经皮椎体后凸成形术后邻近椎间盘退变对邻近椎体再发骨折的影响

目的 探讨经皮椎体后凸成形术（percutaneous kyphoplasty，PKP） 术后邻近椎间盘退变与邻近椎体再发骨折的相关性。方法 收集2008 年12 月- 2012 年2 月安徽医科大学第二附属医院骨科135 例骨质疏松性椎体压缩性骨折患者资料进行回顾性分析研究，根据术前MRI 结果，确认病椎邻近椎间盘无明显退变患者82 例，纳入研究范围，其中男性16 例，女性66 例。所有病椎均给予双侧入路经皮椎体后凸成形术治疗。手术前、后及随访期间均行X 线及MRI 检查，根据术后邻近骨折椎体的椎间盘是否发生退变分为退变组及非退变组。结果 平均随访2 年，随访率为96.3%（79/82）。术后病椎邻近椎间盘出现退变42 例（53.2%）。术后邻近椎体发生骨折19 例，退变组出现邻近椎体骨折14 例（14/42），非退变组邻近椎体骨折5 例（5/37），两组再发骨折发生率的差异有统计学意义（P = 0.04）。对末次随访退变组进行分析，在排除椎体再发骨折影响下，其VAS 及ODI 评分与术后比较差异无统计学意义（P ＞ 0.05），但增加骨折因素下再次进行统计分析发现其差异有统计学意义（P ＜ 0.05）。结论 PKP 术后邻近椎间盘退变的发生并不影响治疗效果，但可能会增加邻近椎体再发骨折的风险。

Effect of adjacent intervertebral disc degeneration on recurrent adjacent vertebral fracture after percu-tanous kyphoplasty

Objective To study the correlation between adjacent intervertebral disc degeneration and recurrent adjacent vertebral fracture after percutaneous kyphoplasty （PKP）. Methods Clinical data about 135 patients with vertebral compression fractures due to osteoporosis admitted to our hospital From December 2008 to February 2012 were retrospectively analyzed. Of these 135 patients, 82 （16 males and 66 females） with no significant adjacent disc degeneration according to their MRI underwent bilateral PKP, and X-ray and MRI before and after PKP and during the follow-up period. The patients were divided into non-degeneration group and degeneration group according to whether they had degeneration after operation. Results Of the 82 patients, 79 （96.3%） were followed up for an average period of 2 years. Adjacent disc degeneration occurred in 42 （53.2%） after PKP. Of the 19 patients who developed adjacent vertebral degeneration, 14 （33.3%） were in the degeneration group and 5 （13.5%） were in the non-degeneration group （P = 0.04）. No significant difference was observed in the VAS and ODI scores of degeneration group at the last follow-up. However, analysis of the factors for fracture showed that the VAS and ODI scores were significantly different. Conclusion Adjacent disc degeneration does not affect the treatment of recurrent adjacent vertebral fracture but may increase its risk after PKP.