老年性骨质疏松脊柱良性骨折与转移瘤性骨折的MRI鉴别

目的探讨脊椎骨质疏松性压缩骨折的MRI表现及其与转移性压缩骨折的鉴别诊断.资料与方法回顾性分析53例老年性骨质疏松伴压缩性骨折和20例转移性椎体压缩骨折患者的MRI资料.全部病例均行常规MRI检查(矢状位、横轴位).分析两者引起的压缩骨折MRI征象,包括椎体和椎弓根的形态及信号改变、椎间盘增厚、椎体内真空现象和椎旁软组织形态.探讨两者之间的差别.结果两者在椎体和椎弓根形态及信号、椎体内真空现象、椎旁软组织形态上存在非常显著性差异(P＜0.01).结论 MRI能准确显示骨质疏松性压缩骨折的形态及信号,与转移瘤之间有显著差异,大多能对二者做出鉴别诊断.     

A Randomized Trial Comparing Balloon Kyphoplasty and Vertebroplasty for Vertebral Compression Fractures due to Osteoporosis

BACKGROUND AND PURPOSE:Several trials have compared vertebral augmentation with nonsurgical treatment for vertebral compression fractures. This trial compares the efficacy and safety of balloon kyphoplasty and vertebroplasty.MATERIALS AND METHODS:Patients with osteoporosis with 1–3 acute fractures (T5–L5) were randomized and treated with kyphoplasty (n = 191) or vertebroplasty (n = 190) and were not blinded to the treatment assignment. Twelve- and 24-month subsequent radiographic fracture incidence was the primary end point. Due to low enrollment and early withdrawals, the study was terminated with 404/1234 (32.7%) patients enrolled.RESULTS:The average age of patients was 75.6 years (77.4% female). Mean procedure duration was longer for kyphoplasty (40.0 versus 31.8 minutes, P < .001). At 12 months, 7.8% fewer patients with kyphoplasty (50/140 versus 57/131) had subsequent radiographic fracture, and there were 8.6% fewer at 24 months (54/110 versus 64/111). The results were not statistically significant (P > .21). When we used time to event for new clinical fractures, kyphoplasty approached statistical significance in longer fracture-free survival (Wilcoxon, P = .0596). Similar pain and function improvements were observed. CT demonstrated lower cement extravasation for kyphoplasty (157/214 versus 164/201 levels treated, P = .047). For kyphoplasty versus vertebroplasty, common adverse events within 30 postoperative days were procedural pain (12/191, 9/190), back pain (14/191, 28/190), and new vertebral fractures (9/191, 17/190); similar 2-year occurrence of device-related cement embolism (1/191, 1/190), procedural pain (3/191, 3/190), back pain (2/191, 3/190), and new vertebral fracture (2/191, 2/190) was observed.CONCLUSIONS:Kyphoplasty and vertebroplasty had similar long-term improvement in pain and disability with similar safety profiles and few device-related complications. Procedure duration was shorter with vertebroplasty. Kyphoplasty had fewer cement leakages and a trend toward longer fracture-free survival.

Vertebral compression fractures (VCFs) are clinically recognized in 1.4 million individuals worldwide annually,¹ often resulting in pain, disability, vertebral deformity,² and considerable negative economic impact.³ Balloon kyphoplasty (BKP) and vertebroplasty (VP) are percutaneous procedures aimed at reducing pain and providing fracture stability. Balloon kyphoplasty uses orthopedic inflatable bone tamps before bone cement injection in an attempt to correct vertebral deformity and control cement distribution.^4–6 Vertebroplasty is similar, using needles to deliver bone cement without orthopedic balloons.⁷ When Kyphoplasty and Vertebroplasty In the Augmentation and Restoration of vertebral body compression fractures (KAVIAR) was initiated, no comparative randomized controlled trials (RCTs) existed, and evidence remains limited.⁸ Several RCTs demonstrated better clinical outcomes for kyphoplasty and vertebroplasty compared with nonsurgical management.^4,7,9–11 The KAVIAR study objectives were to document and compare BKP and VP safety and effectiveness in patients with osteoporosis with VCF. The primary end point, subsequent radiographic VCF incidence, was selected because stabilization and deformity correction may have an effect on new VCF occurrence.¹² Secondary end points included pain, disability, and quality-of-life assessments.     

