经皮椎体后凸成形术后非骨折椎体骨折的原因分析

摘要

目的 探讨经皮椎体后凸成形术后非骨折椎体发生骨折的原因.方法 回顾性分析2010年6月至2014年6月采用经皮椎体后凸成形术治疗512例(618节)骨质疏松性椎体压缩骨折患者资料,男107例(121节),女405例(497节);年龄51～91岁,平均(70.38±7.59)岁;单节段骨折406例,双节段骨折106例;骨折节段为T4～L5;患者骨密度(bone mineral density,BMD)T值为-1.0～-5.2 SD.分析所有患者的年龄、性别、身高、体重、体重指数(body mass index,BMI)、腰椎BMD、骨水泥注入量、术后并发症情况(肺栓塞、骨水泥渗漏、神经损伤等情况)、椎体前/中缘高度恢复率及骨折治疗的节段等.结果 52例(10.16％,52/512)患者出现非骨折椎体骨折,4例发生骨折椎体再骨折.52例非骨折椎体骨折患者的平均年龄为(71.88±7.74)岁,其中女性占94.23％ (49/52),平均BMD的T值为(-4.03± 0.60)SD,初次双节段骨折比率为51.92％ (27/52);456例无骨折患者平均年龄(70.21±7.56)岁,其中女性占77.19％ (352/456),平均BMD的T值为(-2.89±0.55) SD,初次双节段骨折比率为17.32％(79/456);两组以上指标比较,差异均有统计学意义.非骨折椎体骨折组与无骨折组BMI、骨水泥注入量、椎间盘渗漏数、椎体前/中缘高度恢复率比较差异均无统计学意义.52例发生非骨折椎体骨折患者中,32例(61.54％,32/52)骨折发生于非邻椎,20例(38.46％,20/52)骨折发生于邻椎;两组以上各指标比较,差异均无统计学意义.结论 骨质疏松程度、女性及初次双节段骨折是导致椎体后凸成形术后非骨折椎体发生骨折的主要原因.%Objective To investigate the causes of re-fractures of non fracture vertebral body after percutaneous kyphoplasty (PKP).Methods 512 patients (618 vertebral bodies) treated with PKP because of osteoporosis VCFs were recruited from June 2010 to June 2014.There were 107 males (121 vertebral bodies) and 405 females (497 vertebral bodies) with the mean age of 70.38±7.59 years old (51 to 91 years).There were 406 single segment fracture and 106 double segment fractures cases,and the fracture segments were T4 to L5.The T value of the patients' bone mineral density (BMD) was from-1.0 to-5.2 SD.The clinic characteristics of all the patients including age,sex,body weight,body height,body mass index (BMI),BMD score of the spine,volume of bone cement,restoration rate of anterior/middle vertebral height,postoperative complications (pulmonary embolism,bone cement leakage,nerve injury),and treated vertebral level were analyzed.Results 52 patients (10.16％,52/512) experienced refractures of non fracture vertebral body after kyphoplasty,and 4 experienced re-fracture of the fracture vertebral body after kyphoplasty.The average age of the 52 patients was 71.88±7.74 years old,meanwhile,the ratio of female was 94.23％ (49/52),the mean T value of BMD-4.03±0.60 SD,the ratio of initial double segment fractures 51.92％ (27/52).In addition,among the 456 cases with no fracture,the average age was 70.21±7.56 years,the ratio of female was 77.19％ (352/456);the mean T value of BMD was-2.89±0.55 SD;the ratio of initial double segment fractures was 17.32％(79/456).The data above (age,T value of BMD and initial double segment fractures) were all with statistical significant differences.Whereas the BMI,volume of bone cement,intervertebral disc leakage and restoration rate of anterior/middle vertebral height had no significant difference between the two groups.Furthermore,in the re-fracture of non fracture vertebral body group,32 cases (61.54％,32/52) were nonadjacent fractures,and 20 (38.46％,20/52) were adjacent fractures.Conclusion Osteoporosis degree,female and initial double segment fractures were major risk factors in the development of re-fracture of non fracture vertebral body after PKP.