PVP治疗骨质疏松性椎体压缩骨折预防相邻椎体骨折的随机对照研究

Randomized controlled study of PVP in treatment of osteoporotic vertebral compression fractures for prevention of adjacent vertebral fractures

目的探讨骨质疏松性椎体压缩骨折经皮椎体成形（PVP）术后继发相邻椎体骨折的影响因素,并制定干预措施。方法采用前瞻性对照研究,纳入自2012-06—2014-06诊治的72例骨质疏松性椎体压缩骨折。对脊柱骨质疏松程度进行评定,中度风险和高度风险患者按数字表法随机进入试验组和对照组。试验组中度风险患者予以双侧注射低模量骨水泥5 ml,高度风险患者予以双侧注射低模量骨水泥3 ml;对照组中度风险和高度风险患者均予以单侧注射普通骨水泥5 ml。比较术前及末次随访时的相邻椎体前缘压缩率、中柱压缩率及后倾角（Q角）。结果术后所有患者均获得随访6~18个月,平均12.5个月。试验组、对照组中度风险、高度风险患者末次随访时相邻椎体前缘压缩率、中柱压缩率及Q角均增加,差异有统计学意义（P〈0.05）。对照组中度风险、高度风险患者末次随访时相邻椎体前缘压缩率、中柱压缩率及Q角均较试验组更高,差异有统计学意义（P〈0.05）。试验组中度风险（P=0.041）、高度风险患者（P=0.044）相邻椎体骨折发生率均低于对照组,差异有统计学意义（P〈0.05）。结论按照骨质疏松程度分组,采用低弹性模量骨水泥双侧注射,并合理调整骨水泥的用量,规范的抗骨质疏松治疗可以降低PVP术后相邻椎体骨折的发生率。

Objective To investigate the factors of the occurrence of the secondary adjacent vertebral fractures after percutaneous vertebrolplasty（PVP） for osteoporotic vertebral compression fractures（OVCF）. Methods From June 2012 to June 2014, 72 patients with OVCF were evaluated for the degree of osteoporosis of the spine by dual energy X-ray absorption spectrometry. Patients with moderate risk and high risk were randomly enrolled into the experimental group and the control group according to the number table method. In the experimental group, the patients with moderate risk were injected with 5 ml of low modulus bone cement, and the high risk patients were injected with 3ml of low modulus bone cement. In the control group, patients with moderate risk and high risk were given unilateral injection of 5 ml of normal bone cement. The anterior edge compression rate, the middle column compression ratio and Q angle of the adjacent vertebral bodies before operation and at the last follow-up were compared. Results All patients were followed up for 6-18 months with an average of 12.5 months. In the experimental group and the control group with moderate risk and high risk patients at the end of the follow-up, the anterior edge compression rate, the middle column compression ratio and Q angle of the adjacent vertebral bodies were increased, the difference was statistically significant （P 〈0.05）. In the patients with moderate risk and high risk in the control group, the anterior edge compression rate, the middle column compression ratio and the Q angle of the adjacent vertebral bodies were higher than those in the experimental group at the end of the last follow-up, the difference was statistically significant （P 〈0.05）. The incidence of adjacent vertebral fractures in the experimental group were significantly lower than that in the control group, the difference was statistically significant （P 〈0.05）. Conclusion Grouping according to the degree of osteoporosis, bilateral injection of low elastic modulus bone cement, rationally adjusting the dosage of bone cement, and standard anti-osteoporosis treatment can reduce the incidence of adjacent vertebral fractures after PVP.