椎体后凸矫形成型术--治疗椎体压缩性骨折的新策略

椎体后凸矫形成型术 (kyphoplasty)是国外发展起来的治疗椎体压缩性骨折的最新技术手段。该技术结合了介入诊断学技术及材料科学的优势 ,利用一系列穿刺器械和气压检测手段 ,对痛性骨质疏松性椎体压缩性骨折的治疗进行了有益的探索 ,经临床验证治疗效果好 ,无严重并发症 ,是一种具有良好应用前景的技术。本文就这一技术的现状及发展趋势作一综述。1　国内外现状和意义椎体压缩性骨折 (vertebralbodycompressionfrac tures ,VCFs)是骨关节系统多发病 ,主要有骨质疏松性骨折、外伤性骨折和病理性骨折等 ,而以骨质疏松性骨折最为常见。有资料…     

腰椎侧凸患者椎体骨小梁结构稀少与骨质疏松的相关性

目的观察成人腰椎侧凸患者椎体骨小梁的改变及其与骨质疏松的相关性。资料与方法收集经腰椎CT检查确诊的腰椎侧凸患者(病例组)及无腰椎侧凸的腰腿痛患者(对照组)各100例,分别测量两组受试者椎体CT值及椎体骨小梁容积百分比(BV/TV);同时重建骨小梁的三维图像,观察骨小梁的结构改变。结果病例组椎体CT值及BV/TV值均较对照组明显降低(P<0.05)。容积再现三维图像显示,病例组患者骨小梁连续性中断,数目减少;对照组患者骨小梁相对致密。所有受试者BV/TV值与年龄呈负相关(r=―0.513,P<0.01)。结论随着年龄增加,BV/TV值降低,骨松质发生改变,腰椎侧凸发生率提高。骨小梁结构稀疏、数目减少及骨松质发生改变是成人发生腰椎侧凸的主要因素。     

Risk Prediction of New Adjacent Vertebral Fractures After PVP for Patients with Vertebral Compression Fractures: Development of a Prediction Model

Purpose

We aim to determine the predictors of new adjacent vertebral fractures (AVCFs) after percutaneous vertebroplasty (PVP) in patients with osteoporotic vertebral compression fractures (OVCFs) and to construct a risk prediction score to estimate a 2-year new AVCF risk-by-risk factor condition.

Materials and Methods

Patients with OVCFs who underwent their first PVP between December 2006 and December 2013 at Hospital A (training cohort) and Hospital B (validation cohort) were included in this study. In training cohort, we assessed the independent risk predictors and developed the probability of new adjacent OVCFs (PNAV) score system using the Cox proportional hazard regression analysis. The accuracy of this system was then validated in both training and validation cohorts by concordance (c) statistic.

Results

421 patients (training cohort: n = 256; validation cohort: n = 165) were included in this study. In training cohort, new AVCFs after the first PVP treatment occurred in 33 (12.9%) patients. The independent risk factors were intradiscal cement leakage and preexisting old vertebral compression fracture(s). The estimated 2-year absolute risk of new AVCFs ranged from less than 4% in patients with neither independent risk factors to more than 45% in individuals with both factors.

Conclusions

The PNAV score is an objective and easy approach to predict the risk of new AVCFs.

     

