椎体强化术后骨水泥相对终板的位置对邻椎再骨折的影响

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摘要目的探讨经皮椎体成形术(percutaneousvertebroplasty，PVP)或经皮椎体后凸成形术(percutaneous kyphoplasty，PKP)后，骨水泥相对术椎及邻椎终板的位置对邻椎再骨折的影响。方法回顾性分析2013年7月1日至2017年3月1日因骨质疏松性椎体压缩性骨折在我院行PVP或PKP术患者的临床资料，共纳入191例患者，年龄56~83岁，平均69.8岁。随访时间为20个月，共计202节手术椎体，其中男性椎体37节，女性椎体165节。根据是否发生邻椎骨折分为邻椎骨折组(n＝22)和非邻椎骨折组(n＝180)，比较两组年龄、性别、体重指数、骨密度，以及骨水泥的终板接触率、椎间盘内渗漏率、骨水泥边界距邻椎终板的最短距离。结果两组患者的年龄、性别、体重指数、骨密度差异无统计学意义(P＞0.05)，两组间骨水泥与术椎终板接触率差异无统计学意义(χ²=3.251，P＝0.071)，而邻椎骨折组的骨水泥椎间盘内渗漏率显著高于非邻椎骨折组，差异有统计学意义(χ²=5.018，P＝0.025)；邻椎骨折组骨水泥边界距邻椎终板的距离的均值为(6.49±3.13)mm，非邻椎骨折组距离为(8.71±4.38)mm，两组间差异有统计学意义(t＝2.307，P＝0.022)。结论椎间盘内骨水泥渗漏是同侧邻椎再骨折的危险因素；骨水泥边界距邻椎终板距离越近，同侧邻椎再骨折的可能性越大，由此术者可根据术前椎间隙高度是否狭窄在术椎的充分强化与骨水泥距邻椎终板的安全距离之间作出取舍。

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	李亚军 1
	王业华 1*
	方贻铃 2
	李超 1

关键词 ：邻椎骨折, 终板接触, 骨水泥渗漏, 安全距离

Abstract：Objective To explore the impact upon adjacent vertebrae fracture resulting from the position of bone-cement relative to surgical vertebrae and adjacent vertebrae endplates after percutaneous vertebroplasty(PVP) or percutaneous kyphoplasty (PKP).Methods The clinical data of 191 patients aging from 56 to 83 who received PVP or PKP from July 2013 to March 2017 because of osteoporotic vertebral compression fractures were retrospectively analyzed.The follow-up period was 20 monthsandthe average age of the patients was 69.8 years old.There were 202 surgical vertebrae，including 37 vertebrae of male patients and 165 vertebrae from female patients.According to the occurrence of adjacent vertebral fracture(AVF)，the patients were divided into two groups.The first group was AVF Group(n＝22)and the second group was non-AVF Group(n＝180).The age，gender，body mass index (BMI)，bone mineral density (BMD)，the contact rate of bone-cement endplates，the leakage rate of cement intervertebral disc and the distance between bone-cement and adjacent vertebral endplate in the two groups were compared.Results There was no significant difference in age，gender，BMI and BMD between the two groups (P＞0.05).The difference between the contact rate of bone-cement and surgical vertebra in the two groups was of no statistical significance(χ²=3.251，P＝0.071)，but the bone-cement intradiscal leak in the Group AVF was significantly higher than that in the group non-AVF and the difference was statistically significant(χ²=5.018，P＝0.025).The mean value of the distance between bone-cement and adjacent vertebral endplate in the Group AVF was (6.49±3.13)mm，while the distance in the Group non-AVF was(8.71±4.38)mm.The difference between the two groups was statistically significant(t＝2.307，P＝0.022).Conclusion The bone-cement intradiscal leakageis risk factor for adjacent vertebral fracture.The smaller distance of bone-boundary between adjacent endplate，the chance of occurring homolateral AVF is larger.The operators can choose different methods to adequately strengthen the surgical vertebrae or to guarantee safe distance between bone-cement and adjacent vertebral endplate according to the height of vertebrae before surgery.

Key words： adjacent vertebral fracture endplate contact intradiscal leak safe distance

通讯作者: 王业华

作者简介: 李亚军(1993－ )，男，研究生在读，徐州医科大学附属医院骨科，221000。

引用本文:

李亚军 1，王业华 1*，方贻铃 2，李超 1. 椎体强化术后骨水泥相对终板的位置对邻椎再骨折的影响[J]. 实用骨科杂志, 2019, 25(9): 769-780.
Li Yajun 1，Wang Yehua 1*，Fang Yiling 2，et al. Effect of Bone-cement Position Relative to Endplate after Vertebral Augmentationon Adjacent Vertebrae Fracture. sygkzz, 2019, 25(9): 769-780.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2019/V25/I9/769

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