骨质疏松性椎体压缩骨折骨水泥强化术后邻近椎体骨折相关因素研究进展
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摘要
骨水泥强化术包括经皮椎体成形术和经皮椎体后凸成形术,现已广泛应用于治疗骨质疏松性椎体压缩骨折并取得显著效果。近年来,随着手术病例的增多,骨水泥强化术后邻近椎体骨折的发生率明显增加。术后邻近椎体骨折与术中骨水泥注入量的多少、骨水泥椎间盘渗漏、椎体高度的过度恢复等手术因素及骨质疏松的自然进程、初始骨折的位置数目、椎体内裂隙样变、其他部位骨折史等非手术因素密切相关。因此,未来在使用骨水泥强化术治疗椎体压缩骨折时,应合理注入骨水泥量、避免骨水泥椎间盘渗漏和椎体高度过度恢复,规范手术流程,以减少术后邻近椎体骨折的发生。
Bone cement augmentation,including percutaneous vertebroplasty and percutaneous kyphoplasty,has been widely used in the treatment of osteoporotic vertebral compression fractures and achieved significant results. In recent years,with the increase of surgical cases,the incidence of fractures of adjacent vertebral bodies after augmentation surgery has increased significantly. Postoperative adjacent vertebral body fractures are closely related to operative factors such as the amount of cement injected,intervertebral leakage of cement,excessive recovery of vertebral height,and non-operative factors such as the natural course of osteoporosis,the position and number of initial fractures,the fissure-like changes in vertebral body and the history of fracture in other parts. Therefore,in the future,in the treatment of vertebral compression fractures with bone cement reinforcement,the amount of bone cement should be injected reasonably,the intervertebral leakage of bone cement and the excessive recovery of vertebral height should be avoided,and the operation procedure should be standardized,so as to reduce the occurrence of adjacent vertebral fracture after operation.
Bone cement augmentation,including percutaneous vertebroplasty and percutaneous kyphoplasty,has been widely used in the treatment of osteoporotic vertebral compression fractures and achieved significant results. In recent years,with the increase of surgical cases,the incidence of fractures of adjacent vertebral bodies after augmentation surgery has increased significantly. Postoperative adjacent vertebral body fractures are closely related to operative factors such as the amount of cement injected,intervertebral leakage of cement,excessive recovery of vertebral height,and non-operative factors such as the natural course of osteoporosis,the position and number of initial fractures,the fissure-like changes in vertebral body and the history of fracture in other parts. Therefore,in the future,in the treatment of vertebral compression fractures with bone cement reinforcement,the amount of bone cement should be injected reasonably,the intervertebral leakage of bone cement and the excessive recovery of vertebral height should be avoided,and the operation procedure should be standardized,so as to reduce the occurrence of adjacent vertebral fracture after operation.
引文
[1]中华医学会骨质疏松和骨矿盐疾病分会.骨质疏松性椎体压缩性骨折诊疗与管理专家共识[J].中华骨质疏松和骨矿盐疾病杂志,2018,11(5):425-437.
[2]Buchbinder R,Johnston RV,Rischin KJ,et al.Percutaneous vertebroplasty for osteoporotic vertebral compression fracture[J/CD].Cochrane Database Syst Rev,2018,11:CD006349.
[3]吴耀,王峰,周建强,等.经皮椎体成形术和经皮椎体后凸成形术治疗骨质疏松性椎体骨折的临床疗效分析[J].中国骨伤,2014,27(5):385-389.
[4]李军科,齐向北,黄习彬,等.椎体成形术中最小骨水泥注入量的研究[J].中华实验外科杂志,2016,33(1):192-194.
[5]Al-Ali F,Bawow T,Luke K.Vertebroplasty:What is important and what is not[J].AJNR Am J Neuroradiol,2009,30(10):1835-1839.
[6]Borensztein M,Camino Willhuber GO,Posadas Martinez ML,et al.Analysis of risk factors for new vertebral fracture after percutaneous vertebroplasty[J].Global Spine J,2018,8(5):446-452.
