[1]李格,梅伟,刘沛霖,等.骨质疏松性椎体压缩骨折经皮椎体成形术后邻近椎体再骨折的危险因素探讨[J].中医正骨,2016,28(06):18-20.
 LI Ge,MEI Wei,LIU Peilin,et al.Investigation on risk factors for adjacent vertebral refractures after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(06):18-20.
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骨质疏松性椎体压缩骨折经皮椎体成形术后邻近椎体再骨折的危险因素探讨()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第28卷
期数:
2016年06期
页码:
18-20
栏目:
临床研究
出版日期:
2016-06-20

文章信息/Info

Title:
Investigation on risk factors for adjacent vertebral refractures after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures
作者:
李格1梅伟2刘沛霖2毛克政2
1.河南省中医院,河南 郑州 450002;
2.河南省郑州市骨科医院,河南 郑州 450052
Author(s):
LI Ge1MEI Wei2LIU Peilin2MAO Kezheng2
1.Henan Provincial Hospital of TCM,Zhengzhou 450002,Henan,China
2.Zhengzhou Orthopaedic Hospital,Zhengzhou 450052,Henan,China
关键词:
脊柱骨折 骨质疏松性骨折 骨折压缩性 椎体成形术 手术后并发症 再骨折 危险因素 临床试验
Keywords:
spinal fractures osteoporotic fractures fracturescompression vertebroplasty postoperative complications refractures risk factors clinical trail
摘要:
目的:探讨骨质疏松性椎体压缩骨折经皮椎体成形术(percutaneous vertebroplasty,PVP)后邻近椎体再骨折的危险因素。方法:收集采用PVP治疗的225例骨质疏松性椎体压缩骨折患者的病例资料。按照PVP术后是否发生邻近椎体骨折,将患者分为再骨折组和未再骨折组。统计分析患者的性别、年龄、初次骨折椎体数量、术前椎体骨密度降低值、单个椎体骨水泥注射量、骨水泥椎间盘渗漏率和再骨折发生时间。结果:再骨折组31例,未再骨折组194例。再骨折组邻近椎体再骨折时间为PVP术后10 d至48个月,中位数13个月。再骨折组男8例、女23例,未再骨折组男39例、女155例; 2组患者的性别比较,差异无统计学意义(χ2=0.171,P=0.679)。再骨折组初次骨折椎体数量<3椎27例、≥3椎4例,未再骨折组初次骨折椎体数量<3椎183例、≥3椎11例; 2组患者初次骨折椎体数量比较,差异无统计学意义(χ2=1.235,P=0.266)。2组患者单个椎体骨水泥注射量比较,差异无统计学意义[(3.59±1.45)mL,(4.97±1.06)mL,t=0.624,P=0.542]。再骨折组的患者年龄大于未再骨折组[(75.34 ± 4.79)岁,(72.59 ± 6.67)岁,t=1.216,P=0.000],术前椎体骨密度降低值大于未再骨折组[(2.92±0.25)SD,(2.75±0.38)SD,t=1.127,P=0.031]。再骨折组骨水泥椎间盘渗漏12例,未再骨折组骨水泥椎间盘渗漏15例,再骨折组的骨水泥椎间盘渗漏率高于未再骨折组(χ2=21.444,P=0.000)。结论:高龄、骨水泥椎间盘渗漏及椎体骨密度降低可能是导致骨质疏松性椎体压缩骨折PVP术后邻近椎体再骨折的危险因素。
Abstract:
Objective:To explore the risk factors for adjacent vertebral refractures after percutaneous vertebroplasty(PVP)in patients with osteoporotic vertebral compression fractures.Methods:The medical records of 225 patients with osteoporotic vertebral compression fractures who were treated with PVP were collected.The patients were divided into refracture group(31 cases)and non-refracture group(194 cases)according to whether the adjacent vertebral fractures happened after PVP.The gender,age,number of initial fractured vertebral bodies,decreased value of preoperative vertebral bone mineral density,consumption of bone cements that were injected into single vertebral body,incidence rate of leakage of bone cements into intervertebral disc and the occurrence time of refractures were analyzed.Results:The occurrence time of adjacent vertebral refractures ranged from 10 days to 48 months(Median=13 months)after PVP in refracture group.The patients consisted of 8 males and 23 females in refracture group and the patients consisted of 39 males and 155 females in non-refracture group.There was no statistical difference in constituent ratio of gender between the 2 groups(χ2=0.171,P=0.679).The number of initial fractured vertebral bodies was<3 in 27 cases and≥3 in 4 cases in refracture group,while it was<3 in 183 cases and≥3 in 11 cases in non-refracture group.There was no statistical difference in the number of initial fractured vertebral bodies between the 2 groups(χ2=1.235,P=0.266).There was no statistical difference in consumption of bone cements that were injected into single vertebral body between the 2 groups(3.59+/-1.45 vs 4.97+/-1.06 ml,t=0.624,P=0.542).The patients were older and the decreased values of preoperative vertebral bone mineral density were greater in refracture group compared to non-refracture group(75.34+/-4.79 vs 72.59+/-6.67 yrs, t=1.216,P=0.000; 2.92+/-0.25 vs 2.75+/-0.38 SD,t=1.127,P=0.031).The leakage of bone cements into intervertebral disc was found in refracture group(12 cases)and non-refracture group(15 cases),and the incidence rate of leakage of bone cements into intervertebral disc was higher in refracture group compared to non-refracture group(χ2=21.444,P=0.000).Conclusion:Great age,leakage of bone cements into intervertebral disc and decrease in vertebral bone mineral density may be the risk factors which lead to the adjacent vertebral refractures after PVP in patients with osteoporotic vertebral compression fractures.

