骨质疏松性腰椎压缩骨折经皮椎体成形术后骨水泥上边界和上终板间距与椎体再压缩的相关性分析  

Analysis of correlation between upper border of bone cement and upper endplate spacing after percutaneous vertebroplasty for osteoporotic vertebral compression fractures and recompression of surgical vertebrae

作　　者：孟宵 周呈强 廖一峰 周海斌 王云清 MENG Xiao;ZHOU Chengqiang;LIAO Yifeng;ZHOU Haibin;WANG Yunqing(Department of Spinal Surgery,Xuzhou Medical University Affiliated Second Hospital,Xuzhou,Jiangsu 221006,China)

机构地区：[1]徐州医科大学第二附属医院脊柱外科,江苏徐州221006

出　　处：《中国骨与关节损伤杂志》2025年第3期237-242,共6页Chinese Journal of Bone and Joint Injury

基　　金：江苏省研究生科研与实践创新计划项目(SJCX23_1406)。

摘　　要：目的评估骨质疏松性腰椎压缩骨折经皮椎体成形术骨水泥上边界和上终板间距与手术椎体再压缩的相关性。方法回顾性分析自2020-01—2022-12采用经皮椎体成形术治疗的278例L_(1)骨质疏松性椎体压缩骨折,根据术后DR片测量骨水泥上边界和椎体上终板间距并分成4组,A组114例(间距0 mm),B组92例(间距>0~2 mm),C组48例(间距>2~4 mm),D组24例(间距>4 mm)。比较4组手术时间、骨水泥注入量,术后第2天、6个月疼痛VAS评分、ODI指数、伤椎椎体前缘高度比值,以及术后6个月手术椎体再压缩发生率。手术椎体再压缩评定标准是术后6个月与术后第2天侧位X线片上L_(1)椎体前缘高度测量值差≥1 mm。结果278例均获得随访,随访时间6~12个月,平均8.6个月。4组间术前和术后第2天的疼痛VAS评分、ODI指数、伤椎椎体前缘高度比值差异无统计学意义(P>0.05)。4组间术后6个月疼痛VAS评分、ODI指数、伤椎椎体前缘高度比值差异有统计学意义(P<0.05),A组与B组比较P>0.05,C组与D组比较P>0.05,而C、D组分别与A、B组比较P<0.05。4组间术后6个月手术椎体再压缩发生率差异有统计学意义(P<0.05),A组与B组比较P>0.05,C组与D组比较P>0.05,而C、D组分别与A、B组比较P<0.05。有限元分析结果显示,随着骨水泥上边界和上终板间距加大,直立、前屈、后伸、左侧弯、右侧弯、左旋转、右旋转7种运动载荷下L_(1)椎体承受的最大应力逐渐增加。结论骨质疏松性腰椎压缩骨折经皮椎体成形术后骨水泥是否与手术椎体上终板接触(或是间距≤2 mm)与术后手术椎体再次压缩、疼痛复发、脊柱功能障碍有密切相关性。Objective To evaluate the correlation between the upper border of bone cement and upper endplate spacing of percutaneous vertebroplasty for osteoporotic lumbar compression fractures and surgical vertebral recompression.Methods A retrospective analysis of 278 patients with L_(1)osteoporotic vertebral compression fractures treated with percutaneous vertebroplasty from January 2020 to December 2022 was conducted.According to the postoperative DR films of the upper border of the cement and the spacing of the vertebral body’s upper endplates,they were divided into 4 groups,114 cases in group A(spacing of 0 mm),92 cases in group B(0 mm4 mm).The 4 groups were compared in terms of operative time,amount of bone cement injected,pain VAS scores,ODI index,height ratio of the anterior margin of the injured vertebral body on the 2nd day and at 6 months after operation,and the incidence of recompression of the operated vertebral body at 6 months postoperatively.Surgical vertebral recompression was assessed as a difference of≥1 mm in the height measurement of the anterior margin of the L_(1)vertebral body on lateral radiographs between at 6 months and on the 2nd day postoperatively.Results All 278 cases were followed up for 6 to 12 months,with a mean of 8.6months.The differences in pain VAS scores,ODI indices,and height ratios of the anterior margins of the injured vertebrae between before and on the 2nd day after operation were not statistically significant between the 4 groups(P>0.05).The differences in pain VAS scores,ODI indices,and height ratios of the anterior margins of the injured vertebrae at 6 months postoperatively were statistically significant among the 4 groups(P<0.05),with P>0.05 comparing group A with group B,and P>0.05 comparing group C with group D,while P<0.05 comparing groups C and D with groups A and B,respectively.The difference in the incidence of surgical vertebral body recompression at 6 months postoperatively between the 4 groups was statistically significant(P<0.05),and P>0.05 when comparing group

关 键 词：骨质疏松性椎体压缩骨折 经皮椎体成形术 椎体再压缩 骨水泥 椎体上终板 

分 类 号：R687.3[医药卫生—骨科学]