骨质疏松性椎体压缩骨折PKP术后近期手术椎体再骨折原因探讨

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摘要目的探讨经皮椎体后凸成形术治疗单椎体骨质疏松性椎体压缩骨折术后近期手术椎体再骨折相关原因，为临床预防提供参考。方法对已行椎体后凸成形术(percutaneous kyphoplasty，PKP)治疗且符合纳入标准的188例患者临床资料进行回顾性分析，根据患者的临床表现及影像学显示，分为手术椎体再骨折组(A组，共24例)，无再发椎体骨折组(B组，共164例)。术后随访1年以上，记录所有入选患者的性别、年龄、身高、体重、身体质量指数(body mass index，BMI)、骨密度、手术节段、骨水泥注入量、骨水泥弥散形态、骨水泥与椎体上下终板间距离、术后佩戴支具的时间、术后是否规范化使用抗骨质疏松治疗等相关因素，探讨导致术后手术椎体再骨折的原因。结果性别、年龄、身高、体重、BMI、手术节段、骨水泥注入量、术后佩戴支具时间等因素在A、B两组间差异无统计学意义(P＞0.05)。A组患者术后规范抗骨质疏松治疗依从性较B组差，术后6个月A、B两组骨密度T值分别为(－2.46±0.700)、(－2.21±0.715)，差异有统计学意义(P＜0.05)，末次随访时A、B两组分别为(－2.37±0.896)、(－1.92±0.804)，差异有统计学意义(P＜0.01)。将椎体内骨水泥弥散形态分为团块状与海绵状，其中A、B两组团块状分布分别为15例、58例，海绵状分布分别为9例、106例，差异有统计学意义(χ²＝6.490，P＜0.05)。术后3 d复查测量A、B两组骨水泥上缘距上终板距离分别为(3.38±0.744)mm、(1.98±0.707)mm，骨水泥下缘距下终板距离分别为(3.13±0.835)mm、(1.82±0.475)mm，差异均有统计学意义(P＜0.05)。结论 PKP术后近期手术椎体再骨折是多方面综合因素共同引起的，其中骨水泥弥散形态、骨水泥与椎体上下终板间距离以及骨密度是导致手术椎体再骨折的重要危险因素。

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关键词 ：经皮椎体后凸成形术, 骨质疏松, 椎体压缩骨折, 再骨折

Abstract：Objective To investigate the cause of vertebral fracture after recent percutaneous kyphoplasty for vertebral osteoporosis vertebral compression fractures.Methods A retrospective analysis of related clinical data of 188 patients with PKP treatment who meet theinclusion criteria was performed.According to the clinical manifestation and imaging of thepatient，the patients were divided intogroup A(surgicalvertebral fracture，n＝24) and group B (Nosurgical vertebral fracture，n＝164).Follow-upafter the operationwasone year at lest.The records included the patient's age、gender、height、weight、body mass index (BMI)、bone mineral density、operation section、injection amount of bone cement、bone cement dispersion morphology、the distance that between bone cement and cranial endplates andcaudalendplates、wear the support time after surgery and whether to use a standardized antiosteoporosis treatment and other related factors，to explore the cause of postoperative surgical vertebral fracture.Results There was no significant difference between group A and group B，in terms of age、gender、height、weight、body mass index (BMI)、operation section、injection amount of bone cement and wear the support time(P＞0.05).For postoperative management of patients with postoperative adherence to the treatment of osteoporosis，group A was not as good asto group B.Six months after surgery，the bone mineral density were(－2.46±0.700)、(－2.21±0.715)respectively.The difference was statistically significant(P＜0.05).The final follow-up bone mineral density were (－2.37±0.896) and(－1.92±0.804)respectively.There was a significant difference between group A and group B(P＜0.01).The shapes of bone cement in vertebral body were divided into masses and spongy.There were 15 cases and 58 caseswith mass-shapedbonecement，and 9 cases and 106 cases with the spongy-shapedbone cementin group A and group B respectively.The difference was statistically significant(χ²＝6.490，P＜0.05).3 day safter surgery，we measured the distance that between bone cement and caudal endplates.It were(3.38±0.744)mm in group A and(1.98±0.707)min group B.And the distance between bone cement and cranial endplates were(3.13±0.835)mm in group A and(1.82±0.475)min group B.The differences were statistical significance(P＜0.05).Conclusion The refractures after PKP are caused by multiple factors.The important risk factors include bone cement shape、the distance between bone cement and cranial endplates andcaudalendplates and bone mineral density.

Key words： percutaneous kyphoplasty osteoporotic vertebral compression fractures broken again

基金资助:卫生部医药卫生科技发展研究中心科研基金(W2014ZT210)
甘肃省中医药管理局科研课题(GZK-2016-49)
国家中医药管理局国家中医临床研究基地业务建设科研专项课题(JDZX2015039)

通讯作者: 邓强

作者简介: 彭冉东(1990－ )，男，研究生在读，甘肃中医药大学，730000。

引用本文:

彭冉东 1，邓强 2*，李中锋 2，张彦军 2，韩宪富 1，李军杰 1. 骨质疏松性椎体压缩骨折PKP术后近期手术椎体再骨折原因探讨[J]. 实用骨科杂志, 2017, 23(9): 781-785.
Peng Randong 1，Deng Qiang 2，LI Zhongfeng 2，et al. Osteoporotic Vertebral Compression Fractures after PKP Holds the Recent Surgery Vertebral Fracture Reason again Explore the Delta. sygkzz, 2017, 23(9): 781-785.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2017/V23/I9/781

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