单节段经皮椎体成形术后症状性椎体再骨折相关因素研究

The related factors of symptomatic vertebral refracture after single segmental percutaneous vertebroplasty

目的探讨行单节段经皮椎体成形术(percutaneous vertebroplasty,PVP)后发生症状性椎体再骨折的危险因素。方法选取2015年5月~2016年10月,对诊断为骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)并行PVP的94例患者行回顾性研究,19位患者在术后随访期间出现症状性椎体再骨折(再骨折组),75位未发生再骨折(对照组)。比较分析两组的生物学和手术各参数。结果随访出现再骨折病例中,邻近椎体再骨折11例(57.89%,11/19),非邻近椎体再骨折8例(42.11%,8/19),邻位椎体骨折均为术后6月以内发生,非邻位椎体再骨折中仅2例(25.00%,2/8)发生在术后6月以内。既往骨折病史(P=0.01)、骨水泥是否分布对称(P=0.02)、骨水泥量(P=0.02)及骨水泥分布位置(P=0.03)是椎体再骨折发生的独立危险因素。结论骨水泥填充位置、骨水泥量、分布是否对称以及既往骨折病史是发生再骨折的影响因素,而PVP术后更长时间内出现椎体再骨折与骨质疏松(osteoporosis,OP)相关。

Objective To investigate the risk factors of symptomatic vertebral re-fracture after single segmental percutaneous vertebroplasty（PVP）. Methods From May 2015 to Oct 2016, retrospective analysis was performed on 94 patients diagnosed with osteoporotic vertebral compression fracture（OVCF） concurrent PVP surgery. 19 patients underwent symptomatic vertebral fracture（re-fracture group） and 75 patients did not have any vertebral re-fracture（control group） during postoperative follow-up. The clinical and surgical parameters of the two groups were compared and analyzed. Results In the re-fracture cases, the adjacent vertebral fractures were found in 11 cases（57.89%, 11/19）, non adjacent vertebral fractures in 8 cases（42.11%, 8/19）, the adjacent vertebral fractures were all occurred within 6 months after operation, and only 2 cases of non adjacent vertebral body re-fractures（25.00%, 2/8） occurred within 6 months after operation. The history of fractures（P=0.01）, bone cement distribution symmetry（P=0.02）, bone cement volume（P=0.02） and bone cement distribution position（P=0.03） are independent risk factors for the vertebral re-fracture. Conclusion The distribution position of bone cement and whether the symmetrical, cement volume and the history of fractures are the factors affecting the recurrence of re-fracture, and the vertebral re-fracture is related with osteoporosis for a longer period after PVP.