椎体强化术后夹心椎体骨折的相关因素分析

目的 探讨椎体强化术后夹心椎体骨折的相关因素.方法 2006年1月至2010年10月行经皮椎体成形术或经皮椎体后凸成形术治疗且资料随访完整的患者有449例,对其中存在夹心椎现象的41例(41节)骨质疏松性椎体压缩骨折患者的临床资料进行回顾性分析,男9例,女32例;年龄54 ～85岁,平均71.1岁.根据症状、体格检查及影像学资料判断夹心椎是否骨折；以夹心椎是否骨折作为二分类因变量,选取性别、年龄、身高、体质量、体质量指数、夹心椎是否位于胸腰段、累计手术椎体节段数、夹心椎两侧强化椎体骨水泥注射入路(单侧或双侧椎弓根)、手术方式、骨水泥注射量、骨水泥椎间盘渗漏及术前、术后夹心椎局部后凸角等作为自变量进行统计学分析.结果 41例患者术后获9～44个月(平均21.6个月)随访.41例(41节)夹心椎中,9例(9节)夹心椎发生骨折.手术前、后夹心椎局部后凸角骨折组非骨折组比较差异有统计学意义(P＜0.05)；进一步分析结果显示仅术前夹心椎局部后凸角是夹心椎骨折的危险因素(P=0.024).结论 术前脊柱后凸畸形严重程度对椎体骨水泥强化术后邻近椎体骨折有影响,后凸畸形越严重,骨折风险越高.

Risk factors for sandwich vertebral fracture after cement augmentation of two adjacent vertebral bodies

Objective To investigate potential risks of sandwich vertebral fracture after cement augmentation of the 2 adjacent vertebral bodies.Methods A series of 41 patients with 41 sandwich vertebral levels who had undergone percutaneous vertebroplasty or percntaneous kyphoplasty from January 2006to October 2010 for osteoporotic vertebral compression fracture (OVCF) were reviewed by this study.They were 32females and 9 males,aged from 54 to 85 years (mean,71.1years).Sandwich vertebral fraeture was identified by a hybrid method combining physical and image examinations A database was created containing the demographic characteristics and surgical variables.The incidence of sandwich vertebral fracture was calculated and multiple logistic regression analysis was conducted to identify risk factors of the fracture.Results All the patients had a mean follow-up of 21.6 months (range,9 to 44 months).Nine of 41 sandwich levels developed vertebral fractures.The pre- and postoperative local kyphotic angulations were found to make a statistical difference for the fracture( P ＜ 0.05).Only the preoperative kyphotic angulation at the sandwich region was positively associated with the subsequent fracture of the sandwich vertebral body(P=0.024).Conclusions Thepreoperative spinal kyphotic deformity has an effect on the sandwich vertebral fracture after cement augmentation of the 2 adjacent vertebral bodies.The more serious the kyphosis,the more likely the fracture.