经皮椎体强化术后对邻近椎间盘影响的观察  

Effect of percutaneous vertebral augmentation on adjacent intervertebral disc

作　　者：江瑞信 阮耀钦 蔡金辉 叶浩翊 刘志锋 Jiang Ruixin;Ruan Yaoqin;Cai Jinhui;Ye Haoyi;Liu Zhifeng(Department of Medical Imaging,Zengcheng District People’s Hospital of Guangzhou,Guangzhou 511300,Guangdong,China)

机构地区：[1]广东省广州市增城区人民医院影像科,广东广州511300

出　　处：《右江民族医学院学报》2021年第3期354-358,共5页Journal of Youjiang Medical University for Nationalities

基　　金：广东省科技计划项目(2014A020212426);广州市科技计划项目(1563000399)。

摘　　要：目的探讨胸腰椎骨质疏松性压缩性骨折(osteoporosis vertebral compression fractures,OVCF)经皮椎体强化术(percutaneous vertebral augmentation,PVA)治疗后对邻近椎间盘退变(intervertebral disc degeneration,IDD)的影响。方法回顾性分析61例采用PVA治疗并进行1年以上MRI随访的OVCF患者的影像及临床资料。分析观察组椎间盘(邻近椎间盘)及对照组椎间盘(非邻近椎间盘)Pfirrmann分级的差异,并比较手术方式、骨水泥注入量、分布、累及终板与椎间盘退变的相关性。另外选取同期手术治疗的10例随访时间<12个月的患者作为早期组,将本组患者(复查时间均≥12个月)作为中远期组,比较这两组邻近椎间盘退变的差异,分析PVA术后早期对邻近椎间盘的影响。结果纳入研究的椎间盘共241块,其中观察组椎间盘120块,对照组椎间盘121块。观察组术后发生退变加重的椎间盘58块(58/120,48.33%);对照组术后发生退变加重的椎间盘仅25块(25/121,20.66%),两组比较差异具有统计学意义(P<0.001)。早期组(<12个月)及中远期组(≥12个月)邻近椎间盘等级增加差异无统计学意义(P>0.05)。结论PVA术可加速邻近椎间盘的退变,并且在早期(<12个月)就发生退变等级的增加,但不会加速非邻近椎间盘退变。Objective To investigate the effect of percutaneous vertebral augmentation(PVA)on the adjacent intervertebral disc degeneration(IDD)after the treatment of osteoporosis vertebral compression fractures(OVCF).Methods This study retrospectively analyzed the imaging and clinical data of 61 patients with OVCF treated with PVA and followed up with MRI for more than 1 year.We observed the differences in Pfirrmann grading between the observation group(adjacent intervertebral disc)and the control group(non-adjacent intervertebral discs).And we also compared the correlations of operation mode,injection volume of bone cement,the distribution,the involvement of endplate,and the degeneration of intervertebral disc.Meanwhile,10 patients who underwent surgery during the same period and were followed up less than 12 months were selected as the early group.On the other hand,the patients in this group(reexamination time≥12 months)were regarded as the medium and long-term group.The differences in IDD between these two groups were compared to analyze the early postoperative influence of PVA on adjacent intervertebral disc.Results A total of 241 intervertebral discs were included in the study,with 120 intervertebral discs in the observation group and 121 in the control group.In the observation group,58 intervertebral discs(58/120,48.33%)were degenerated and aggravated after operation.In the control group,only 25 discs(25/121,20.66%)were degenerated and aggravated after surgery,and the difference between these two groups was statistically significant(P<0.001).There was no significant difference in the increase of degeneration grade for adjacent intervertebral discs between the early group(<12 months)and the medium and long-term group(≥12 months)(P>0.05).Conclusion PVA can accelerate the degeneration of adjacent intervertebral discs and shows an increase in degeneration grade at early stage(<12 months),but it will not accelerate the degeneration of non-adjacent intervertebral discs.

关 键 词：骨折 压缩性 经皮椎体成形术 经皮椎体后凸成形术 椎间盘退变 Pfirrmann分级 

分 类 号：R683[医药卫生—骨科学]