椎体成形术后相邻椎体再骨折的临床研究

Clinical study of adjacent vertebral re-fractures after vertebroplasty

目的探讨如何减少经皮椎体成形术(percutaneous vertebroplasty,PVP)或经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)术后相邻椎体的再骨折。方法 98例PVP或PKP术后患者分为两组:A组,行PVP或PKP手术治疗,术前及术后给予抗骨质疏松治疗(即钙剂、骨化三醇、鲑鱼降钙素或阿仑膦酸钠"三联"药物抗骨质疏松治疗1年);B组,只行PVP或PKP手术治疗,术前及术后未给予抗骨质疏松治疗。结果随访6～32个月,平均21.5个月。A组较第1次手术后骨密度明显改善(P<0.05)。相邻椎体再骨折的发生率明显减低。结论骨质疏松性椎体压缩骨折(Osteoporoticvertebral compression fractures,OVCF)是老年脆性骨折之一,PVP或PKP术中需在骨水泥"牙膏期"缓慢充填,防止骨水泥外渗,尤其是椎间盘的外渗,使骨水泥分布尽量均匀同时接触上下终板,以超过目前球囊4ml的骨水泥容量更为合适。术前及术后必须抗骨质疏松治疗,这些是减少术后相邻椎体再骨折的有效方法。

Objective To investigate how to reduce the incidence of adjacent vertebral re-fracture after percutaneous vertebroplasty （PVP） or percutaneous kyphoplasty （PKP）. Methods A total of 98 patients, who underwent PVP or PKP, were divided into two groups. Patients in Group A not only received PVP or PKP, but also received anti-osteoporosis treatment （calcium, calcitriol, salmon calcitonin or alendronate sodium, so-called ＂triple＂ drug treatment for osteoporosis for 1 year） before and after the operation. Patients in Group B received PVP or PKP only, without using any drugs for the treatment of osteoporosis. Results The follow-up ranged from 6 to 32 months, with an average of 21.5 months. Bone mineral density in Group A improved significantly （ P 〈 0.05 ）. The incidence of adjacent vertebral re - fractures reduced obviously. Conclusion Osteoporotic vertebral compression fracture （OVCF） is one of fragility fractures in senile patients. Filling of bone cement should be performed slowly during toothpaste period of PVP or PKP to prevent the bone cement leakage, especially leaking to the intervertebral disc. The distribution of bone cement should be equal and fully contacted to the upper and lower plates. The filling amount should be 4 ml more than the balloon volume. Anti-osteoporosis treatment should be performed before and after the surgery. These are the effective methods for reducing the incidence of postoperative adjacent vertebral re - fractures.