经皮椎体成形及后凸成形治疗对临近椎间盘退变的影响及机制

Effect of percutaneous vertebroplasty and percutaneous kyphoplasty on adjacent intervertebral disc degeneration and mechanism

背景:相较于传统的保守治疗,经皮椎体成形和经皮后凸成形两种术式可更快的缓解椎体骨质疏松压缩骨折疼痛症状,但骨水泥灌注恢复了骨折椎体刚度的同时,理论上也会改变骨折椎体的应力分布和增加临近椎体的应力载荷,造成临近椎间盘退变。目的:观察经皮椎体成形、经皮后凸成形对临近椎间盘退变的影响,并探讨其中可能的机制。方法:收集椎体骨质疏松压缩骨折患者85例,分为经皮椎体成形组42例、经皮后凸成形组23例,并设置了行保守治疗的23例患者作为对照。分析患者在治疗前后不同时间点的ODI评分和椎间盘指数、外周血白细胞介素1β,白细胞介素6,肿瘤坏死因子α水平变化。结果与结论:经皮椎体成形和经皮后凸成形均能达到较快的缓解疼痛及减少卧床时间的满意疗效,但出院后24个月的ODI评分比较,两组差异无显著性意义(P>0.05)。在出院后24个月,经皮椎体成形组和经皮后凸成形组的MRI指数低于保守治疗组及治疗前(P<0.05);外周血白细胞介素1β,白细胞介素6及肿瘤坏死因子α值则高于保守治疗组及治疗前(P<0.05),且经皮后凸成形组较经皮椎体成形组差异更明显(P<0.05)。提示经皮椎体成形及经皮后凸成形能加速临近椎间盘的退变,且后者的影响可能更大些。另外,白细胞介素1β、白细胞介素6、肿瘤坏死因子α与椎间盘退变程度密切相关。

BACKGROUND：Compared with conservative treatment, percutaneous vertebroplasty （PVP） and percutaneous kyphoplasty （PKP） can rapidly relieve the pain caused by the compression of osteoporotic vertebral body. However, the perfusion of bone cement can not only restore the rigidity of fractured vertebrae, but also theoretical y alter the stress distribution of fractured vertebrae and increase the stress load of adjacent vertebrae, thus causing adjacent intervertebral disc degeneration. OBJECTIVE：To observe the effects of PVP and PKP on the adjacent intervertebral disc degeneration and explore the possible mechanism. METHODS：A total of 85 patients with osteoporotic vertebral compression fracture were divided into three groups：conservative treatment group （n=23）, PVP group （n=42） and PKP group （n=23）. ODI scores, DHI, MRII, and peripheral interleukin-1β, interleukin-6, tumor necrosis factor-αlevels were col ected and analyzed at different time points. RESULTS AND CONCLUSION：The results showed that, PVP group and PKP group relieved pain effectively,＆amp;nbsp;reduced the time in bed, and had a better treatment satisfaction, but there were no significant differences in the scores of ODI scores between PVP group and PKP group at 24 months after discharge （P〉0.05）. At 24 months after discharge, MRII in the PVP group and PKP group were lower than that in conservative treatment group and before treatment （P〈0.05）, while peripheral interleukin-1, interleukin-6, tumor necrosis factor-αlevels were higher （P〈0.05）, there were significant differences between PVP group and PKP group （P〈0.05）. The disc degeneration adjacent to the fractured vertebral body can be accelerated by PVP and PKP procedures, and the latter is more serious. Interleukin-1, interleukin-6, tumor necrosis factor-αlevels are closely related to the degree of intervertebral disc degeneration.