[7]刘建,俞雷钧,宋红浦,等.经皮椎体成形术后非手术椎体骨折的危险因素分析[J].中国骨伤,2013,26(3):190-193.
[8]Chen WJ,Kao YH,Yang SC,et al.Impact of cement leakage into disks on the development of adjacent vertebral compression fractures[J].J Spinal Disord Tech,2010,23(1):35-39.
[9]Yan L,Jiang R,He B,et al.A comparison between unilateral transverse process-pedicle and bilateral puncture techniques in percutaneous kyphoplasty[J].Spine(Phila Pa 1976),2014,39(26 SpecNo.):B19-26.
[10]潘爱星,杨晋才,海涌,等.单侧与双侧穿刺经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折的对比研究[J].中国骨与关节杂志,2016,5(1):44-47.
[11]张斌,尚咏.经皮椎体后凸成形术后继发邻近椎体骨折的危险因素分析[J].临床骨科杂志,2014,17(3):249-252.
[12]Cheng X,Long HQ,Xu JH,et al.Comparison of unilateral versus bilateral percutaneous kyphoplasty for the treatment of patients with osteoporosis vertebral compression fracture(OVCF):Asystematic review and meta-analysis[J].Eur Spine J,2016,25(11):3439-3449.
[13]Kim MH,Lee AS,Min SH,et al.Risk factors of new compression fractures in adjacent vertebrae after percutaneous vertebroplasty[J].Asian Spine J,2011,5(3):180-187.
[14]曲道奎,焦守国,杨明,等.PKP术后新发有症状椎体压缩骨折的影响因素分析[J].中国骨与关节损伤杂志,2016,31(7):701-703.
[15]Rho YJ,Choe WJ,Chun YI.Risk factors predicting the new symptomatic vertebral compression fractures after percutaneous vertebroplasty or kyphoplasty[J].Eur Spine J,2012,21(5):905-911.
[16]陈建常,王鑫,马在松,等.骨质疏松患者PVP/PKP术后新发椎体压缩性骨折相关危险因素[J].中国矫形外科杂志,2015,23(10):902-907.
[17]Kim SH,Kang HS,Choi JA,et al.Risk factors of new compression fractures in adjacent vertebrae after percutaneous vertebroplasty[J].Acta Radiol,2004,45(4):440-445.
[18]Li YA,Lin CL,Chang MC,et al.Subsequent vertebral fracture after vertebroplasty:Incidence and analysis of risk factors[J].Spine,2012,37(3):179-183.
[19]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.
[20]Kaufman JM,Palacios S,Silverman S,et al.An evaluation of the Fracture Risk Assessment Tool(FRAX)as an indicator of treatment efficacy:The effects of bazedoxifene and raloxifene on vertebral,nonvertebral,and all clinical fractures as a function of baseline fracture risk assessed by FRAX[J].Osteoporos Int,2013,24(10):2561-2569.
[21]Klazen CA,Venmans A,de Vries J,et al.Percutaneous vertebroplasty is not a risk factor for new osteoporotic compression fractures:Results from VERTOSⅡ[J].Am J Nenroradiol,2010,31(8):1447-1450.
[22]Sun G,Tang H,Li M,et al.Analysis of risk factors of subsequent fracture after vertebroplasty[J].Eur Spine J,2014,23(6):1339-1345.
[23]Seo DH,Oh SH,Yoon KW,et al.Risk factors of new adjacent compression fracture after percutaneous vertebroplasty:Effectiveness of bisphosphonate in osteoporotic or osteopenic elderly patients[J].Korean J Neurotrauma,2014,10(2):86-91.
[24]Ren HL,Jiang JM,Chen,IT,et al.Risk factors of new symptomatic vertebral compression fractures in osteoporotic patients undergone percutaneous vertebmplasty[J].Eur Spine J,2015,24(4):750-758.
[25]覃裕,邱冰,朱思刚,等.骨质疏松性椎体压缩骨折椎体成形术后再骨折的影响因素分析[J].中华创伤杂志,2016,32(9):799-801.
