經皮椎體成形術和經皮椎體后凸成形術強化T12、L1骨質疏松性壓縮性骨折對鄰近腰椎體骨密度的影響_《中國修復重建外科雜志》

作者：

張長春 ¹ , 朱坤 ^1,2 , 周建生 ¹ , 周新社 ¹ , 牛國旗 ¹ , 吳敏 ¹ , 邵晨 ^1,2

1蚌埠醫學院第一附屬醫院骨科（安徽蚌埠，233004）;;
2蚌埠醫學院研究生部;

關鍵詞：

骨質疏松性壓縮性骨折經皮椎體成形術經皮椎體后凸成形術骨密度

DOI：

10.7507/1002-1892.20130180

視頻：

導出 下載 收藏 掃碼 引用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的比較經皮椎體成形術（percutaneous vertebroplasty，PVP）和經皮椎體后凸成形術（percutaneous kyphoplasty，PKP）治療絕經后女性T12、L1椎體骨質疏松性壓縮性骨折術后對鄰近腰椎體骨密度的影響。方法2008年1月－2011年6月收治符合選擇標準的T12、L1骨質疏松性壓縮性骨折患者59例，根據采用手術方法不同隨機分為PVP組（29例）和PKP組（30例）。兩組患者年齡、絕經時間、病程、致傷原因、骨折椎體、骨折分度等一般資料比較，差異均無統計學意義（P gt; 0.05）。于術前、術后1周和末次隨訪時測量手術區域后凸Cobb角；于圍手術期及末次隨訪時測量患者手術區域下位腰椎（L5除外）骨密度值、股骨頸骨密度值及體重指數（body mass index，BMI），了解抗骨質疏松情況；并應用FRAX在線工具評價兩組患者未來10年主要骨質疏松性骨折和髖部骨折的概率。結果兩組患者均獲隨訪，隨訪時間12～48個月，平均25.5個月。兩組末次隨訪時T12、L1后凸Cobb角與術前比較差異均有統計學意義（P lt; 0.05）；術后1周及末次隨訪時PKP組Cobb角顯著小于PVP組（P lt; 0.05）。兩組組間及組內圍手術期、末次隨訪時BMI比較差異均無統計學意義（P gt; 0.05）。兩組末次隨訪時下腰椎骨密度及其T值均較圍手術期顯著改善（P lt; 0.05）；兩組間圍手術期下腰椎骨密度及其T值比較差異無統計學意義（P gt; 0.05），末次隨訪時兩組間差異有統計學意義（P lt; 0.05）。兩組間及組內圍手術期、末次隨訪時股骨頸骨密度及其T值比較差異均無統計學意義（P gt; 0.05）。骨折風險評估：兩組間及組內圍手術期、末次隨訪時主要骨質疏松性骨折和髖部骨折的概率比較差異均無統計學意義（P gt; 0.05）。結論經PVP和PKP治療1年以上未繼發骨折的T12、L1節段骨質疏松性壓縮性骨折患者，術后鄰近腰椎骨密度的增加提高了其椎體強度，遠期鄰近腰椎骨折發生率較低，且PKP相對于PVP，更有助于提高鄰近腰椎骨密度。

引用本文： 張長春,朱坤,周建生,周新社,牛國旗,吳敏,邵晨. 經皮椎體成形術和經皮椎體后凸成形術強化T12、L1骨質疏松性壓縮性骨折對鄰近腰椎體骨密度的影響. 中國修復重建外科雜志, 2013, 27(7): 819-823. doi: 10.7507/1002-1892.20130180 復制

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, 葛寶豐, 徐印坎. 實用骨科學. 3版. 北京:人民軍醫出版社, 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.	柏樹令. 系統解剖學. 6版. 北京: 人民衛生出版社, 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, 葛寶豐, 徐印坎. 實用骨科學. 3版. 北京:人民軍醫出版社, 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. 柏樹令. 系統解剖學. 6版. 北京: 人民衛生出版社, 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.

《中國修復重建外科雜志》

經皮椎體成形術和經皮椎體后凸成形術強化T12、L1骨質疏松性壓縮性骨折對鄰近腰椎體骨密度的影響

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

上一篇

下一篇

Format

Content

《中國修復重建外科雜志》

經皮椎體成形術和經皮椎體后凸成形術強化T12、L1骨質疏松性壓縮性骨折對鄰近腰椎體骨密度的影響

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

上一篇

下一篇

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料