椎体内裂隙及其位置对骨质疏松椎体压缩骨折疗效影响

An evaluation of intravertebral vacuum cleft and its varied locations in osteoporotic vertebral compression fractures

[目的]分析骨质疏松椎体压缩骨折(osteoporotic vertebral compression fractures,OVCFs)中椎体内裂隙(intravertebral vacuum cleft,IVC)发病率及其在伤椎内位置特点,并比较不同位置IVC对经皮椎体强化术治疗有IVC的OVCFs治疗效果影响差异。[方法]共有52例单节段并位于胸腰区域(T_(11)~L_1)有IVC的OVCFs患者纳入回顾性研究,随访时间均超过两年。根据IVC在伤椎内的位置特点,将所有患者分为三组:IVC偏上组、IVC偏下组和IVC达到上下终板组。三组组间及组内相应的放射学和临床参数在术前、术后(即时、术后1年、术后2年)分别比较。[结果]三组患者术前基值差异均无统计学意义,具有可比性。三组患者术后即时的椎体高度及后凸角均显著矫正;三组术后即时放射学及临床参数差异无统计学意义。在术后1、2年随访期间内,三组患者椎体高度及后凸角角均进展性加重,尤以IVC偏下组为最重,其次是IVC偏上组。三组在伤椎复位率及复位角差异无统计学意义(P<0.05);IVC偏下组2年内的高度及后凸丢失率显著超过其他两组(P<0.05)。[结论]经皮椎体强化术起初对于所有IVC的OVCFs患者有效。然而,在后期随访中IVC偏下组更易出现严重的椎体再塌陷及后凸畸形,因此建议术后需要严密的观察及随访。

[Objective] To determine the incidence and distribution characteristics of intravertebral vacuum cleft （IVC） and assess effect of its varied location on long-term therapeutic efficacy of percutaneous vertebral augmentation （pVA） treatment for osteoporotic vertebral compression fractures （OVCFs） . [Methods] In a total, 52 patients treated with PVA for single OVCFs with IVC were reviewed. The follow-up period was at least ：2 years. The varied locations of IVC with- in the affected vertebrae were respectively classified into three groups by imaging evaluation： the IVC adjacent to superior, endplale inferior endplate, and IVC reaching both endplates. Radiological and clinical parameters were analyzed and com- pared preoperatively and postoperatively （immediately, 1 year, and 2 years） . [Results] The baseline measurements among three groups showed no significant difference. The vertebral height and kyphotic angle was immediately corrected postop- eratively in all three groups. No significant difference in immediately postoperative radiological and clinical parameters was found among the three groups. However, significant recollapse in the group with IVC adjacent to inferior endplate were noted within 2 years follow-up, which were more severe than the other two groups. The progressive height loss and progressive angle in the IVC adjacent to inferior endplate group was significantly higher than other two groups. [Conclusion] PVA treatment was initially effective in all patients in OVCFs with IVC, but the severe recollapse of the augmented vertebrae with IVC adjacent to inferior endplate would happen after long term follow-up. Therefore, we strongly recommend its striet observation and follow-up.