骨水泥强化预防经皮穿刺球囊扩张椎体后凸成形术后高危患者上位节段再骨折的疗效

Effect of prophylactic cement augmentation on preventing upper adjacent vertebral fracture after percutaneous kyphoplasty

目的:探讨预防性上位椎体强化对于避免经皮穿刺球囊扩张椎体后凸成形术(percutaneous balloon kyphoplasty,PKP)后上位节段再骨折的安全性及有效性。方法:回顾性纳入2013年12月至2017年12月北京积水潭医院接受PKP及一期行上位椎体预防性骨水泥强化的患者26例。预防性强化的选择标准包括椎间隙渗漏、高龄、严重骨质疏松、具有内科合并症(高血压病、糖尿病等)、激素使用史或骨质疏松性骨折史。收集围手术期及随访资料,分析患者再骨折的发生情况。结果:26例患者中,41个骨折椎体,平均年龄73.2(70.0~86.0)岁,术前疼痛视觉模拟评分(visual analog scale,VAS)7.2分,术前腰椎定量电脑断层扫描(quantitative computed tomography,QCT)43.2 mg/mL。纳入患者术中均出现骨水泥渗漏,其中20例患者术前存在上终板裂隙、4例患者球囊扩张过程中出现上终板可疑损伤,2例患者穿刺过程中损伤上终板。骨折椎体平均骨水泥用量3.5(2.5~7.5)mL,上位椎体骨水泥用量为4.0(3.5~8.0)mL(P=0.036)。随访1年,共3例患者出现其他椎体再骨折,均未发生在相邻节段。结论:在骨水泥渗漏的高危患者中行选择性上位椎体预防性强化手术有助于避免强化节段再骨折的发生,且不会引起新的邻近椎体骨折。

Objective:To explore the safety and efficacy of prophylactic upper vertebral body augmentation for preventing adjacent vertebral fracture after percutaneous kyphoplasty.Methods:From Dec 2013 to Dec 2017,26 patients who underwent kyphoplasty due to osteoporotic compression fractures and simultaneous prophylactic vertebral augmentation in Beijing Jishuitan Hospital were enrolled.The inclusion criteria included intra-disc leakage,elderly,severe osteoporosis,and medical comorbidities(eg.high blood pressure,diabetes mellitus),history of corticoid usage,or osteoporotic fractures.The perioperative parameters and follow-up data were collected,and the occurrence of subsequent fractures was analyzed.Results:A total of 26 patients were enrolled with 41 fractured vertebrae,the median age was 73.2(70.0-86.0)years,preoperative pain visual analog scale(VAS)was 7.2 points,preoperative quantitative computed tomography was 43.2 mg/mL.All patients had intra-disc cement leakage,among whom 20 patients had upper endplate fissures before surgery,4 patients had suspicious damage to the upper endplate during balloon expansion,and 2 patients had upper endplate damage during puncture.The average median of bone cement in fractured vertebrae was 3.5(2.5-7.5)mL,and 4.0(3.5-8.0)mL in upper-level augmentation(P=0.036).A total of three patients had remote vertebral re-fractures within the first year after surgery,none of which occurred in adjacent segments.Conclusions:In high-risk patients with intra-disc cement leakage,selective upper vertebral cement augmentation can avoid re-fractures of upper segments and will not cause new adjacent vertebral body fractures.