回顾性调查了82例接受经皮椎体成形/经皮椎体后凸成形治疗的骨质疏松性椎体压缩骨折患者的病历资料,依据术前CT有无终板骨折将患者分为无终板骨折组、上终板骨折组及下终板骨折组。测量患者的椎体压缩率、手术椎体高度恢复率、Cobb角及骨密度,并记录疼痛目测类比评分、骨水泥弥散类型、骨水泥分布区域及骨水泥渗漏情况。采用单因素分析与卡方检验分析终板骨折与术后伤椎高度丢失、后凸畸形及慢性疼痛是否相关,以及终板骨折对骨水泥弥散分布的影响。结果与结论:(1)3组患者在术后早期伤椎高度和后凸畸形均得到明显改善;而在末次随访中,3组患者均观察到椎体前高度明显下降及Cobb角明显增大,其中上终板骨折组及下终板骨折组的伤椎高度丢失率和Cobb角均比无终板骨折组大(P<0.05);(2)各组术前目测类比评分相比差异无显著性意义(P>0.05),3组术后目测类比评分均显著低于术前(P<0.05);但上终板骨折组及下终板骨折组末次随访目测类比评分高于术后,而无终板骨折组末次随访与术后目测类比评分相比,差异无显著性意义(P>0.05);(3)终板骨折组(上终板骨折组+下终板骨折组)的骨水泥团块状分布、骨水泥未同时与两终板接触占比明显高于无终板骨折组(P<0.05),骨折处骨水泥分布不足在终板骨折组及无终板骨折组之间差异无显著性意义(P>0.05);(4)提示经皮椎体成形/经皮椎体后凸成形可显著改善伤椎高度、后凸畸形及疼痛,但在术后远期终板骨折不仅与术后椎体高度丢失和后凸畸BACKGROUND:Although vertebral augmentation can quickly stabilize fractures,relieve pain symptoms,and correct kyphosis,as the number of cases continues to increase,it has been clinically found that some patients have long-term kyphosis and chronic pain problems after surgery.OBJECTIVE:To explore the effects of endplate fractures on the loss of injured vertebral height,kyphosis and chronic pain after percutaneous vertebroplasty/percutaneous kyphoplasty.METHODS:A retrospective study investigated the medical records of 82 patients with osteoporotic vertebral compression fracture,who treated with percutaneous vertebroplasty/percutaneous kyphoplasty.The patients were divided into three groups according to the presence or absence of endplate fractures:unfractured group,superior vertebral endplate fracture group,and inferior endplate fracture group.The vertebral compression rate,vertebral height recovery rate,Cobb angle,and bone mineral density of each patient were measured and visual analogue scale,bone cement dispersion type,bone cement distribution area,and cement leakage were recorded.Univariate analysis and chi-square test were used to analyze whether endplate fractures were related to postoperative injury vertebral height loss,kyphosis and chronic pain,and the influence of endplate fractures on the distribution of bone cement.RESULTS AND CONCLUSION:(1)The height of the injured vertebrae and kyphosis in the three groups were significantly improved.In the last followup,all patients observed a significant decrease in the height of the anterior vertebrae and an increase in Cobb angle.The loss rate of injured vertebral height and Cobb angle in the superior vertebral and inferior endplate fracture groups were greater than those in the unfractured group(P<0.05).(2)There was no significant difference in the preoperative visual analogue scale scores between the groups(P>0.05).The postoperative visual analogue scale scores of the three groups were significantly lower than the preoperative scores(P<0.05),but the last follow-u

关 键 词：骨质疏松 椎体压缩骨折 终板骨折 伤椎高度丢失 后凸畸形 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]