两种术式治疗老年骨质疏松性椎体压缩性骨折的效果及其术后继发相邻椎体骨折的危险因素分析

Risk factors of adjacent vertebral body fracture secondary to percutaneous vertebral augmentation in elderly patients with osteoporotic vertebral compression fracture

目的评估老年骨质疏松性椎体压缩性骨折(osteoporotic vertebral compression fracture,OVCF)患者行经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)和经皮椎体成形术(percutaneous vertebroplasty,PVP)的临床治疗效果,探讨术后继发相邻椎体骨折的危险因素。方法选取2014年7月至2018年6月在北京老年医院骨科住院有症状的单节段骨质疏松性胸腰椎椎体压缩性骨折的患者为研究对象,其中行PKP术的189例患者为PKP组,行PVP术的173例患者为PVP组,随访1年,比较两种手术方法的治疗效果。以随访时继发邻近椎体骨折的25例患者为病例组,未继发邻近椎体骨折的337例患者为对照组,分析可能的危险因素。结果共入组362例患者,PKP和PVP两种术后均使患者疼痛视觉模拟评分(visual analogue scale,VAS)明显减低,两种术后继发邻近椎体骨折的比率差异无统计学意义;Logistic多因素回归分析显示,高龄(OR=1.075,95%CI:1.040~1.112,P<0.001),骨密度T值减低(OR=0.576,95%CI:0.351~0.946,P=0.030),骨水泥渗漏(OR=2.284,95%CI:1.200~4.344,P=0.018),术后矢状位Cobb s角过度矫正(OR=1.188,95%CI:1.124~1.255,P=0.009)是OVCF术后继发邻近椎体骨折的独立危险因素。结论PKP和PVP两种手术方法均可以提供效果相当的疼痛缓解率,两种术式继发邻近椎体骨折的风险差异无统计学意义;高龄、骨密度T值降低、骨水泥渗漏(椎间盘内渗漏)和术后局部矢状位Cobb’s角过度纠正是OVCF术后邻近椎体继发骨折的独立危险因素。

Objective To assess the risk of adjacent vertebral fractures following percutaneous kyphoplasty(PKP)and percutaneous vertebroplasty(PVP)for osteoporotic vertebral compression fractures(OVCF)in the elderly,the risk factors for secondary adjacent vertebral fractures were included.Methods The patients with symptomatic single-segment osteoporotic thoracolumbar vertebral compression fractures who were hospitalized in the Orthopedics Department of Beijing Geriatric Hospital from July 2014 to June 2018 were selected as the study subjects,among them,patients with PKP were in the PKP group(189 cases),and patients with PVP were in the PVP group(173 cases).They were followed up for 1 year.The risk of compression fractures of adjacent vertebral bodies after the two surgical methods were compared by statistical analysis.Results Both PKP and PVP significantly reduced visual analogue scale(VAS)scores in 362 patients,and there was no significant difference in the rate of adjacent vertebral fractures between the two groups.Age(OR=1.075,95%CI:1.040-1.112,P<0.001),bone density T value decreased(OR=0.576,95%CI:0.351-0.946,P=0.030),cement leakage(OR=2.284,95%CI:1.200-4.344,P=0.018),postoperative correction of local sagittal Cobb s angle(OR=1.188,95%CI:1.124-1.255,P=0.009)are independent risk factors for adjacent vertebral fractures after OVCF.Conclusion Both PKP and PVP can provide comparable pain relief rates,and there was no difference in the risk of secondary adjacent vertebral fractures between the two procedures.Age,bone mineral density,bone cement leakage(intradiscal leakage)and overcorrection of sagittal Cobb s angle were independent risk factors for secondary adjacent vertebral fractures after OVCF.