经皮椎体成形术和经皮椎体后凸成形术强化T12、L1骨质疏松性压缩性骨折对邻近腰椎体骨密度的影响_《中国修复重建外科杂志》

作者：

张长春 ¹ , 朱坤 ^1,2 , 周建生 ¹ , 周新社 ¹ , 牛国旗 ¹ , 吴敏 ¹ , 邵晨 ^1,2

1蚌埠医学院第一附属医院骨科（安徽蚌埠，233004）;;
2蚌埠医学院研究生部;

关键词：

骨质疏松性压缩性骨折经皮椎体成形术经皮椎体后凸成形术骨密度

DOI：

10.7507/1002-1892.20130180

视频：

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目的比较经皮椎体成形术（percutaneous vertebroplasty，PVP）和经皮椎体后凸成形术（percutaneous kyphoplasty，PKP）治疗绝经后女性T12、L1椎体骨质疏松性压缩性骨折术后对邻近腰椎体骨密度的影响。方法2008年1月－2011年6月收治符合选择标准的T12、L1骨质疏松性压缩性骨折患者59例，根据采用手术方法不同随机分为PVP组（29例）和PKP组（30例）。两组患者年龄、绝经时间、病程、致伤原因、骨折椎体、骨折分度等一般资料比较，差异均无统计学意义（P gt; 0.05）。于术前、术后1周和末次随访时测量手术区域后凸Cobb角；于围手术期及末次随访时测量患者手术区域下位腰椎（L5除外）骨密度值、股骨颈骨密度值及体重指数（body mass index，BMI），了解抗骨质疏松情况；并应用FRAX在线工具评价两组患者未来10年主要骨质疏松性骨折和髋部骨折的概率。结果两组患者均获随访，随访时间12～48个月，平均25.5个月。两组末次随访时T12、L1后凸Cobb角与术前比较差异均有统计学意义（P lt; 0.05）；术后1周及末次随访时PKP组Cobb角显著小于PVP组（P lt; 0.05）。两组组间及组内围手术期、末次随访时BMI比较差异均无统计学意义（P gt; 0.05）。两组末次随访时下腰椎骨密度及其T值均较围手术期显著改善（P lt; 0.05）；两组间围手术期下腰椎骨密度及其T值比较差异无统计学意义（P gt; 0.05），末次随访时两组间差异有统计学意义（P lt; 0.05）。两组间及组内围手术期、末次随访时股骨颈骨密度及其T值比较差异均无统计学意义（P gt; 0.05）。骨折风险评估：两组间及组内围手术期、末次随访时主要骨质疏松性骨折和髋部骨折的概率比较差异均无统计学意义（P gt; 0.05）。结论经PVP和PKP治疗1年以上未继发骨折的T12、L1节段骨质疏松性压缩性骨折患者，术后邻近腰椎骨密度的增加提高了其椎体强度，远期邻近腰椎骨折发生率较低，且PKP相对于PVP，更有助于提高邻近腰椎骨密度。

引用本文： 张长春,朱坤,周建生,周新社,牛国旗,吴敏,邵晨. 经皮椎体成形术和经皮椎体后凸成形术强化T12、L1骨质疏松性压缩性骨折对邻近腰椎体骨密度的影响. 中国修复重建外科杂志, 2013, 27(7): 819-823. doi: 10.7507/1002-1892.20130180 复制

