椎体后凸成形术后邻近椎体再发骨折发生率及相关危险因素的分析研究

Incidence and risk factors of fracture in adjacent levels in patients treated with kyphoplasty

目的采用循证医学研究方法,评价椎体后凸成形术(PKP)治疗骨质疏松性椎体压缩骨折术后邻近椎体再发骨折的发生率及危险因素,为临床治疗提供参考。方法检索椎体后凸成形术治疗骨质疏松性骨折术后邻近椎体再发骨折的中外文文献,根据具体的纳入标准筛选文献进行统计分析,共有12篇临床研究(外文10篇,中文2篇)、1 816例患者纳入最终统计分析。结果研究分析发现,邻近椎体再发骨折的发生率为6.5%～26.3%,其发生的危险因素包括骨密度、骨水泥外渗、椎体后凸角等,但存在争议。结论椎体后凸成形术后邻近椎体再发骨折的主要危险因素是骨质疏松症和骨水泥外渗,提高椎体后凸成形术技术水平,规范化的抗骨质疏松治疗是降低并发症的有效手段。

Objective To evaluate the incidence and risk factors of postoperative complications of osteoporotie vertebral compression fracture by employing evidence-based medicine method so as to provide basis for clinical treatment strategy. Methods Eligible literatures on vertebral body compression fractures treated with pereutaneous kyphoplasty were retrieved through Chinese and English medicine database. Then the retrieved literatures were organized and analyzed. Results Two Chinese and ten English literatures were included in the study. According to the results, the percentage of subsequent fractures after kyphoplasty varied from 6.5% to 26.3 %. The risk factors related to adjacent fractures included bone density, cement leakage, and kyphotie angle, but the exact risk factors of subsequent vertebral fractures following kyphoplasty were still in dispute. Conclusion The major risk factors contributing to adjacent vertebral fractures were osteoporosis and cement leakage, and good operative technique and antiosteoporosis treatment are the effective methods to reduce the incidence of subsequent vertebral fractures.