椎体后凸成形术与邻近椎体继发骨折的关系

目的]探讨椎体后凸成形术后临近(相邻或间隔)椎体继发骨折的危险因素.方法]对2006年2月～2009年3月进行椎体后凸成形术的391例单椎体骨折患者进行回顾性分析.对于新发骨折的研究限于治疗椎体上下3个椎体.患者分为3组:相邻椎体骨折组、间隔椎体骨折组和没有继发骨折的对照组.对临床资料、影像学资料以及手术相关因素进行分析.研究各因素与椎体后凸成形术后继发临近椎体骨折的关系,并比较相邻椎体和间隔椎体继发骨折影响因素的不同.结果]临床表现、影像学资料表明45例患者48个椎体继发骨折.其中29例患者,32个继发椎体骨折为相邻椎体组；16例患者、16个继发椎体骨折为间隔椎体组；346例患者为对照组.局部后凸角度、椎体压缩程度和术后骨折高度恢复情况是相邻及间隔椎体继发骨折的共同危险因素.在前者,低体重指数和骨水泥椎间隙的渗漏是危险因素.在后者,局部节段活动范围减小是危险因素.但前者较后者更早发生.结论]相邻或间隔椎体继发骨折的机理可能不同,有不同的高危因素.椎体后凸成形术可能加速了新发椎体的骨折.

Risk factors of subsequent vertebral fractures after percutaneous kyphoplasty

Objective]To evaluate the risk factors related to the development of new vertebral fractures at the neighbouring levels(adjacent vs nonadjacent vertebrae) after percutaneous kyphoplasty(PKP).Method]Totally 391 kyphoplasties in 391 patients were performed from February 2006 to March 2009.Evaluations of the three vertebras superior and inferior to the treated vertebras were performed.The patients were divided into 3 groups:adjacent fracture group,nonadjacent fracture group and the control group composed of patients with no evidence of a new fracture.Clinical,imaging and procedure related factors for each group were statistically analysed.Result]Forty-five of the patients had new vertebral fractures after PKP in a total of 48 vertebras.In 29 patients 32 vertebras were classified as adjacent fractures,and in 16 patients 16 vertebras were classified as nonadjacent fractures.The other 346 patients were classified as control group.In case involving adjacent fractures,lower body mass index and intradiscal cement leakage were the significant risk factors of fracture.In contrast,lower mobility of the index segment was related to nonadjacent fracture.In addition,local kyphosis,degree of vertebral compression and reduction of the compressed vertebral fracture were all the risk factors.However,adjacent fracture occurred sooner than nonadjacent fracture.Conclusion]The mechanisms of subsequent fracture at adjacent and nonadjacent vertebras after PKP differs with the related risk factors.The subsequent fracture may be accelerated by PKP although we cannot draw the conclusion that PKP is the cause of new fractures.