椎体强化术后再发椎体骨折的临床特点和危险因素

doi:10.3969/j.issn.1671-167X.2015.02.009

摘要/Abstract

摘要： 目的：探讨骨质疏松性椎体骨折行椎体强化术［包括经皮椎体后凸成形术（percutaneous kyphoplasty, PKP）及经皮椎体成形术（percutaneous vertebroplasty, PVP）］后，椎体发生再骨折的临床特点及危险因素。方法：回顾性分析2006年3月到2013年10月于北京大学人民医院因单节段椎体压缩骨折行PKP或PVP的患者148例，其中再发椎体骨折29例（共42个椎体），未再发椎体骨折119例，所有患者随访（34.4±26.8）个月。记录患者性别、年龄、身高、体重、体质指数、有无糖尿病、有无合并其他骨折病史、受伤节段、是否再次骨折、再次骨折与首次手术的间隔时间、再次骨折的节段、有无规律抗骨质疏松治疗、骨水泥用量、手术方式（PKP或PVP）、单侧或双侧穿刺、骨水泥是否渗透、骨水泥弥散好坏、椎体前缘高度纠正的百分比、术后Cobb角的改变、腰椎骨密度T值，并进行Cox回归分析。结果：相邻椎体骨折有16人（55.17%，16/29），非相邻椎体骨折13人（44.83%,13/29）。3个月内再骨折人数占总人数的31.03%（9/29），1年内再骨折人数占总人数的55.17%（16/29）。高龄（P=0.027, HR=1.051, 95%CI=1.006~1.098）、既往存在其他骨折病史（P=0.012，HR=0.386, 95%CI=0.184~ 0.812）是预测再骨折的独立危险因素，上述其他因素与再骨折无关（P>0.05）。结论：高龄、既往存在其他骨折病史是再骨折的独立危险因素，骨质疏松性骨折行椎体强化术后再骨折的原因多是由于骨质疏松症的自然病程所致。

关键词: 骨折, 压缩性, 脊柱骨折, 椎体成形术, 骨质疏松, 危险因素

Abstract: Objective：To identify the characteristics and risk factors of the refractures after percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP). Methods:A retrospective analysis of 148 patients who had undergone PKP or PVP between March 2006 and October 2013 inPeking University People’s Hospital was conducted. In the study, 29 patients with 42 refractured vertebra and 119 patients without refracture were included. All the patients were observed for a time of (34.4±26.8) months. Clinical, imaging and procedure related factors (gender, age, height, weight, body mass index, the level of the injured vertebra, the time interval between the procedure and the refracture, the level of the refractured vertebra, the bone cement volume injected, performed PKP or PVP，performed unilateral or bilateral, the percentage of anterior vertebral height restoration, the correction of the Cobb angle, cement diffusion, bone mineral density, presence or absence of diabetes mellitus, history of fractures of the whole body, anti-osteoporosis treatment, cement leakage) for each group were analyzed by Cox proportional hazards regression analysis. Results:Of all the patients,16 (55.17%, 16/29) had refractures in the adjacent vertebra, and 13 (44.83%, 13/29) had refractures in the nonadjacent vertebra. Refractures within 3 months accounted for 31.03% (9/29) of all the refractures, and within 1 year accounted for 55.17% (16/29). Both older age (P=0.027, HR=1.051, 95% CI=1.006-1.098) and a history of fractures of the whole body (P=0.012, HR=0.386, 95% CI=0.184-0.812) were statistically significant as the independent risk factors for predicting refractures. Others were not associated with refractures (P>0.05). Conclusion:Older age and a history of fractures of the whole body are the independent risk factors of the refractures after PKP and PVP. The mechanism of the refractures after PKP and PVP is mainly the natural development of osteoporosis.

Key words: Fractures, compression, Spinal fractures, Vertebroplasty, Osteoporosis, Risk factors

中图分类号:

R683.2

黄天霁, 寇玉辉, 殷晓峰, 熊建, 张培训, 张殿英, 付中国, 薛峰, 姜保国. 椎体强化术后再发椎体骨折的临床特点和危险因素[J]. 北京大学学报（医学版）, 2015, 47(2): 237-241.

HUANG Tian-Ji, KOU Yu-Hui, YIN Xiao-Feng, XIONG Jian, ZHANG Pei-Xun, ZHANG Dian-Ying, FU Zhong-Guo, XUE Feng, JIANG Bao-Guo. Clinical characteristics and risk factors of newly developed vertebral fractures after vertebral augmentation[J]. Journal of Peking University(Health Sciences), 2015, 47(2): 237-241.

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