骨水泥分布情况对PVP术后邻椎骨折影响的影响探讨
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摘要
目的探讨骨水泥分布情况对PVP手术后再发邻椎骨折的影响。方法纳入2013-07-2016-07,行PVP手术治疗的OVCF患者162例,术后均随访1年以上,共19例发生邻椎骨折。将此19例作为再骨折组,另143例作为对照组,统计两组患者的性别、年龄、手术节段、骨密度值、骨水泥用量、骨水泥渗漏情况等基础临床数据;另外,对骨水泥分布情况进行量化考量:以量体指数对骨水泥用量进行量化,以分布指数对骨水泥在椎体内的位置进行量化。将上述指标统一进行组间单因素分析和多因素Logistic回归模型进行处理。结果①19例中,13例经再次PVP手术、6例经保守治疗后,均获康复。②单因素分析显示,骨密度值、骨水泥渗漏、骨水泥分布指数,均有统计学意义(P<0.05);Logistic回归模型显示,骨水泥分布指数为3项独立的危险因素之一(另两项为骨水泥渗漏和骨密度值)。结论 PVP手术患者的骨水泥分布指数对邻椎骨折有重要影响,而骨水泥用量和量体指数则不是独立的危险因素。
Objective The effect of bone cement distribution on adjacent vertebral fracture after PVP operation was discussed by comprehensive consideration. Methods A total of 162 OVCF patients who underwent PVP surgery in July 2013 July-2016 were followed up for more than 1 years. A total of 19 patients suffered from adjacent vertebral fractures.The 19 cases were treated as refracture group, and the other 143 cases as control group. The basic clinical data of gender, age, operative segment, bone mineral density, bone cement dosage and bone cement leakage in the two groups were counted;In addition, the quantitative distribution of bone cement was quantified: the volume index was used to quantify the amount of bone cement, and the distribution index was used to quantify the location of bone cement in the vertebral body.The above indexes were analyzed by single factor comparison between groups, and the Logistic regression model was used to treat the patients with statistical significance. Results (1)In 19 cases, 13 cases underwent PVP operation again and 6 cases were cured after conservative treatment.(2) Single factor analysis showed that bone mineral density, bone cement leakage, bone cement distribution index were statistically significant(P <0.05).The Logistic regression model showed that the cement distribution index was one of the 3 independent risk factors(the other two were bone cement leakage and bone mineral density). Conclusion bone cement distribution index has an important influence on adjacent vertebral fracture in PVP patients,while bone cement dosage and body mass index are not independent risk factors.
Objective The effect of bone cement distribution on adjacent vertebral fracture after PVP operation was discussed by comprehensive consideration. Methods A total of 162 OVCF patients who underwent PVP surgery in July 2013 July-2016 were followed up for more than 1 years. A total of 19 patients suffered from adjacent vertebral fractures.The 19 cases were treated as refracture group, and the other 143 cases as control group. The basic clinical data of gender, age, operative segment, bone mineral density, bone cement dosage and bone cement leakage in the two groups were counted;In addition, the quantitative distribution of bone cement was quantified: the volume index was used to quantify the amount of bone cement, and the distribution index was used to quantify the location of bone cement in the vertebral body.The above indexes were analyzed by single factor comparison between groups, and the Logistic regression model was used to treat the patients with statistical significance. Results (1)In 19 cases, 13 cases underwent PVP operation again and 6 cases were cured after conservative treatment.(2) Single factor analysis showed that bone mineral density, bone cement leakage, bone cement distribution index were statistically significant(P <0.05).The Logistic regression model showed that the cement distribution index was one of the 3 independent risk factors(the other two were bone cement leakage and bone mineral density). Conclusion bone cement distribution index has an important influence on adjacent vertebral fracture in PVP patients,while bone cement dosage and body mass index are not independent risk factors.
引文
[1]胡自强.高黏度骨水泥在骨质疏松性胸腰椎体压缩骨折患者PVP手术中的效果[J].西部医学,2015,27(2):270-272.
[2]刘波.液压输送骨水泥PVP与PKP治疗骨质疏松性椎体压缩骨折的比较研究[J].颈腰痛杂志,2017,38(2):169-173.
[3] Moon ES, Kim HS, Park JO, et al. The incidence of new vertebral compression fractures in women after kyphoplasty and factors involved[J]. Yonsei Med J, 2007, 48(4):645-52.
[4] Lin WC, Cheng TT, Lee YC, et al. New vertebral osteoporotic compression fractures after percutaneous vertebroplasty:retrospective analysis of risk factors[J]. J Vasc Interv Radiol, 2008, 19(2 Pt1):225-31.
[5]陈江民.经皮椎体后凸成形术治疗骨质疏松性压缩骨折后椎体再骨折的原因分析与治疗[D].泸州医学院,2014.
[6]李贵星.骨水泥椎体强化术后再发邻椎骨折的综合治疗[J].颈腰痛杂志,2017,38(5):424-427.
[7] Liebschner MA, Rosenberg WS, Keaveny TM. Effects of bone cement volume and distribution on vertebral stiffness after vertebroplasty[J]. Spine(Phila Pa 1976),2001,26(14):1547-1554.
[8]卢昌怀,刘志军,张宏波,等.骨水泥量及分布对椎体成形术后相邻椎体生物力学影响的三维有限元分析[J].中国骨质疏松杂志,2015,21(1):29-33.
[9] Belkoff SM, Mathis JM, Jasper LE, et al. The biomechanics of vertebroplasty. The effect of cement volume on mechanical behavior[J].Spine(Phila Pa 1976), 2001, 26(14):1537-1541.
[2]刘波.液压输送骨水泥PVP与PKP治疗骨质疏松性椎体压缩骨折的比较研究[J].颈腰痛杂志,2017,38(2):169-173.
[3] Moon ES, Kim HS, Park JO, et al. The incidence of new vertebral compression fractures in women after kyphoplasty and factors involved[J]. Yonsei Med J, 2007, 48(4):645-52.
[4] Lin WC, Cheng TT, Lee YC, et al. New vertebral osteoporotic compression fractures after percutaneous vertebroplasty:retrospective analysis of risk factors[J]. J Vasc Interv Radiol, 2008, 19(2 Pt1):225-31.
[5]陈江民.经皮椎体后凸成形术治疗骨质疏松性压缩骨折后椎体再骨折的原因分析与治疗[D].泸州医学院,2014.
[6]李贵星.骨水泥椎体强化术后再发邻椎骨折的综合治疗[J].颈腰痛杂志,2017,38(5):424-427.
[7] Liebschner MA, Rosenberg WS, Keaveny TM. Effects of bone cement volume and distribution on vertebral stiffness after vertebroplasty[J]. Spine(Phila Pa 1976),2001,26(14):1547-1554.
[8]卢昌怀,刘志军,张宏波,等.骨水泥量及分布对椎体成形术后相邻椎体生物力学影响的三维有限元分析[J].中国骨质疏松杂志,2015,21(1):29-33.
[9] Belkoff SM, Mathis JM, Jasper LE, et al. The biomechanics of vertebroplasty. The effect of cement volume on mechanical behavior[J].Spine(Phila Pa 1976), 2001, 26(14):1537-1541.