参考文献/References:

[1] 王胜华,陈成东,周国顺,等.椎体凸成形联合骨水泥强化椎弓根内固定治疗重度骨质疏松性胸腰椎压缩性骨折[J].浙江医学,2014,36(11):977-978.
[2] Trout AT,Kallmes DF.Does vertebroplasty cause incident vertebral fractures?A review of available data[J].AJNR Am J Neuroradiol,2006,27(7):1397-1403.
[3] Li YA,Lin CL,Chang MC,et al.Subsequent vertebral fracture after vertebroplasty: incidence and analysis of risk factors[J].Spine(Phila Pa 1976),2012,37(3):179-183.
[4] 国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:176.
[5] Heaney RP.Long-latency deficiency disease: insights from Calcium and vitamin D[J].Am J Clin Nutr,2003,78(5):912-919.
[6] Arabi A,Baddoura R,Awada H,et al.Hypovitaminosis D osteopathy:Is it mediated through PTH,lean mass, or is it a direct effect?[J].Bone,2006,39(2):268-275.
[7] 贾璞,费琦,李锦军,等.椎体后凸成形术后椎体再骨折相关因素分析研究[J].中国骨与关节外科,2013,6(2):153-156.
[8] Burge R,Dawson-Hughes B,Solomon DH,et al.Incidence and economic burden of osteoporosis-related fractures in the United States,2005-2025[J].J Bone Miner Res,2007,22(3):465-475.
[9] 杨立宇,付勤.骨质疏松性椎体压缩性骨折椎体后凸成形术后邻近椎体骨折的相关因素[J].中华骨质疏松和骨矿盐疾病杂志,2012,5(4):298-303.
[10] 赵云芳,滕范文,香淑媚.PVP术后对邻近节段椎体生物力学影响的有限元分析[J].齐齐哈尔医学院学报,2015,36(20):2980-2981.
[11] Nouda S,Tomita S,Kin A,et al.Adjacent vertebral body fracture following vertebroplasty with polymethylmethacrylate or Calcium phosphate cement: biomechanical evaluation of the cadaveric spine[J].Spine(Phila Pa 1976),2009,34(24):2613-2618.
[12] 王方,吴强.骨质疏松模型经皮椎体后凸成形术和经皮椎体成形术术后邻近椎体骨折的研究[J].中华实验外科杂志,2014,31(11):2527-2530.
[13] 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.
[14] Tanigawa N,Kariya S,Komemushi A,et al.Cement leakage in percutaneous vertebroplasty for osteoporotic compression fractures with or without intravertebral clefts[J].AJR Am J Roentgenol,2009,193(5):W442-W445.
[15] Sun G,Tang H,Li M,et al.Analysis of risk factors of subsequent fractures after vertebroplasty[J].Eur Spine J,2014,23(6):1339-1345.

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通讯作者:梅伟 E-mail:13613711661@163.com
更新日期/Last Update: 2016-06-30