[26]陈继良,许庆山,王旭,等.经皮椎体成形术治疗骨质疏松性椎体压缩性骨折伴椎体内裂隙样变的疗效观察[J].中国微创外科杂志,2018,18(2):138-142.
[27]Wang YT,Wu XT,Chen H,et al.Adjacent-level symptomatic fracture after percutaneous vertebral augmentation of osteoporotic vertebral compression fracture:A retrospective analysis[J].J Orthop Sci,2014,19(6):868-876.
[28]Trout AT,Kallmes DF,Lane JI,et al.Subsequent vertebral fractures after vertebroplasty:Association with intraosseous clefts[J].AJNR Am J Neuroradiol,2006,27(7):1586-1591.
[29]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.
[30]Lee DG,Park CK,Park CJ,et al.Analysis of risk factors causing new symptomatic vertebral compression fractures after percutaneous vertebroplasty for painful osteoporotic vertebral compression fractures:A 4-year follow-up[J].J Spinal Disord Tech,2015,28(10):E578-583.
[31]唐政杰,侯宇,张亘瑷,等.椎体后凸成形术后再发骨折的相关危险因素分析[J].中国矫形外科杂志,2015,23(2):124-131.
[32]Zhu JJ,Zhang DS,Lou SL,et al.Surgical treatment of secondary fractures after percutaneous vertebroplasty:A retrospective study[J].Indian J Orthop,2017,51(3):269-272.
[33]尤瑞金,杨德育,吕宏升,等.椎体强化术后邻近椎体再骨折的治疗[J].中国矫形外科杂志,2016,24(14):1274-1277.
[2]Buchbinder R,Johnston RV,Rischin KJ,et al.Percutaneous vertebroplasty for osteoporotic vertebral compression fracture[J/CD].Cochrane Database Syst Rev,2018,11:CD006349.
[3]吴耀,王峰,周建强,等.经皮椎体成形术和经皮椎体后凸成形术治疗骨质疏松性椎体骨折的临床疗效分析[J].中国骨伤,2014,27(5):385-389.
[4]李军科,齐向北,黄习彬,等.椎体成形术中最小骨水泥注入量的研究[J].中华实验外科杂志,2016,33(1):192-194.
[5]Al-Ali F,Bawow T,Luke K.Vertebroplasty:What is important and what is not[J].AJNR Am J Neuroradiol,2009,30(10):1835-1839.
[6]Borensztein M,Camino Willhuber GO,Posadas Martinez ML,et al.Analysis of risk factors for new vertebral fracture after percutaneous vertebroplasty[J].Global Spine J,2018,8(5):446-452.
[7]刘建,俞雷钧,宋红浦,等.经皮椎体成形术后非手术椎体骨折的危险因素分析[J].中国骨伤,2013,26(3):190-193.
[8]Chen WJ,Kao YH,Yang SC,et al.Impact of cement leakage into disks on the development of adjacent vertebral compression fractures[J].J Spinal Disord Tech,2010,23(1):35-39.
[9]Yan L,Jiang R,He B,et al.A comparison between unilateral transverse process-pedicle and bilateral puncture techniques in percutaneous kyphoplasty[J].Spine(Phila Pa 1976),2014,39(26 SpecNo.):B19-26.
[10]潘爱星,杨晋才,海涌,等.单侧与双侧穿刺经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折的对比研究[J].中国骨与关节杂志,2016,5(1):44-47.
[11]张斌,尚咏.经皮椎体后凸成形术后继发邻近椎体骨折的危险因素分析[J].临床骨科杂志,2014,17(3):249-252.
[12]Cheng X,Long HQ,Xu JH,et al.Comparison of unilateral versus bilateral percutaneous kyphoplasty for the treatment of patients with osteoporosis vertebral compression fracture(OVCF):Asystematic review and meta-analysis[J].Eur Spine J,2016,25(11):3439-3449.
[13]Kim MH,Lee AS,Min SH,et al.Risk factors of new compression fractures in adjacent vertebrae after percutaneous vertebroplasty[J].Asian Spine J,2011,5(3):180-187.
