Department of Radiology, St Luke's International Hospital, Tokyo, Japan.
AJR Am J Roentgenol. 2011 Aug;197(2):451-6. doi: 10.2214/AJR.10.5937.
Previous studies have shown the possible efficacy of prophylactic cement injection for nonfractured vertebrae during percutaneous vertebroplasty for compression fractures. The purpose of this study was to investigate risk factors for subsequent fractures after prophylactic percutaneous vertebroplasty.
This retrospective study included 116 patients with osteoporotic compression fractures who underwent prophylactic percutaneous vertebroplasty. The patients were monitored with physical examinations and radiographs at 1 day and at 3 and 12 months after percutaneous vertebroplasty, and if back pain recurred. We analyzed the following multiple covariates to determine whether they were associated with recurrence: age, sex, steroid use, and the preoperative number of unhealed or chronic compression fractures.
Subsequent fractures in any vertebra occurred within 3 months after the procedure at 26 vertebrae in 21 patients (18.1%), and 36 occurred in 28 patients (24.1%) within 12 months. The occurrence of subsequent fractures within 12 months depended on the preoperative number of unhealed vertebrae: the occurrence rate was 16.9% (11/65) for one vertebra, 27.0% (10/37) for two vertebrae, and 50.0% (7/14) for three or more vertebrae. The incidence of subsequent fractures was significantly higher in patients with three or more fractures than in those with one fracture (p < 0.05). There were no statistically significant differences for the other factors.
Patients with three or more fractures tended to have subsequent fractures, despite undergoing prophylactic percutaneous vertebroplasty. However, there was no increased risk of subsequent fractures related to prophylactic percutaneous vertebroplasty.
既往研究表明，在经皮椎体成形术治疗压缩性骨折时，对非骨折椎体进行预防性骨水泥注射可能具有疗效。本研究旨在探讨预防性经皮椎体成形术后发生后续骨折的危险因素。
本回顾性研究纳入了 116 例骨质疏松性压缩性骨折患者，这些患者均接受了预防性经皮椎体成形术。患者在术后 1 天、3 个月和 12 个月时通过体格检查和影像学检查进行监测，且如果出现背痛复发，则进行监测。我们分析了以下多个协变量，以确定其是否与复发相关：年龄、性别、类固醇使用以及术前未愈合或慢性压缩性骨折的数量。
在 21 例患者（18.1%）的 26 个椎体中，术后 3 个月内任何椎体均出现了后续骨折；在 28 例患者（24.1%）的 36 个椎体中，术后 12 个月内出现了后续骨折。12 个月内发生后续骨折取决于术前未愈合椎体的数量：1 个椎体的发生率为 16.9%（11/65），2 个椎体的发生率为 27.0%（10/37），3 个或更多椎体的发生率为 50.0%（7/14）。3 个或更多椎体骨折的患者发生后续骨折的发生率明显高于 1 个椎体骨折的患者（p<0.05）。其他因素无统计学差异。
尽管进行了预防性经皮椎体成形术，仍有 3 个或更多骨折的患者倾向于发生后续骨折。然而，预防性经皮椎体成形术与后续骨折的风险增加无关。
