骨质疏松性椎体压缩骨折椎体成形术后继发骨折原因分析

Analysis of the reason of secondary fracture after percutaneous vertebroplasty for osteoporotic vertebral compression fractures

目的：探讨椎体成形术（percutaneous vertebroplasty,PVP）治疗骨质疏松性椎体压缩骨折（osteoporotic vertebral compression fracture,OVCF）继发骨折发生原因和防治措施。方法：2011年1月至2013年1月,对采用PVP治疗的180例原发性骨质疏松性椎体压缩骨折进行回顾性分析,男75例,女105例;年龄68-95岁,平均（79.50±5.45）岁。依据临床症状和影像学检查,判定责任椎,行椎体成形术共362个椎,术后平均随访12个月。根据再次出现疼痛和核磁或骨扫描检查判定是否继发骨折,分继发骨折和未继发骨折两组,继发骨折组按性别不同分两组,每组分原手术椎再骨折、邻椎骨折和跳跃椎骨折3类。比较各组间年龄、性别、骨水泥注射量、骨水泥泄露、继发骨折部位、继发骨折率和继发骨折类型等情况。结果：男性椎体成形术109椎,女性椎体成形术253椎,术后继发骨折共22例27椎,其中行2次椎体成形术13例16椎,3次椎体成形术2例4椎,保守治疗7例7椎。继发骨折组和未继发骨折组年龄、性别、骨水泥注射量和骨水泥椎间隙泄露与否比较差异无统计学意义（P〉0.05）。继发骨折组内男女两组间继发骨折率、继发骨折类型差异无统计学意义（P〉0.05）,跳跃椎骨折发生率与邻椎骨折发生率差异无统计学意义（P〉0.05）。继发骨折多发生于术后半年内,而与是否单双侧注射、是否椎间隙泄露无明显关系。结论：椎体压缩骨折椎体成形术后继发骨折与性别和部位无关,术后跳跃椎骨折与邻椎骨折发生率无明显差异,不支持椎体成形术后椎体刚度增加所致邻椎应力增加继而邻椎易骨折这一生物力学观点,认为椎体成形术后继发骨折多发生于术后半年内,是骨质疏松的自然病程。

Objective：To explore the reasons of secondary fracture after percutaneous vertebroplasty （PVP） for osteoporotic vertebral compression fractures （OVCFs） and discuss the measure of prevention and cure. Methods：From January 2011 to January 2013,the clinical data of 180 patients with primary OVCFs treated by PVP were retrospectively analyzed. There were 75 males and 105 females,aged from 68 to 95 years old with an average of （79.50±5.45） years. The involved vertebrae were identified according to the clinical symptoms and imaging data. PVP were performed in 362 vertebrae and the patients were followed up with an average of 12 months. Subsequent vertebral fractures were found through the pain ’s reappearance and MRI or bone scan. The patients were divided into secondary fracture group and no secondary fracture group according to the subsequent fractures or no. Secondary fracture group was divided into two groups according to gender ,and the patients with secondary fracture were also categorized into the original surgical vertebral fractures ,adjacent vertebral fracture and remote vertebral fractures. The age,gender,the cement volume,the cement leakage,secondary fracture site,the incidence and type of secondary fracture were observed and compared among different groups. Results：Among the 362 vertebrae of PVP,there were 109 vertebrae in male and 253 vertebrae in female. And 27 vertebrae （10 in male and 17 in female） of 22 cases （9 males and 13 females） occurred secondary fracture. The second PVP were performed in 13 cases （16 vertebrae） and the third PVP in 2 cases （4 vertebrae）;7 cases （7 vertebrae） were treated with conservative therapy. There was no statistically significant difference on age , gender,cement volume and leakage between secondary fracture group and no secondary fracture group （P〉0.05）. There was no statistically significant difference on the incidence and type of secondary fracture between male and female （P〉0.05）. No significant difference was found on the adjacent and remote vertebral fractures （P〉0.05）. Most of secondary fracture occurred in 6 months,and whether the single and double side injection,cement leakage had no obvious relation. Conclusion：There is no significant difference in the subsequent fracture after PVP for the OVCFs different gender and fractured site ,and also no significant difference in the adjacent and remote vertebral fractures. The report didn＇t support the biomechanical viewpoint that vertebral body stiffness increasing after PVP would lead to adjacent vertebral stress increasing and result easily in adjacent vertebral fracture. Secondary fracture occurs always in 6 months after operation ,which is the natural course of osteoporosis.