Trout Andrew T, Kallmes David F, Layton Kennith F, Thielen Kent R, Hentz Joseph G
Mayo Medical School, Mayo Clinic, Rochester, Minnesota, USA.
J Bone Miner Res. 2006 Nov;21(11):1797-802. doi: 10.1359/jbmr.060723.
Vertebroplasty alters spinal biomechanics and may lead to incident vertebral fractures. The endplate localization of prevalent and incident fractures was evaluated in 86 patients. In the absence of vertebroplasty, superior endplate fractures predominate. After the procedure, inferior endplate fractures are disproportionately common in adjacent vertebrae immediately above the treated level, potentially supporting a causative relationship between vertebroplasty and incident fractures.
To determine retrospectively whether new-onset fractures after vertebroplasty tend to cluster in the endplate immediately adjacent to the cemented vertebra.
Institutional Review Board approval and patient consent for use the use of medical records were obtained for this study. We performed a retrospective review of patients with new (incident) vertebral fractures after vertebroplasty. The median age for these patients was 72.5 years, and 58 (67.4%) were women. Fractures were diagnosed on the basis of MRI or bone scan and were catalogued based on their location within the vertebral body (superior endplate, inferior endplate, or holo-vertebral). Chi(2) and generalized estimating equation (GEE) analyses were used to compare the distribution of fracture subtypes among pre-existing (prevalent) and incident fractures.
The patients had 313 prevalent osteoporotic vertebral fractures and were treated at 137 vertebral levels. Among prevalent fractures, superior endplate fractures predominated (57% superior, 11% inferior; p < 0.0001). After vertebroplasty, 186 incident fractures developed in these 86 patients. Seventy-seven (41%) of these incident fractures occurred adjacent to treated vertebrae. Nonadjacent, incident fractures, like prevalent fractures, occurred predominantly along superior endplate. Incident fractures immediately above treated levels, however, localized disproportionately to the inferior endplate (30% superior, 57% inferior; p < 0.0001).
There are an increased number of inferior endplate fractures of the vertebral body immediately cephalad to the treated level.
椎体成形术会改变脊柱生物力学，可能导致新发椎体骨折。对86例患者的既往骨折和新发骨折的终板定位进行了评估。在未进行椎体成形术的情况下，上位终板骨折占主导。手术后，在治疗节段上方紧邻的相邻椎体中，下位终板骨折极为常见，这可能支持椎体成形术与新发骨折之间的因果关系。
回顾性确定椎体成形术后新发骨折是否倾向于聚集在与骨水泥填充椎体紧邻的终板处。
本研究获得了机构审查委员会的批准以及患者使用病历的同意。我们对椎体成形术后新发（即现发）椎体骨折的患者进行了回顾性研究。这些患者的中位年龄为72.5岁，其中58例（67.4%）为女性。骨折通过MRI或骨扫描诊断，并根据其在椎体内的位置（上位终板、下位终板或全椎体）进行分类。采用卡方检验和广义估计方程（GEE）分析比较既往（即现患）骨折和新发骨折中骨折亚型的分布情况。
患者有313例现患骨质疏松性椎体骨折，在137个椎体节段接受了治疗。在现患骨折中，上位终板骨折占主导（上位57%，下位11%；p<0.0001）。椎体成形术后，这86例患者出现了186例新发骨折。其中77例（41%）新发骨折发生在治疗椎体相邻部位。非相邻的新发骨折与现患骨折一样，主要发生在上位终板。然而，在治疗节段正上方的新发骨折，下位终板的定位比例过高（上位30%，下位57%；p<0.0001）。
在治疗节段上方紧邻的椎体中，下位终板骨折数量增加。