骨质疏松和骨转移瘤致椎体压缩骨折的MRI鉴别诊断

目的 探讨骨质疏松和骨转移瘤椎体压缩骨折的MR鉴别诊断.方法 回顾性阅读病理或临床证实的50例骨质疏松和50例脊椎转移瘤椎体压缩骨折(均伴异常信号)的MRI片,并分析、记录和比较各种征象.结果 105个骨质疏松压缩椎体,10个椎体后缘上或下部尖角状轻度突出.39个椎体角前和(或)后突出.34个椎体T2WI或T2WI FS见前后走行为主或伴有分叉的低信号、高信号或并行的高低信号线.62个转移瘤压缩椎体,54个椎体前和 (或)后缘弧形膨隆,48个椎体中部前后径增大超 过2 mm.15个椎体T2WI或T2WI FS见圆弧状低信号、高信号或并行的高低信号线,25个椎体内T2WI FS伴有多发散在斑点状更高信号.36个为单侧或双侧椎弓根受累,26个伴受累椎弓根膨大,20个伴椎弓峡部后方附件受累.横轴位图像显示16个椎体前侧缘最大厚度超过5 mm异常软组织影.所有所列征象出现率差别均有统计学意义(P＜0.05).结论 骨质疏松和骨转移瘤椎体压缩骨折MR上存在多种征象差别,据此可对多数病人进行鉴别.     

Incidence of Symptomatic Vertebral Fractures in Patients After Percutaneous Vertebroplasty

The aim of this study was to evaluate the incidence of secondary symptomatic vertebral compression fractures (VCFs) in patients previously treated by percutaneous vertebroplasty (VTP). Three hundred sixteen patients with 486 treated VCFs were included in the study according to the inclusion criteria. Patients were kept in regular follow-up using a standardized questionairre before, 1 day, 7 days, 6 months, and 1 year after, and, further on, on a yearly basis after VTP. The incidence of secondary symptomatic VCF was calculated, and anatomical distribution with respect to previous fractures characterized. Mean follow-up was 8 months (6–56 months) after VTP. Fifty-two of 316 (16.4 %) patients (45 female, 7 male) returned for treatment of 69 secondary VCFs adjacent to (35/69; 51%) or distant from (34/69; 49%) previously treated levels. Adjacent secondary VCF occurred significantly more often compared to distant secondary VCF. Of the total 69 secondary VCFs, 35 of 69 occurred below and 27 of 69 above pretreated VCFs. Of the 65 sandwich levels generated, in 7 of 65 (11%) secondary VCFs were observed. Secondary VCF below pretreated VCF occurred significantly earlier in time compared to VCF above and compared to sandwich body fractures. No major complication occurred during initial or follow-up intervention. We conclude that secondary VCFs do occur in individuals after VTP but the rate found in our study remains below the level expected from epidemiologic studies. Adjacent fractures occur more often and follow the cluster distribution of VCF as expected from the natural history of the underlying osteoporosis. No increased rate of secondary VCF after VTP was observed in this retrospective analysis. In accordance with the pertinent literature, short-term and also midterm clinical results are encouraging and provide further support for the usefulness and the low complication rate of this procedure as an adjunct to the spectrum of pain management in patients with severe midline back pain due to osteoporotic spine fractures.     

Efficacy of a Novel Vertebral Body Augmentation System in the Treatment of Patients with Symptomatic Vertebral Body Fractures

CardioVascular and Interventional Radiology - To evaluate the safety and efficacy of a novel augmentation implant in the treatment of patients with symptomatic vertebral body fractures. Thirty...     

经皮椎体成形术治疗骨质疏松椎体压缩骨折的综合疗效评价

目的 前瞻性评估经皮椎体成形术(PVP)治疗骨质疏松性椎体压缩骨折患者的生活质量及无症状骨水泥渗漏是否影响远期疗效.资料与方法 用视觉模拟评分法(VAS)、生活自理能力表(ADL)和下腰部活动障碍表(OLBPDQ)前瞻性评价疼痛性椎体压缩骨折126例PVP治疗术前及术后不同时期的综合疗效.结果 平均随访9.9个月(3～24个月),获得完整随访资料有72例.术前、术后1天、1个月、3个月、6个月及1年以上随访时VAS分别为8.53±0.85、3.22±1.20、3.06±1.02、2.06±0.98、1.61±0.85及1.24±0.85,术后1天VAS平均下降了5.31;Barthel指数术前、术后1周、1个月、3个月、6个月及1年以上分别为40.5±16.9、69.4±22.3、78.5 ±20.6、87.3±15.1、91.7±9.7、93.0±7.9,术后1周较术前提高了28.9(71%);ODI指数术前、术后1周、1个月、3个月、6个月及1年以上分别为33.81±5.54、20.90±5.31、16.90±4.78、12.11±6.41、9.71±4.82、8.69±4.81,术后1周较术前下降了12.91(38%).术后CT证实骨水泥在椎旁少量渗漏共有12例18节,其各随访时点VAS、ADL及ODI总分分别与无渗漏的60例同期比较均无显著性差异(P>0.5).结论 PVP治疗疼痛性骨质疏松椎体压缩骨折可迅速缓解患者疼痛和提高生活质量,而且疗效可保持长期稳定;无症状骨水泥渗漏对患者生命质量无影响.     

