PVP或PKP治疗激素诱导骨质疏松性椎体压缩骨折的临床研究

doi:10.3969/j.issn.1671-167X.2015.02.010

摘要/Abstract

摘要： 目的：回顾性研究经皮椎体成形术（percutaneous vertebroplasty，PVP）或经皮后凸成形术（percutaneous kyphoplasty，PKP）治疗糖皮质激素诱导骨质疏松性椎体压缩骨折的临床特点和术后再发骨折的风险。方法：2010年1月至2013年12月北京大学第一医院骨科应用PVP或PKP治疗的骨质疏松性椎体压缩骨折病例570例，其中糖皮质激素诱导骨质疏松性椎体压缩骨折42例，完整随访21例定为糖皮质激素诱导的骨质疏松(glucocorticosteroid-induced osteoporosis，GIOP)组；原发性骨折疏松椎体压缩骨折病例528例，完整随访391例，按照性别、年龄匹配的原则1∶４配比84例定为对照组。记录两组病例胸腰椎椎体骨折节段；比较两组病例中单节段骨折和多节段骨折的比例；比较两组病例胸椎节段、胸腰段节段和腰椎节段骨折的比例；以再发骨折行二次手术为终点事件计算患者骨水泥灌注术后生存率及绘制生存曲线，比较两组病例的生存率。结果：GIOP组随访（24.0±13.1）个月，对照组随访（25.8±14.4）个月（P>0.05）。GIOP组单节段骨折11例，双节段骨折2例，三节段骨折3例，四节段骨折2例，五节段骨折2例，八节段骨折1例。对照组单节段骨折67例，双节段骨折12例，三节段骨折2例，四节段骨折3例。GIOP组单节段骨折比例明显低于对照组（52.4% vs. 79.8%，P=0.01）。GIOP组骨折节段共50节段，对照组骨折节段共109节段。胸椎节段（T1~T10）比例GIOP组18%，对照组11.9% （P>0.05）；胸腰段节段（T11~L1）比例GIOP组46%，对照组58.7%（P>0.05）；腰椎节段（L2~L5）比例GIOP组36%，对照组29.4%（P>0.05）。随访期内GIOP组和对照组因胸腰椎椎体再发骨折行二次PVP或PKP手术的比例分别为23.8%和6.0%，GIOP组生存率明显低于对照组（P<0.01）。结论：GIOP椎体压缩骨折好发部位与原发性骨质疏松椎体压缩骨折类似（胸腰段节段>腰椎节段>胸椎节段），但GIOP椎体压缩骨折多节段骨折的风险高，PVP或PKP治疗后椎体再发骨折风险高。

关键词: 骨折, 压缩性, 椎体成形术, 后凸成形术, 骨质疏松, 糖皮质激素类

Abstract: Objective：To investigate the clinical characteristics of vertebral compression fracture (VCF) in glucocorticosteroidinduced osteoporosis (GIOP) and risk of vertebral refracture after percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP). Methods:In the study, 570 cases who received PVP or PKP as treatments of VCF from January 2010 to December 2013 were retrospective reviewed, of which 42 were GIOP and 21 were followed up as GIOP group, and the other 528 were primary osteoporosis and 391 were followed up, of which 84 were selected as Control group based on age and gender. The fracture location, ratio of single segment fracture and multiple segments fracture in the two groups were compared. In the final follow up, the reoperation rates for vertebral refractures by the Kaplan-Meier method in the two groups were compared.Results:The follow up periods were (24.0±13.1) months in GIOP group and (25.8±14.4) months in control group（P>0.05）. In GIOP group, there were 11 cases with onesegment fracture, 2 with two-segments fracture, 3 with three-segments fracture, 2 with four-segments fracture, 2 with five-segments fracture and 1 with eight-segments fracture. In Control group, there were 67 cases with one-segment fracture, 12 with twosegments fracture, 3 with three-segment fracture, and 2 with four-segments fracture. The ratio of single segment fracture in GIOP group was significantly lower than that in Control group（52.4% vs. 79.8%，P=0.01）. There were 50 fracture segments in GIOP group and 109 fracture segments in Control group. The ratios of fracture segments located in thoracic segments（T1-T10）, thoracolumbar segments（T11-L1）and lumbar segments（L2-L5）were 18%, 46% and 36% in GIOP group and 11.9%, 58.7% and 29.4% in Control group（P>0.05）. The refracture rate in GIOP group was higher than that in control group （23.8% vs. 6.0%）. The survival rate was lower in GIOP group than that in control group （P<0.01）. Conclusion: The predilection site of VCF was similar in GIOP and primary osteoporosis (thoracolumbar segments> thoracic segments> lumbar segments). The risk of multiple segments VCF was higher in GIOP than in primary osteoporosis. The risk of vertebral refractures after PVP or PKP was higher in GIOP than in primary osteoporosis.

Key words: Fracture, compression, Vertebroplasty, Kyphoplasty, Osteoporosis, Glucocorticoids

中图分类号:

R683.2

孙浩林, 李淳德, 朱佳琳, 邑晓东, 刘洪, 卢海霖, 李宏, 于峥嵘, 王宇. PVP或PKP治疗激素诱导骨质疏松性椎体压缩骨折的临床研究[J]. 北京大学学报（医学版）, 2015, 47(2): 242-247.

SUN Hao-Lin, LI Chun-De, ZHU Jia-Lin, YI Xiao-Dong, LIU Hong, LU Hai-Lin, LI Hong, YU Zheng-Rong, WANG Yu. Clinical research of percutaneous vertebroplasty or percutaneous kyphoplasty for treating osteoporotic vertebral compression fractures induced by glucocorticosteroid[J]. Journal of Peking University(Health Sciences), 2015, 47(2): 242-247.

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