PVP术后椎体前缘高度恢复率与邻近椎体骨折的相关性研究
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摘要
[目的]探讨伤椎经皮椎体成形术(percutaneous vertebroplasty, PVP)术后椎体前缘高度恢复率与术后邻近椎体骨折可能存在的相关性。[方法]回顾性分析济宁医学院附属医院本部及济宁医学院附属医院邹城院区2015年1月～2018年5月行PVP治疗的602例单节段骨质疏松性椎体压缩骨折患者资料,依据PVP术后是否发生邻近椎体骨折分为骨折组与非骨折组,记录两组患者的年龄、性别、BMI及伤椎椎体前缘高度恢复率。[结果]602例中共368例患者随访资料完整,纳入本研究,随访时间6～24个月,平均(17.31±8.40)个月。所有患者手术均顺利完成,术后疼痛明显缓解。至末次随访,术后35例患者(9.51%)新发生邻近椎体骨折,14例(40.00%)患者发生在胸椎,21例(60.00%)患者发生在腰椎;其中,1例T9,13例T12,15例L1,6例L2。伤椎椎体前缘高度恢复率显著大于非骨折组,差异具有统计学意义(P<0.05)。Logisti回归分析显示伤椎前缘高度恢复率是术后邻近椎体新发骨折的危险因素。[结论]超过一定范围,椎体前缘高度恢复越高,越可能发生术后邻近椎体新发骨折。
[Objective] To explore the correlation between the anterior vertebral height recovery rate of the involved vertebra and the new-onset adjacent vertebral fractures after percutaneous vertebroplasty(PVP). [Method] A retrospective analysis was conducted on 602 patients who received PVP for a single-level osteoporotic vertebral compression fractures from January2015 to May 2018 in our department. According to whether or not new-onset adjacent vertebral fractures happened after PVP,the patients were divided into the fracture group and non-fracture group. The age, gender, BMI, decrement of visual analogue scale(VAS) for pain and anterior vertebral height recovery rate were compared between the two groups. [Results] Of the 602 patients, 368 patients who were completely followed up for 6-24 month with an average of(17.31±8.40) months were included into this study. All the 368 patients had PVP performed smoothly, and achieved significantly pain relief after operation. To the latest follow up, 35 patients were proved new-onset adjacent vertebral fracture, involving T9 in 1 case, T12 in 13 cases, L1 in 15 cases,L2 in 9 cases. The fracture group got significantly greater anterior vertebral height recovery rate of the involved vertebra than the non-fracture group, which was statistically significant(P<0.05). The logistic multiple regression revealed that the anterior vertebral height recovery rate was the risk factor of new-onset adjacent vertebral body fracture. [Conclusion] In a certain extent, the more anterior vertebral height recovery rate achieved in primary PVP, the poorer pain relief and more chance of new-onset adjacent fracture should be expected.
[Objective] To explore the correlation between the anterior vertebral height recovery rate of the involved vertebra and the new-onset adjacent vertebral fractures after percutaneous vertebroplasty(PVP). [Method] A retrospective analysis was conducted on 602 patients who received PVP for a single-level osteoporotic vertebral compression fractures from January2015 to May 2018 in our department. According to whether or not new-onset adjacent vertebral fractures happened after PVP,the patients were divided into the fracture group and non-fracture group. The age, gender, BMI, decrement of visual analogue scale(VAS) for pain and anterior vertebral height recovery rate were compared between the two groups. [Results] Of the 602 patients, 368 patients who were completely followed up for 6-24 month with an average of(17.31±8.40) months were included into this study. All the 368 patients had PVP performed smoothly, and achieved significantly pain relief after operation. To the latest follow up, 35 patients were proved new-onset adjacent vertebral fracture, involving T9 in 1 case, T12 in 13 cases, L1 in 15 cases,L2 in 9 cases. The fracture group got significantly greater anterior vertebral height recovery rate of the involved vertebra than the non-fracture group, which was statistically significant(P<0.05). The logistic multiple regression revealed that the anterior vertebral height recovery rate was the risk factor of new-onset adjacent vertebral body fracture. [Conclusion] In a certain extent, the more anterior vertebral height recovery rate achieved in primary PVP, the poorer pain relief and more chance of new-onset adjacent fracture should be expected.
