椎体后凸成形术与邻近椎体继发骨折的关系Risk factors of subsequent vertebral fractures after percutaneous kyphoplasty
贾小林;谭祖键;杨阜滨;厉洋;
摘要(Abstract):
[目的]探讨椎体后凸成形术后临近(相邻或间隔)椎体继发骨折的危险因素。[方法]对2006年2月~2009年3月进行椎体后凸成形术的391例单椎体骨折患者进行回顾性分析。对于新发骨折的研究限于治疗椎体上下3个椎体。患者分为3组:相邻椎体骨折组、间隔椎体骨折组和没有继发骨折的对照组。对临床资料、影像学资料以及手术相关因素进行分析。研究各因素与椎体后凸成形术后继发临近椎体骨折的关系,并比较相邻椎体和间隔椎体继发骨折影响因素的不同。[结果]临床表现、影像学资料表明45例患者48个椎体继发骨折。其中29例患者,32个继发椎体骨折为相邻椎体组;16例患者、16个继发椎体骨折为间隔椎体组;346例患者为对照组。局部后凸角度、椎体压缩程度和术后骨折高度恢复情况是相邻及间隔椎体继发骨折的共同危险因素。在前者,低体重指数和骨水泥椎间隙的渗漏是危险因素。在后者,局部节段活动范围减小是危险因素。但前者较后者更早发生。[结论]相邻或间隔椎体继发骨折的机理可能不同,有不同的高危因素。椎体后凸成形术可能加速了新发椎体的骨折。
关键词(KeyWords): 骨质疏松;危险因素;经皮椎体后凸成形术;椎体骨折
基金项目(Foundation):
作者(Author): 贾小林;谭祖键;杨阜滨;厉洋;
Email:
DOI:
参考文献(References):
- [1]Mudano AS,Bian J,Cope JU,et al.Vertebroplasty and kyphoplastyare associated with an increased risk of secondary vertebral compres-sion fractures:a population-based cohort study[J].Osteoporos Int,2009,5:819-826.
- [2]Trout AT,Kallmes DF.Does vertebroplasty cause incident vertebralfractures?A review of available data[J].AJNR Am J Neuroradiol,2006,7:1397-1403.
- [3]Ahn Y,Lee JH,Lee HY,et al.Predictive factors for subsequent ver-tebral fracture after percutaneous vertebroplasty[J].NeurosurgSpine,2008,2:129-136.
- [4]Thomas T,Barou O,Vico L,et al.Recurrence of vertebral fracture withcyclical etidronate therapy in osteoporosis:histomorphometry and X-Raymicroanalysis evaluation[J].J Bone Miner Res,1999,2:198-205.
- [5]Kim YJ,Lee JW,Kim KJ,et al.Percutaneous vertebroplasty for in-travertebral cleft:analysis of therapeutic effects and outcome predic-tors[J].Skeletal Radiol,2010,8:757-766.
- [6]Korovessis P,Zacharatos S,Repantis T,et al.Evolution of bone min-eral density after percutaneous kyphoplasty in fresh osteoporotic ver-tebral body fractures and adjacent vertebrae along with sagittal spinealignment[J].J Spinal Disord Tech,2008,4:293-298.
- [7]Rousing R,Hansen KL,Andersen MO,et al.Twelve-months follow-up in forty-nine patients with acute/semiacute osteoporotic vertebralfractures treated conservatively or with percutaneous vertebroplasty:a clinical randomized study[J].Spine,2010,5:478-482.
- [8]Chen WJ,Kao YH,Yang SC,et al.Impact of cement leakage intodisks on the development of adjacent vertebral compression fractures[J].J Spinal Disord Tech,2010,1:35-39.
- [9]Kaufmann TJ,Trout AT,Kallmes DF.The effects of cement volumeon clinical outcomes of percutaneous vertebroplasty[J].AJNR Am JNeuroradiol,2006,9:1933-1937.
- [10]Trout AT,Kallmes DF,Kaufmann TJ.New fractures after vertebro-plasty:adjacent fractures occur significantly sooner[J].AJNR Am JNeuroradiol,2006,1:217-223.