经皮椎体后凸成形术治疗骨质疏松性椎体压缩性骨折术后邻椎骨折的临床研究

Clinical study on adjacent vertebral fractures after percutaneous kyphoplasty surgery in the treatment of osteoporotic vertebral compression fractures

目的探讨骨质疏松性椎体压缩性骨折经皮椎体成形术(PKP)治疗术后邻椎再骨折的相关高危因素。方法回顾性分析68例骨质疏松性椎体压缩性骨折行PKP椎体成形术后邻椎再骨折病例,随机分为PKP椎体成形实验组和保守治疗对照组,每组34例,比较两组治疗后邻椎再骨折的发生率。结果 68例均获随访,时间6~12个月,平均(7.3±2.4)个月,回访示:PKP手术实验发生邻椎再骨折12例(35.29%),对照组发生邻椎再骨折4例(11.76%);体重指数<20 kg/m^2时,实验组再骨折率为50%,对照组再骨折率为18%;骨密度小于-2.5 SD时,实验组再骨折率为60%,对照组再骨折率为16%;两组比较,差异均有统计学意义(P<0.05)。结论 PKP治疗骨质疏松性椎体压缩性骨折增加邻椎骨折的发生率,其高危因素可能与骨质疏松、体重指数、骨水泥注入量、注入方式有相关性。

Objective To investigate the related risk factors of recurrent adjacent vertebral fractures after the percuta- neous vertebroplasty （PKP） surgery for the treatment of osteoporotic vertebral compression fractures. Methods A total of 68 cases of recurrent adjacent vertebral fractures after percutaneous kyphoplasty surgery in the treatment of osteoporotic vertebral compression fractures were retrospectively analyzed. The patients were randomly divided into PKP vertebro- plasty experimental group and conservative treatment control group, with 34 cases in each group. The incidence of re- current adjacent vertebral fractures after treatment between the two groups was compared. Results Sixty-eight patients were followed up for 6 to 12 months, averaged（7.3±2.4） months. Return visit results showed that 12 cases of recurrent adjacent vertebral fractures occurred in PKP operation, with the rate of 35.29%. 4 cases of recurrent adjacent vertebral fractures occurred in the control group, with the rate of 11.76%. When the body mass index was less than 20 kg/m2, the recurrent fracture rate of the experimental group was 50%, and the recurrent fracture rate of the control group was 18%. And when the bone density was less than -2.5 SD, the fracture rate was 60% in the experimental group while 16% in the control group, the differences were statistically significant between two groups（P〈0.05）. Conclusion PKP in the treatment of osteoporotic vertebral compression fractures increases the incidence of adjacent vertebral fractures, and its risk factors may be correlated with osteoporosis, body mass index, bone cement injecting amount and injection method.