Percutaneous Vertebroplasty and Kyphoplasty for Pathologic Vertebral Fractures in the Medicare Population: Safer and Less Expensive than Open Surgery

PurposeTo compare cost and outcomes of surgical and percutaneous treatments of pathologic vertebral fractures.Materials and MethodsStandard Medicare 5% anonymized inpatient files (1999–2009) were retrospectively reviewed. Patients with a diagnosis of vertebral fracture without spinal cord injury and primary or metastatic bony malignancy were divided into percutaneous or surgical groups based on whether they received vertebroplasty/kyphoplasty or surgical treatment. Patients who had no intervention or both interventions were excluded. Cost, length of stay, and type of discharge were examined while controlling for demographic and comorbidity variables.ResultsA total of 451 patients were included; 52% received percutaneous treatment and 48% received surgery. Patients treated percutaneously were older (P<.001) and more likely to be female (P=.04). Percutaneous therapy predicted $14,862 less Medicare cost and $13,565 less overall cost (P<.001 for both), and 4.1 fewer inpatient days (P<.001). Patients who underwent surgery had higher odds of death (odds ratio=3.38, P=.016), discharge to a rehabilitation facility (odds ratio=3.3, P=.003), and transfer to another inpatient facility (odds ratio=8.53, P<.001), and lower odds of discharge to home (odds ratio=0.42, P<.001) and hospice (odds ratio=0.08, P=.002).ConclusionsIn a Medicare population with bony malignancy and vertebral fractures, percutaneous therapy predicted significantly reduced cost and length of stay versus surgery. Patients who underwent percutaneous therapy were significantly less likely to die, be transferred, or be discharged to rehabilitation facilities, and were more likely to be discharged to home or hospice.     

Outcomes after Peripancreatic Fluid Drainage in Patients with Simultaneous Pancreas-Kidney Transplantation

PurposeTo determine the clinical outcomes of patients who underwent image-guided drainage of peripancreatic fluid collections after simultaneous pancreas-kidney (SPK) transplantation.Materials and MethodsA retrospective review of all patients who underwent peripancreatic fluid collection drainage after SPK, from January 2000 to August 2017, at a single institution was performed. Patient characteristics, surgical technique, medication regimen, microbial analysis, and clinical outcomes were reviewed. Thirty-one patients requiring a total of 41 drainages were included in this study. The median age was 44 years (range 30–58 years), and median time between SPK and drainage was 28 days (range 8 to 3,401 days). Fisher’s exact test, unpaired Student t-tests, and Pearson correlations were used for statistical analysis.ResultsFever (51%) and abdominal pain (31%) were the most common presenting symptoms. The average amount of fluid drained at the time of drain placement was 97 mL (SD 240 mL). The average time spent with a drain in place was 33 days (SD 31 days). Microorganisms were isolated in the fluid of 22 of 41 drainages (54%), with mixed gastrointestinal flora being the most common. No further intervention was needed in 34 of 41 drainages (82%). However, drainage failed in 5 of 31 patients (16%), requiring surgical intervention with removal of the pancreas transplant.ConclusionsPercutaneous drainage of peripancreatic fluid collections after SPK transplantation is a safe and effective treatment option.     

One-Stage Percutaneous Treatment in a Patient with Pelvic and Vertebral Compression Fractures

An active 38-year-old patient presenting a vertebral compression fracture associated with a pelvic fracture was treated in one stage with CT-guided fixation of the sacrum and kyphoplasty. This treatment decreased the pain, restored the vertebral height, and enabled the patient to be ambulatory. The main advantage of this double approach was to shorten the hospital stay and the nonworking period.     