1.	Lee KA, Hong SJ, Lee S, et al. Analysis of adjacent fracture after percutaneous vertebroplasty: does intradiscal cement leakage really increase the risk of adjacent vertebral fracture? Skeletal Radiol, 2011, 40(12): 1537-1542.
2.	Campbell PG, Harrop JS. Incidence of fracture in adjacent levels in patients treated with balloon kyphoplasty: a review of the literature. Curr Rev Musculoskelet Med, 2008, 1(1): 61-64.
3.	Lin H, Bao LH, Zhu XF, et al. Analysis of recurrent fracture of a new vertebral body after percutaneous vertebroplasty in patients with osteoporosis. Orthop Surg, 2010, 2(2): 119-123.
4.	Zafeiris CP, Lyritis GP, Papaioannou NA, et al. Hypovitaminosis D as a risk factor of subsequent vertebral fractures after kyphoplasty. Spine J, 2012, 12(4): 304-312.
5.	Tatsumi RL, Ching AC, Byrd GD, et al. Predictors and prevalence of patients undergoing additional kyphoplasty procedures after an initial kyphoplasty procedure. Spine J, 2010, 10(11): 979-986.
6.	Sanfélix-Genovés J, Arana E, Sanfélix-Gimeno G, et al. Agreement between semi-automatic radiographic morphometry and Genant semi-quantitative method in the assessment of vertebral fractures. Osteoporos Int, 2012, 23(8): 2129-2134.
7.	胥少汀, 葛宝丰, 徐印坎. 实用骨科学. 3版. 北京:人民军医出版社, 2008: 1198-1207, 1773-1785.
8.	Kanis JA, Melton LJ 3rd, Christiansen C, et al. The diagnosis of osteoporosis. J Bone Miner Res, 1994, 9(8): 1137-1141.
9.	Kanis JA, Johnell O, Oden A, et al. FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int, 2008, 19(4): 385-397.
10.	Kanis JA. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. WHO Study Group. Osteoporos Int, 1994, 4(6): 368-381.
11.	Lunt M, O’Neill TW, Felsenberg D, et al. Characteristics of a prevalent vertebral deformity predict subsequent vertebral fracture: results from the European Prospective Osteoporosis Study (EPOS). Bone, 2003, 33(4): 505-513.
12.	柏树令. 系统解剖学. 6版. 北京: 人民卫生出版社, 2005: 50-51.
13.	Korovessis P, Zacharatos S, Repantis T, et al. Evolution of bone mineral density after percutaneous kyphoplasty in fresh osteoporotic vertebral body fractures and adjacent vertebrae along with sagittal spine alignment. J Spinal Disord Tech, 2008, 21(4): 293-298.
14.	Lin H, Bao LH, Zhu XF, et al. Analysis of recurrent fracture of a new vertebral body after percutaneous vertebroplasty in patients with osteoporosis. Orthop Surg, 2010, 2(2): 119-123.
15.	Yan D, Duan L, Li J, et al. Comparative study of percutaneous vertebroplasty and kyphoplasty in the treatment of osteoporotic vertebral compression fractures. Arch Orthop Trauma Surg, 2011, 131(5): 645-650.
16.	Lu K, Liang CL, Hsieh CH, et al. Risk factors of subsequent vertebral compression fractures after vertebroplasty. Pain Med, 2012, 13(3):376-382.
17.	Kim MH, Lee AS, Min SH, et al. Risk factors of new compression fractures in adjacent vertebrae after percutaneous vertebroplasty. Asian Spine J, 2011, 5(3): 180-187.
18.	Kayanja MM, Schlenk R, Togawa D, et al. The biomechanics of 1, 2, and 3 levels of vertebral augmentation with polymethylmethacrylate in multilevel spinal segments. Spine (Phila Pa 1976), 2006, 31(7): 769-774.
19.	Tanigawa N, Komemushi A, Kariya S, et al. Radiological follow-up of new compression fractures following percutaneous vertebroplasty. Cardiovasc Intervent Radiol, 2006, 29(1): 92-96.
20.	Uppin AA, Hirsch JA, Centenera LV, et al. Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis. Radiology, 2003, 226(1): 119-124.