[14]曲道奎,焦守国,杨明,等.PKP术后新发有症状椎体压缩骨折的影响因素分析[J].中国骨与关节损伤杂志,2016,31(7):701-703.
[15]Rho YJ,Choe WJ,Chun YI.Risk factors predicting the new symptomatic vertebral compression fractures after percutaneous vertebroplasty or kyphoplasty[J].Eur Spine J,2012,21(5):905-911.
[16]陈建常,王鑫,马在松,等.骨质疏松患者PVP/PKP术后新发椎体压缩性骨折相关危险因素[J].中国矫形外科杂志,2015,23(10):902-907.
[17]Kim SH,Kang HS,Choi JA,et al.Risk factors of new compression fractures in adjacent vertebrae after percutaneous vertebroplasty[J].Acta Radiol,2004,45(4):440-445.
[18]Li YA,Lin CL,Chang MC,et al.Subsequent vertebral fracture after vertebroplasty:Incidence and analysis of risk factors[J].Spine,2012,37(3):179-183.
[19]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.
[20]Kaufman JM,Palacios S,Silverman S,et al.An evaluation of the Fracture Risk Assessment Tool(FRAX)as an indicator of treatment efficacy:The effects of bazedoxifene and raloxifene on vertebral,nonvertebral,and all clinical fractures as a function of baseline fracture risk assessed by FRAX[J].Osteoporos Int,2013,24(10):2561-2569.
[21]Klazen CA,Venmans A,de Vries J,et al.Percutaneous vertebroplasty is not a risk factor for new osteoporotic compression fractures:Results from VERTOSⅡ[J].Am J Nenroradiol,2010,31(8):1447-1450.
[22]Sun G,Tang H,Li M,et al.Analysis of risk factors of subsequent fracture after vertebroplasty[J].Eur Spine J,2014,23(6):1339-1345.
[23]Seo DH,Oh SH,Yoon KW,et al.Risk factors of new adjacent compression fracture after percutaneous vertebroplasty:Effectiveness of bisphosphonate in osteoporotic or osteopenic elderly patients[J].Korean J Neurotrauma,2014,10(2):86-91.
[24]Ren HL,Jiang JM,Chen,IT,et al.Risk factors of new symptomatic vertebral compression fractures in osteoporotic patients undergone percutaneous vertebmplasty[J].Eur Spine J,2015,24(4):750-758.
[25]覃裕,邱冰,朱思刚,等.骨质疏松性椎体压缩骨折椎体成形术后再骨折的影响因素分析[J].中华创伤杂志,2016,32(9):799-801.
[26]陈继良,许庆山,王旭,等.经皮椎体成形术治疗骨质疏松性椎体压缩性骨折伴椎体内裂隙样变的疗效观察[J].中国微创外科杂志,2018,18(2):138-142.
[27]Wang YT,Wu XT,Chen H,et al.Adjacent-level symptomatic fracture after percutaneous vertebral augmentation of osteoporotic vertebral compression fracture:A retrospective analysis[J].J Orthop Sci,2014,19(6):868-876.
[28]Trout AT,Kallmes DF,Lane JI,et al.Subsequent vertebral fractures after vertebroplasty:Association with intraosseous clefts[J].AJNR Am J Neuroradiol,2006,27(7):1586-1591.
[29]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.
[30]Lee DG,Park CK,Park CJ,et al.Analysis of risk factors causing new symptomatic vertebral compression fractures after percutaneous vertebroplasty for painful osteoporotic vertebral compression fractures:A 4-year follow-up[J].J Spinal Disord Tech,2015,28(10):E578-583.
[31]唐政杰,侯宇,张亘瑷,等.椎体后凸成形术后再发骨折的相关危险因素分析[J].中国矫形外科杂志,2015,23(2):124-131.
[32]Zhu JJ,Zhang DS,Lou SL,et al.Surgical treatment of secondary fractures after percutaneous vertebroplasty:A retrospective study[J].Indian J Orthop,2017,51(3):269-272.
[33]尤瑞金,杨德育,吕宏升,等.椎体强化术后邻近椎体再骨折的治疗[J].中国矫形外科杂志,2016,24(14):1274-1277.