经皮椎体成形术和经皮椎体后凸成形术强化T_(12)、L_1骨质疏松性压缩性骨折对邻近腰椎体骨密度的影响

INFLUENCE ON ADJACENT LUMBAR BONE DENSITY AFTER STRENGTHENING OF T_(12),L_1 SEGMENT VERTEBRAL OSTEOPOROTIC COMPRESSION FRACTURE BY PERCUTANEOUS VERTEBROPLASTY AND PERCUTANEOUS KYPHOPLASTY

目的比较经皮椎体成形术(percutaneous vertebroplasty,PVP)和经皮椎体后凸成形术(percutaneouskyphoplasty,PKP)治疗绝经后女性T12、L1椎体骨质疏松性压缩性骨折术后对邻近腰椎体骨密度的影响。方法 2008年1月-2011年6月收治符合选择标准的T12、L1骨质疏松性压缩性骨折患者59例,根据采用手术方法不同随机分为PVP组(29例)和PKP组(30例)。两组患者年龄、绝经时间、病程、致伤原因、骨折椎体、骨折分度等一般资料比较,差异均无统计学意义(P>0.05)。于术前、术后1周和末次随访时测量手术区域后凸Cobb角;于围手术期及末次随访时测量患者手术区域下位腰椎(L5除外)骨密度值、股骨颈骨密度值及体重指数(body mass index,BMI),了解抗骨质疏松情况;并应用FRAX在线工具评价两组患者未来10年主要骨质疏松性骨折和髋部骨折的概率。结果两组患者均获随访,随访时间12～48个月,平均25.5个月。两组末次随访时T12、L1后凸Cobb角与术前比较差异均有统计学意义(P<0.05);术后1周及末次随访时PKP组Cobb角显著小于PVP组(P<0.05)。两组组间及组内围手术期、末次随访时BMI比较差异均无统计学意义(P>0.05)。两组末次随访时下腰椎骨密度及其T值均较围手术期显著改善(P<0.05);两组间围手术期下腰椎骨密度及其T值比较差异无统计学意义(P>0.05),末次随访时两组间差异有统计学意义(P<0.05)。两组间及组内围手术期、末次随访时股骨颈骨密度及其T值比较差异均无统计学意义(P>0.05)。骨折风险评估:两组间及组内围手术期、末次随访时主要骨质疏松性骨折和髋部骨折的概率比较差异均无统计学意义(P>0.05)。结论经PVP和PKP治疗1年以上未继发骨折的T12、L1节段骨质疏松性压缩性骨折患者,术后邻近腰椎骨密度的增加提高了其椎体强度,远期邻近腰椎骨折发生率较低,且PKP相对于PVP,更有助于提高邻近腰椎骨密度。

Objective To observe the influence on adjacent lumbar bone density after strengthening of T12, L1 segment vertebral osteoporotic compression fracture by percutaneous vertebroplasty （PVP） and percutaneous kyphoplasty （PKP） in postmenopausal female. Methods Between January 2008 and June 2011, 59 patients with T12, L1 segment thoracolumbar osteoporotic compression fracture were treated with PVP in 29 cases （PVP group） and PKP in 30 cases （PKP group）, who were in accordance with the inclusion and exclusion criteria. No significant difference was found in gender, duration of menopause, disease druation, causes of injury, fractured vertebral body, and vertebral fracture classification between 2 groups （P 〉 0.05）. The kyphosis Cobb angle of surgical area was measured at preoperation, 1 week after operation, and last follow-up; the lower three lumbar spine bone mineral density （BMD） of the surgical area, the femoral neck BMD, and body mass index （BMI） of patients were measured at perioperative period and last follow-up to find out the statement of anti-osteoporosis; FRAX online tools were used to evaluate the probability of major osteoporotic fracture and hip fracture of the next 10 years. Results The average follow-up was 25.5 months （range, 12-48 months） in 2 groups. There was significant difference in kyphosis Cobb angle of T12, L1 between preoperation and last follow-up in 2 groups （P 〈 0.05）; the Cobb angle of PKP group was significantly less than that of PVP group at 1 week after operation and last follow-up （P 〈 0.05）. No significant difference was found in BMI between 2 groups, and between perioperative period and last follow-up in the same group （P 〉 0.05）. The lower three lumbar spine BMD of the surgical area and its T value at last follow-up was improved significantly when compared with BMD at perioperative period （P 〈 0.05）; there was no significant difference in the lower three lumbar spine BMD and its T value between 2 groups at perioperative period （P 〉 0.05）, but significant difference was found between two groups at last follow-up （P 〈 0.05）. Difference was not significant in the femoral neck BMD and its T value between 2 groups, and between perioperative period and last follow-up in the same group （P 〉 0.05）. The probability of major osteoporotic fracture and hip fracture of the next 10 years was not significantly different between 2 groups and between perioperative period and last follow-up in the same group （P 〉 0.05）. Conclusion The increased BMD of adjacent lumbar spine can improve the strength of the vertebral body and reduce the incidence of adjacent vertebral fracture in patients with T12, L1 segment vertebral osteoporotic compression fracture after PVP/PKP, and PKP is superior to PVP increasing BMD of adjacent lumbar spine.