MRI对PVP/PKP术后相邻椎体骨折风险的预测价值  

The Risk Prediction of Adjacent Vertebral Fracture after PVP/PKP Via MRI

作　　者：贺倩 杜小丽 张波莉 HE Qian;DU Xiao-li;ZHANG Bo-li(Department of Radiology,Chengdu First People’s Hospital,Chengdu 610041,Sichuan Province,China)

机构地区：[1]四川省成都市中西医结合医院放射科,四川成都610041

出　　处：《中国CT和MRI杂志》2023年第4期161-164,共4页Chinese Journal of CT and MRI

摘　　要：目的探讨MRI在预测骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCF)经皮椎体成形术后相邻椎体骨折风险中的价值。方法纳入2017年12月~2020年12月收治的148例OVCF患者,其中88例行经皮椎体成形术(percutaneous vertebroplasty,PVP)或经皮椎体后凸成形术(percutaneous kyphoplasty,PKP),60例行保守治疗,两组患者治疗前均行MRI检查,治疗后行DR、MRI进行复查,分析并评价相邻椎体骨折发生率的差异。结果两组患者治疗后相邻椎体骨折发生率(χ^(2)=0.332,P=0.565)无统计学意义(P>0.05),发生相邻椎体骨折随访时间(χ^(2)=5.334,P=0.021)有统计学意义(P<0.05);PVP/PKP术组中椎体裂隙(χ^(2)=11.537,P=0.001)、终板损伤(χ^(2)=4.596,P=0.032)、达终板骨折线(χ^(2)=12.329,P=0.000)、椎间盘损伤(χ^(2)=4.545,P=0.033)对相邻椎体骨折有统计学意义(P<0.05),骨水泥渗漏(χ^(2)=0.417,P=0.519)、骨水泥分布形态(χ^(2)=5.718,P=0.221)无统计学意义(P>0.05)。结论与保守治疗相比,椎体成形术不会增加邻近椎体骨折的风险,但PVP/PKP术后邻近椎体骨折时间短于保守治疗,所以我们建议OVCF患者行PVP/PKP术前、术后,仍需通过MRI对椎体裂隙、终板损伤、椎间盘损伤、达终板骨折线这些危险因素进行评估。Objective To observe imaging features of osteoporotic vertebral compression fractures(OVCF)to predict the risk of adjacent vertebral fractures after percutaneous vertebroplasty.Methods A retrospective analysis of the clinical data of 148 cases with OVCF of 2017.12-2020.12 in our hospital,and 88 cases who was performed with percutaneous vertebroplasty(PVP)or percutaneous kyphoplasty(PKP),and 60 cases underwent conservative treatment.Both groups underwent MRI before treatment,DR and MRI for reexamination after treatment.Then summarize and evaluate the difference about the incidence of adjacent vertebral fractures between the two groups.Results After treatment,the incidence of adjacent vertebral fractures in the two groups(χ^(2)=0.332,P=0.565)was not statistically significant(P>0.05),and the follow-up time of adjacent vertebral fractures(χ^(2)=5.334,P=0.021)was statistically significant(P<0.05).In the PVP/PKP group,with intravertebral clefts(χ^(2)=11.537,P=0.001),endplate injuries(χ^(2)=4.596,P=0.032),fracture line reaches the endplate(χ^(2)=12.329,P=0.000)and intervertebral disc injuries(χ^(2)=4.545,P 0.033)were associated with the adjacent vertebral fractures(P<0.05),while bone cement leakage(χ^(2)=0.417,P=0.519)and bone cement distribution(χ^(2)=5.718,P=0.221)were not statistically significant(P>0.05).Conclusion Compared with conservative treatment,percutaneous vertebroplasty do not lead to an increasing incidence of adjacent vertebral fractures following,however,the time of adjacent vertebral fracture after PVP/PKP was shorter than that of conservative treatment.So we suggest OVCF still need observe imaging features about intravertebral clefts,endplate injuries,fracture line reaches the endplate and intervertebral disc injuries before PVP/PKP.

关 键 词：骨质疏松性椎体压缩骨折 椎体成形术 相邻椎体骨折 MRI DR 

分 类 号：R683.2[医药卫生—骨科学] R445.2[医药卫生—外科学]