经皮穿刺椎体后凸成形术治疗骨质疏松性椎体压缩骨折术后发生继发性椎体骨折的危险因素分析

Risk factors of subsequent vertebral fracture after percutaneous kyphoplasty

目的 分析骨质疏松性椎体压缩骨折（OVCF）患者行经皮穿刺椎体后凸成形术（PKP）后发生继发性椎体骨折的情况及相关危险因素.方法 对2005年7月至2007年10月行PKP手术治疗的95例OVCF患者（135个椎体）,动态监测其术后状态及正常椎体继发骨折与否;对其临床相关参数如性别、骨质疏松原因、骨折部位、矢状面成角、骨水泥注入量、骨水泥椎间隙渗漏、椎体高度恢复、术后支具佩戴、抗骨质疏松治疗及原发骨折类型进行统计学分析,以筛选出发生继发性骨折的相关危险因素.结果 所有患者术后随访10～35个月（平均18个月）;其中19例（20.0%）患者25个（18.5%）正常椎体（22个位于手术节段邻近上下椎体）术后发生继发性骨折;其中12例患者的继发骨折在术后3个月内发生.继发性骨质疏松骨折、骨水泥椎间隙渗漏及新鲜椎体骨折是PKP治疗OVCF后发生继发性椎体骨折的危险因素（P＜0.05）.结论 OVCF进行PKP手术后部分患者可能在术后早期发生继发性椎体骨折,其发生与骨质疏松原因、术中骨水泥椎间隙渗漏及新鲜椎体骨折相关.

Objective To evaluate the risk factors for subsequent vertebral fractures after percutaneous kyphoplasty （PKP） in patients with osteoporotic vertebral compression fracture （OVCF）. Methods The 95 OVCF patients who had undergone PKP from July 2005 to October 2007 were followed up to observe the incidence of subsequent vertebral fracture. Altogether 135 levels of vertebrae were involved. Statistical analyses were done to screen the risk factors associated with subsequent vertebral fractures in this group.Results The follow-ups ranged from10 to 35 months, averaging 18 months. Over the follow-up period, 19 patients （20. 0% ） sustained 25 subsequent fractures （ 18. 5% ）. Twelve patients had fractures within 3 months after the operation. Secondary osteoporosis, intraoperative leakage of bone cement and fresh bone fracture were found to be correlated with subsequent vertebral fracture. Conclusions The subsequent vertebral fracture may occur in OVCF patients undergoing PKP, especially in the early postoperative months. Secondary osteoporosis, intraoperative leakage of bone cement and fresh bone fracture may be the risk factors.