经皮椎体成形术治疗骨质疏松胸腰椎压缩性骨折

目的：探讨骨质疏松性胸腰椎压缩性骨折采用经皮椎体成形术治疗的临床效果。方法：选择我院2009-06～2011-06收治的骨质疏松性胸腰椎压缩性骨折的患者40例,采用PVP治疗,对其临床资料进行回顾性分析。结果：每个椎体平均注射骨水泥4.4 mL。骨水泥椎间盘在术中渗漏1例,术后无下肢神经损伤和血管栓塞症状发生。椎体前方腹腔渗漏1例,术后无特殊不适症状。36例患者术后第2 d即可在腰围保护下离床轻微活动,其它3～5 d陆续可离床活动。术前VAS平均得分（8.6±1.3）,术后平均为（2.1±1.0）,减异有统计学意义（P〈0.05）。行平均12个月的随访,无腰背痛加重或椎体高度丢失等情况发生,X线检查椎体内骨水泥无外漏,分布均匀。结论：骨质疏松胸腰椎压缩性骨折采用经皮椎体成形术治疗,可减轻患者疼痛反映,降低并发症发生率,改善病情,减少被残率,具有非常重要的临床意义。     

经皮椎体成形术治疗老年骨质疏松性椎体骨折

目的 探讨经皮椎体成形术(PVP)治疗老年骨质疏松性椎体骨折的价值.方法 27例老年骨质疏松症患者共33节椎体骨折,均经MRI、CT及平片证实.在透视监视下经椎弓根行椎体穿刺,注入粉(g)GA955液(ml)GA955硫酸钡粉(g)为15GA95510GA9553的聚甲基丙烯酸甲酯(PMMA),术后即刻摄X线正侧位片,1 d后CT观察PMMA分布渗漏状况,定期观察疗效和椎体高度.结果 PVP技术成功率100%,PMMA平均注入量4.6 ml (2.3～7.5 ml),术后1 d CT证实椎体周围PMMA少量渗漏7节,但无临床症状.术后1 d,所有病例腰背部疼痛明显减轻,平均随访8个月,疼痛均无复发,椎体高度无进一步塌陷.结论 PVP对治疗老年骨质疏松性椎体骨折所致的腰背疼痛是有效的.     

骨质疏松性胸腰椎骨折术后发生骨缺损的危险因素分析

【摘要】 目的 分析骨质疏松性胸腰椎骨折术后发生骨缺损的危险因素。方法 选取 2020 年 3 月至 2022年 3 月河南科技大学第一附属医院收治的 40 例骨质疏松性胸腰椎骨折术后发生骨缺损的患者 (设为发生组), 以及 54 例骨质疏松性胸腰椎骨折术后未发生骨缺损的患者 (设为未发生组) 作为研究对象, 收集患者性别、年龄?体重指数、受伤原因、受伤部位、椎间盘是否受损、椎体前缘压缩程度、骨密度 T 值以及是否植骨等情况, 采用多因素 Logistic 回归分析骨质疏松性胸腰椎骨折术后发生骨缺损的相关危险因素。结果 单因素分析结果显示,发生组椎间盘受损、椎体前缘压缩程度≥50%、未进行植骨的患者比例均明显高于未发生组 ( χ2 = 25.288、27.885、40.021, P 均<0.001), 骨密度 T 值明显小于未发生组 (t = 4.242, P<0.001);多因素 Logistic 回归分析结果显示, 椎间盘受损、椎体前缘压缩程度≥50%、骨密度 T 值较小以及未进行植骨是骨质疏松性胸腰椎骨折术后发生骨缺损的独立危险因素 (95% CI 为 4.864 ~ 35.722、4.423 ~ 31.093、2.252 ~ 17.893、8.492 ~ 94.879, P均<0.001)。结论 骨质疏松性胸腰椎骨折术后骨缺损的发生与患者椎间盘受损情况、椎体前缘压缩程度、骨密度 T 值以及是否进行植骨有关。