经皮椎体成形术与经皮椎体后凸成形术术后手术椎体再发骨折比较

Comparison of augmented vertebral refracture after percutaneous vertebroplasty and percutaneous kyphoplasty

目的研究对比经皮椎体成形术(percutaneous vertebroplasty,PVP)和经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCFs)术后1年发生手术椎体再发骨折的差异。方法回顾性分析2008年6月至2015年1月就诊于首都医科大学附属北京友谊医院,并能获得完整随访资料的809例OVCF患者的临床资料,其中PVP组536例,PKP组273例,收集两组患者的性别、年龄、体质量、测量获得的骨密度值、骨水泥注入量、术后复查影像学随访资料。比较两组患者术前、术后24 h和术后12个月手术椎体高度间的差异,包括再骨折发生率、术后椎体高度恢复率、再骨折所造成的手术椎体高度丢失率。结果 PVP组29例患者(手术治疗43个椎体,再骨折35个椎体)发生了手术椎体再骨折,再骨折发生率5.41%;PKP组34例患者(手术治疗45个椎体,再骨折39个椎体)发生了手术椎体再骨折,再骨折发生率12.45%。PKP组的手术椎体再骨折发生率及手术椎体高度丢失率均高于PVP组(P<0.05)。结论椎体强化术后椎体的再骨折风险与术式有关,PKP较PVP术后手术椎体再骨折风险较高。

Objective To compare the vertebral refracture after percutaneous vertebralplasty （PVP） and percutaneous kyphoplasty （PKP） in the treatment of osteoporotie vertebral compression fractures （OVCFs）. Methods We recruited 809 patients treated in Beijing Friendship Hospital affiliated to the Capital Medical Univer- sity with osteoporotie vertebral compression fractures from June 2008 to January 2015 and complete follow-up data in this study. The 809 patients were divided into two groups （PVP group： 536 cases; PKP group： 273 cases）. We evaluated the patients＇ age, sex, bone mineral density values, postoperative radiographic follow-up information in this study. Vertebral heights were measured preoperatively and 24 hours, 12 months postoperatively. We compare the collapsed vertebral differences between the two groups, including： refracture incidence, the height of the vertebral body recovery rate and vertebral height loss ratio caused by the recurrence of fracture. Results Twenty nine patients in the PVP group （ surgical treatment of 43 vertebral body, of which 35 vertebral refracture） had vertebral collapse again, with incidence of refracture 5.41% , while the number was 34 in PKP group （ surgical treatment of 45 vertebral body, with 39 vertebral refracture, 12.45% incidence of refracture ）. For the incidence of vertebral refracture and vertebral height loss ratio of operation, PKP group were higher than those in PVP group （ P 〈 0.05 ）. Conclusions Recurrence of fracture risk of the vertebral augmentation operation correlated to surgery mode. PKP group had higher incidence of vertebral refracture than PVP group.