椎体后凸成形术后邻近椎体再发骨折发生率及相关危险因素的分析研究

摘要

目的 采用循证医学研究方法,评价椎体后凸成形术(PKP)治疗骨质疏松性椎体压缩骨折术后邻近椎体再发骨折的发生率及危险因素,为临床治疗提供参考.方法 检索椎体后凸成形术治疗骨质疏松性骨折术后邻近椎体再发骨折的中外文文献,根据具体的纳入标准筛选文献进行统计分析,共有12篇临床研究(外文10篇,中文2篇)、1816例患者纳入最终统计分析.结果 研究分析发现,邻近椎体再发骨折的发生率为6.5%~26.3%,其发生的危险因素包括骨密度、骨水泥外渗、椎体后凸角等,但存在争议.结论 椎体后凸成形术后邻近椎体再发骨折的主要危险因素是骨质疏松症和骨水泥外渗,提高椎体后凸成形术技术水平,规范化的抗骨质疏松治疗是降低并发症的有效手段.%Objective To explore the operative procedure, clinical outcome and operation points for unstable posterior pelvic ring fracture. Methods From Jan. 2008 to Dec. 2010,44 patients with unstable posterior pelvic ring fracture were treated with operation, which involved in 35 males and 9 females. There were 17 cases of traffic accident injury,21 cases of falling injury,6 cases of crush injury. According to tile classification system; there were 20 cases of Cl. 1,8 cases of Cl. 2,11 cases of Cl. 3 and 5 cases of C2. After open reduction and internal fixation, which were performed on the anterior pelvic ring,35 cases were treated with percutaneous sacroiliac lag screws fixation,3 cases were treated with fixation with percutaneous posterior bilateral iliac plates,6 cases were treated by straight lateral rectus incision and extraperitoneal internal fixation. Results The operation time was 5-18 days after injury. Operations were smoothly performed on all of the 44 cases. All of the 44 cases had recovered smoothly, without sacral nerve injury. Only 3 cases received the posterior approach operation suffered from wound infection, fortunately,they finally had recovered satisfactorily. The postoperative X-ray and CT films indicated satisfactory reduction of pelvic fracture. Conclusion It is very important to reconstruct the pelvic ring for the pelvic' s stabilization. The operation by percutaneous sacroiliac lag screws fixation with "C"-arm is the principal choice for treating the unstable posterior pelvic ring fracture, because of simple operation, stable fixation, less time consuming, less bleeding and slight injury. Ihose who can t receive a satisfactory reduction can choose the anterior/posterior open reduction and internal fixation.