胸腰椎骨折术后形成“蛋壳样”椎体的危险因素

Risk factors for the formation of an eggshell like vertebral body after thoracolumbar fracture surgery

目的探讨胸腰椎骨折行后路钉棒内固定术后,形成"蛋壳样"椎体的相关因素。方法总结2013-02-2016-02行后路椎弓根钉内固定手术治疗的120例胸腰椎单节段骨折患者,术后随访12-19个月,观察术后出现"蛋壳样"椎体的情况,并统计其可能的相关因素:包括性别、年龄、受伤至手术时间、骨折类型、伤椎前缘压缩程度、矢状面Cobb角,骨密度值,伤椎是否置钉,上、下椎体螺钉是否平行于上终板等。并进行单因素分析和多因素Logtistic回归分析。结果 120例中,共62例术后出现"蛋壳样"椎体,发生率为51.7%;其中33例在后期自行愈合,"蛋壳样"改变最终消失;另21例再次行骨水泥强化技术(PVP或PKP)处理,8例未予特殊处理。单因素分析显示,伤椎前缘压缩程度、骨密度值的例数分布情况在两组间有显著性差异(P<0.05);多因素Logistic回归分析提示,这两项指标均为独立的危险因素之一。结论术前椎体压缩程度严重及骨密度值偏低,是导致术后"蛋壳样"椎体的独立危险因素,临床应予以重视。

Objective To investigate the factors related to the formation of“ eggshell like”vertebral bodies after posterior pedicle screw fixation in thoracolumbar fractures. Methods FromFebruary 2013 to February 2016, the clinical data of 120 patients with thoracolumbar fracture whowere treated by the posterior pedicle screw internal fixation were analyzed. The patients were followedup for 12-19 months after operation to observe ＂shell like＂ vertebral body, and its possible relatedfactors, including gender, age, time from injury to operation, the type of fracture, vertebral compressiondegree, sagittal Cobb angle, vertebral bone density, whether with the screw, screw was parallel to thevertebral endplate. Single factor analysis and multiple factor Logistic regression analysis were used.Results In 120 cases, a total of 62 cases had ＂shell like＂ vertebral body after operation, theincidence rate was 51.7% . Of these 62 cases, 33 cases healed, ＂eggshell＂ change eventuallydisappeared, the other 21 cases underwent bone cement augmentation technique （PVP or PKP）, 8cases with no special treatment. Univariate analysis showed that there was significant differencebetween the two groups in the number of cases of distribution of vertebral compression degree, bonedensity （P 〈0.05）. Multivariate Logistic regression analysis showed that these two indicators wereindependent risk factors. Conclusion The severity of vertebral compression and low bone mineraldensity are the independent risk factors of the ＂shell like＂ vertebral body, which should be paid moreattention.