骨水泥强化椎体再压缩骨折的相关因素研究

Relevant factors of cement augmentated vertebral recompression fracture

目的 分析脊柱球囊扩张后凸成形术(PKP)后骨水泥强化椎体再压缩骨折的相关因素 方法 对2011年1月至2015年12月在北京医院骨科行PKP治疗的骨质疏松压缩骨折(OVCF)患者131例,其中19例失访,失访率为14.5%。共纳入112例患者,男35例,女77例,年龄59~92岁,平均70.4±9.2岁,其中有5例患者发生强化椎体再骨折 结果 强化椎体再压缩组(RF组)和强化椎体未再压缩组(NRF组)比较,RF组骨水泥量和NRF组差异无统计学意义( P >0.05),RF组骨水泥量/骨水泥分布体积明显高于NRF组( P <0.05),RF组椎体恢复高度明显高于NRF组( P <0.05),RF组强化椎体骨密度值明显低于NRF组( P <0.05),末次随访VAS评分RF组明显高于NRF组( P <0.05)。 结论 骨水泥的注入量对强化椎体再压缩骨折无明显影响,骨水泥量/骨水泥分布体积越低,骨水泥弥散程度越好,与椎体上下终板接触,强化椎体再骨折的发生率更低,压缩骨折椎体高度恢复越高或脊柱椎体骨质疏松症越严重,强化椎体再骨折的发生率越高,发生强化椎体再压缩骨折的患者预后明显更差。

Objective To analyze the related factors of recompression of cement augmentated vertebral body after percutaneous kyphoplasty (PKP). Methods A total of 131 patients with osteoporotic vertebral compression fracture (OVCF) in the Department of Orthopedics, Beijing Hospital, from January 2011 to December 2015 were treated with PKP. Among those, 19 cases were lost, and the loss rate was 14.5%. A total of 112 cases were included (35 men and 77 women), who were 59 -92 years old (70.4±9.2 years old). Among those, 5 patients had refractures in the cement augmentated vertebral body. Results There was no significant difference in the volume of bone cement between group RF and group NRF ( P >0.05). The injected volume of bone cement/distributed volume of bone cement in group RF was significantly higher than that in group NRF ( P <0.05). The increased height of vertebral body in group RF was significantly higher than that in group NRF ( P <0.05). The bone mineral density in group RF was significantly lower than that in group NRF ( P <0.05). VAS score in group RF was significantly higher than that in group NRF ( P <0.05) at the last follow-up. Conclusion The volume of bone cement has no obvious effect on refracture of the cement augmentated vertebrae, but the more the degree of cement diffusion and contact with the upper and lower endplates of the vertebral body, the lower incidence of refracture of vertebral body. The higher the recovery of vertebral body height and the more severe vertebral osteoporosis are, the higher the incidence of refracture of the vertebral body is. The prognosis of the patients with refractures of cement augmentated vertebra is significantly worse.