1. Lee KA, Hong SJ, Lee S, et al. Analysis of adjacent fracture after percutaneous vertebroplasty: does intradiscal cement leakage really increase the risk of adjacent vertebral fracture? Skeletal Radiol, 2011, 40(12): 1537-1542.
2. Campbell PG, Harrop JS. Incidence of fracture in adjacent levels in patients treated with balloon kyphoplasty: a review of the literature. Curr Rev Musculoskelet Med, 2008, 1(1): 61-64.
3. Lin H, Bao LH, Zhu XF, et al. Analysis of recurrent fracture of a new vertebral body after percutaneous vertebroplasty in patients with osteoporosis. Orthop Surg, 2010, 2(2): 119-123.
4. Zafeiris CP, Lyritis GP, Papaioannou NA, et al. Hypovitaminosis D as a risk factor of subsequent vertebral fractures after kyphoplasty. Spine J, 2012, 12(4): 304-312.
5. Tatsumi RL, Ching AC, Byrd GD, et al. Predictors and prevalence of patients undergoing additional kyphoplasty procedures after an initial kyphoplasty procedure. Spine J, 2010, 10(11): 979-986.
6. Sanfélix-Genovés J, Arana E, Sanfélix-Gimeno G, et al. Agreement between semi-automatic radiographic morphometry and Genant semi-quantitative method in the assessment of vertebral fractures. Osteoporos Int, 2012, 23(8): 2129-2134.
7. 胥少汀, 葛宝丰, 徐印坎. 实用骨科学. 3版. 北京:人民军医出版社, 2008: 1198-1207, 1773-1785.
8. Kanis JA, Melton LJ 3rd, Christiansen C, et al. The diagnosis of osteoporosis. J Bone Miner Res, 1994, 9(8): 1137-1141.
9. Kanis JA, Johnell O, Oden A, et al. FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int, 2008, 19(4): 385-397.
10. Kanis JA. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. WHO Study Group. Osteoporos Int, 1994, 4(6): 368-381.
11. Lunt M, O’Neill TW, Felsenberg D, et al. Characteristics of a prevalent vertebral deformity predict subsequent vertebral fracture: results from the European Prospective Osteoporosis Study (EPOS). Bone, 2003, 33(4): 505-513.
12. 柏树令. 系统解剖学. 6版. 北京: 人民卫生出版社, 2005: 50-51.
13. Korovessis P, Zacharatos S, Repantis T, et al. Evolution of bone mineral density after percutaneous kyphoplasty in fresh osteoporotic vertebral body fractures and adjacent vertebrae along with sagittal spine alignment. J Spinal Disord Tech, 2008, 21(4): 293-298.
14. Lin H, Bao LH, Zhu XF, et al. Analysis of recurrent fracture of a new vertebral body after percutaneous vertebroplasty in patients with osteoporosis. Orthop Surg, 2010, 2(2): 119-123.
15. Yan D, Duan L, Li J, et al. Comparative study of percutaneous vertebroplasty and kyphoplasty in the treatment of osteoporotic vertebral compression fractures. Arch Orthop Trauma Surg, 2011, 131(5): 645-650.
16. Lu K, Liang CL, Hsieh CH, et al. Risk factors of subsequent vertebral compression fractures after vertebroplasty. Pain Med, 2012, 13(3):376-382.
17. Kim MH, Lee AS, Min SH, et al. Risk factors of new compression fractures in adjacent vertebrae after percutaneous vertebroplasty. Asian Spine J, 2011, 5(3): 180-187.
18. Kayanja MM, Schlenk R, Togawa D, et al. The biomechanics of 1, 2, and 3 levels of vertebral augmentation with polymethylmethacrylate in multilevel spinal segments. Spine (Phila Pa 1976), 2006, 31(7): 769-774.
19. Tanigawa N, Komemushi A, Kariya S, et al. Radiological follow-up of new compression fractures following percutaneous vertebroplasty. Cardiovasc Intervent Radiol, 2006, 29(1): 92-96.
20. Uppin AA, Hirsch JA, Centenera LV, et al. Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis. Radiology, 2003, 226(1): 119-124.

《中国修复重建外科杂志》

经皮椎体成形术和经皮椎体后凸成形术强化T12、L1骨质疏松性压缩性骨折对邻近腰椎体骨密度的影响

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《中国修复重建外科杂志》

经皮椎体成形术和经皮椎体后凸成形术强化T12、L1骨质疏松性压缩性骨折对邻近腰椎体骨密度的影响

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