椎体成形术后再骨折相关因素分析

Analysis of refractures factors after percutaneous vertebroplasty

目的：分析经皮穿刺椎体成形术（percutaneous vertebroplasty,PVP）治疗骨质疏松性椎体压缩骨折（osteoporosis vertebral compression fracture,OVCF）后再发骨折的相关因素,探讨引起再骨折的主要因素。方法：回顾性分析行PVP治疗的264例（394个椎体）OVCF患者,分为A组（再发骨折组）34例,B组（未再发骨折组）230例。随访时间6~35个月,平均20.5±8.8个月,记录患者的年龄,性别,术后再发骨折的时间、部位、发生率,空腔样椎体数目,终末随访定量CT（QCT）值,骨水泥渗漏的部位及渗漏率,手术前后VAS评分等因素并对以上因素进行两组间对比分析。结果：PVP后首次再发邻近椎体骨折与跨跃式椎体骨折的总发生率为13%（共34例）,时间为11.7±9.2个月,有21例患者第2、3次再发骨折发生在3个月内。年龄、性别、空腔样椎体数目等因素在A组和B组间差异无显著性（P〉0.05）;QCT值在A组和B组间差异有显著性（P〈0.05）;术前、术后第3天VAS评分在A组、B组各组内比较有显著意义（P〈0.05）,末次随访时VAS评分两组间比较差异有显著性（P〈0.05）。骨水泥渗漏共34例36个椎体,骨水泥渗漏率为9%,渗漏后均无临床相关症状;骨水泥渗漏在A组和B组间差异无显著性（P〉0.05）,A组和B组两组间不同部位骨水泥渗漏情况比较,不管是椎间隙渗漏还是其他部位渗漏,均提示差异无显著性（P〉0.05）;不同部位骨水泥渗漏的患者间在VAS评分（术前、术后、末次随访）对比,均提示差异无显著性（P〉0.05）。结论：OVCF患者行PVP治疗,能够取得满意效果,年龄、性别、空腔样椎体数目、骨水泥渗漏与PVP后再发骨折无明显相关性,骨质疏松可能是引发椎体成形术后再骨折的一个主要因素。

Objectives： To investigate the associated risk factors of percutaneous vertebroplasty（PVP） for the treatment of osteoporotic vertebral compression fractures（OVCF） following fracture, and to investigate the main factor causing fracture. Methods： By retrospective analysis, 264 cases（394 vertebrae） patients of OVCF treated by PVP were divided into 34 cases as group A （refracture group）, while the other 230 cases （no refracture group） were termed as group B. The follow-up time averaged 20.5＋8.8 months（range 6-35 months）, factors such as time, location and incidence rate of refracture, and patient＇s age, gender, the number of vertebral cavity, QCT value, leakage of bone cement, VAS scores before and after operation, were recorded and ana- lyzed. Results： Adjacent vertebral fracture and leaping vertebral fracture total rate of the first-refracture was 13%, the time was 11.7＋9.2 months, 21 cases while the second and the third was occurred in 3 months.The rate of bone cement leakage was 9%, without clinical symptoms. Age, gender, the number of vertebral cavity was no significant differences in group A and B （P〉0.05）. There was significant difference of QCT value between group A and B（P〈0.05）. Compared with preoperation, significant difference of the VAS score appeared in 3 days postoperation of group A and B （P〈0.05）, there was significant difference of the VAS score in the final follow-up between two groups（P〈0.05）. A total of 34 cases（36 vertebral） had bone cement leakage, the rate was 9%, and no clinical symptoms appear after the leakage, leakage of bone cement was no significant differences in group A and B（P〉0.05）. Different parts of the bone cement leakage were compared between the two groups, there was no significant difference （P〉0.05） whether intervertebral leakage or other parts of the leakage. There was no significant differences（P〉0.05） in VAS score（preoperation, postoperation, final follow-up） of patients with different parts of the bone cement leakage. Conclusions： There is satisfactory effect on patient with osteoporotic vertebral compression fractures treated by percutaneous vertebroplasty. Age, gender, the number of vertebral cavity, eakage of bone cement was no significant correlation of refracture after percutaneous vertebroplasty, a major factor of osteoporosis is likely to lead refracture after percutaneous vertebroplasty.