引文
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[12]Kao F C,Hsu Y C,Wu C H,et al.Use of corticosteroids is not associated with repeated vertebroplasty or kyphoplasty within one year after the surgery in patient older than 50 years[J].Acta Orthop Traumato,2017,51(6):459-465.
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[14]Song HM,Gu YF,Li YD,et al.Interventional tumor removal:a new technique for malignant spinal tumor and malignant vertebral compression fractures without epidural involvement[J].Acta Radiol,2014,55(8):976-984.
[15]Yoo G S,Park H C,Yu J I,et al.Stereotactic ablative body radiotherapy for spinal metastasis from hepatocellular carcinoma:its oncologic outcomes and risk of vertebral compression fracture[J].Oncotarget,2017,8(42):72860-72871.
[16]Bolton J M,Morin S N,Majumdar S R,et al.Association of mental disorders and related medication use with risk for major osteoporotic fractures[J].Jama Psychiat,2017,74(6):641-648.
[2]Yang S,Liu Y,Yang H,et al.Risk factors and correlation of secondary adjacent vertebral compression fracture in percutaneous kyphoplasty[J].Int J Surg,2016,36(Pt A):138-142.
[3]Movrin I,Vengust R,Komadina R.Adjacent vertebral fractures after percutaneous vertebral augmentation of osteoporotic vertebral compression fracture:a comparison of balloon kyphoplasty and vertebroplasty[J].Arch Orthop Trauma Surg,2010,130(9):1157-1166.
[4]Jin Y J,Yoon S H,Park K W,et al.The volumetric analysis of cement in vertebroplasty:relationship with clinical outcome and complications[J].Spine,2011,36(12):761-772.
[5]黄天霁,寇玉辉,殷晓峰,等.椎体强化术后再发椎体骨折的临床特点和危险因素[J].北京大学学报:医学版,2015,47(2):237-241.
[6]Solberg J,Copenhaver D,Fishman S M.Medial branch nerve block and ablation as a novel approach to pain related to vertebral compression fracture[J].Curr Opin Anaesthesiol,2016,29(5):596-599.
[7]Zhang JD,Poffyn B,Sys G,et al.Comparison of vertebroplastyandkyphoplasty for complications[J].Orthop Surg,2011,3(3):158-160.
[8]左华,黄永辉,李大鹏,等.经皮椎体成形术及经皮后凸成形术治疗老年骨质疏松性椎体压缩性骨折的长期临床疗效比较[J].中国矫形外科杂志,2015,23(22):2021-2025.
[9]Kim H J,Park S,Park S H,et al.Prevalence of frailty in patients with osteoporotic vertebral compression fracture and its association with numbers of fractures[J].Yonsei Med J,2018,59(2):317-324.
[10]Marcia S,Muto M,Hirsch J A,et al.What is the role of vertebral augmentation for osteoporotic fractures?A review of the recent literature[J].Neuroradiology,2018,60(9319):1-7.
[11]孟纯阳,盛遵启,李庆伟,等.两种术式治疗老年椎体骨质疏松性压缩骨折的循证思考[J].医学与哲学(B),2010,31(10):30-32.
[12]Kao F C,Hsu Y C,Wu C H,et al.Use of corticosteroids is not associated with repeated vertebroplasty or kyphoplasty within one year after the surgery in patient older than 50 years[J].Acta Orthop Traumato,2017,51(6):459-465.
[13]Nieuwenhuijse M J,Muijs S P,van Erkel A R,et al.A clinical comparative study on low versus medium viscosity polymethylmetacrylate bone cement in percutaneous vertebroplasty:viscosity associated with cement leakage[J].Spine,2010,10(9):S118-S119.
[14]Song HM,Gu YF,Li YD,et al.Interventional tumor removal:a new technique for malignant spinal tumor and malignant vertebral compression fractures without epidural involvement[J].Acta Radiol,2014,55(8):976-984.
[15]Yoo G S,Park H C,Yu J I,et al.Stereotactic ablative body radiotherapy for spinal metastasis from hepatocellular carcinoma:its oncologic outcomes and risk of vertebral compression fracture[J].Oncotarget,2017,8(42):72860-72871.
[16]Bolton J M,Morin S N,Majumdar S R,et al.Association of mental disorders and related medication use with risk for major osteoporotic fractures[J].Jama Psychiat,2017,74(6):641-648.