维生素 D 缺乏症是球囊扩张椎体后凸成形术后椎体再骨折的危险因素。

Hypovitaminosis D as a risk factor of subsequent vertebral fractures after kyphoplasty.

机构信息

Laboratory for the Research of the Musculoskeletal System (LRMS), Postgraduate Course on Metabolic Bone Disease, Faculty of Medicine, University of Athens, 2nd Nikis St, Kifisia 145 61, Athens, Greece.

出版信息

Spine J. 2012 Apr;12(4):304-12. doi: 10.1016/j.spinee.2012.02.016. Epub 2012 Apr 10.

DOI:10.1016/j.spinee.2012.02.016

PMID:22494816

Abstract

BACKGROUND CONTEXT

Over the past 20 years, methods of minimally invasive surgery have been developed for the treatment of vertebral compression fractures. Balloon kyphoplasty and vertebroplasty are associated with a recurrent fracture risk in the adjacent levels after the surgical procedure. In certain patient categories with impaired bone metabolism, the risk of subsequent fractures after kyphoplasty is increased.

PURPOSE

To determine the incidence of recurrent fractures after kyphoplasty and explore whether the status of bone metabolism and 25-hydroxyvitamin D (25(OH)D) levels affect the occurrence of these fractures.

STUDY DESIGN

Prospective longitudinal clinical study.

PATIENT SAMPLE

Forty female postmenopausal women with primary osteoporosis and acute symptomatic vertebral compression fractures.

OUTCOME MEASURES

Identification of new vertebral fractures and documentation of indicators of bone metabolism.

METHODS

A total of ninety-eight kyphoplasties were performed in 40 female patients. Balloon kyphoplasty was performed on all symptomatic acute vertebral compression fractures. Age, body mass index, history of tobacco use, number of initial vertebral fractures, intradiscal cement leakage, history of nonspinal fractures, use of antiosteoporotic medications, bone mineral density, bone turnover markers, and 25(OH)D levels were assessed. All participants were evaluated clinically and/or radiographically. Follow-up period was 18 months.

RESULTS

The mean population age was 70.6 years (range, 40-83 years). After initial kyphoplasty procedure, nine patients (11 levels) (22.5% of patients; 11.2% of levels) developed a postkyphoplasty vertebral compression fracture. Cement leakage was identified in seven patients (17.5%). The patients without recurrent fractures after kyphoplasty demonstrated higher levels of 25(OH)D (22.6±5.51 vs. 14.39±7.47; p=.001) and lower N-terminal cross-linked telopeptide values (17.11±10.20 vs. 12.90±4.05; p=.067) compared with the patients with recurrent fractures.

CONCLUSIONS

Bone metabolism and 25(OH)D levels seem to play a role in the occurrence of postkyphoplasty recurrent vertebral compression fractures.

摘要

背景

在过去的 20 年中，已经开发出了微创外科方法来治疗椎体压缩性骨折。球囊后凸成形术和椎体成形术与手术后继发相邻水平骨折的风险相关。在某些骨代谢受损的特定患者类别中，后凸成形术后发生骨折的风险增加。

目的

确定后凸成形术后再发骨折的发生率，并探讨骨代谢状态和 25-羟维生素 D（25(OH)D）水平是否影响这些骨折的发生。

研究设计

前瞻性纵向临床研究。

患者样本

40 名患有原发性骨质疏松症和急性症状性椎体压缩性骨折的绝经后女性。

研究结果

在 40 名女性患者中总共进行了 98 次后凸成形术。所有有症状的急性椎体压缩性骨折均进行球囊后凸成形术。评估了年龄、体重指数、吸烟史、初次椎体骨折数、椎间盘内水泥渗漏、非脊柱骨折史、抗骨质疏松药物的使用、骨密度、骨转换标志物和 25(OH)D 水平。所有参与者均进行了临床和/或放射学评估。随访期为 18 个月。

结果

平均人群年龄为 70.6 岁（范围 40-83 岁）。初次后凸成形术后，9 名患者（11 个节段）（22.5%的患者；11.2%的节段）发生了后凸成形术后椎体压缩性骨折。7 名患者（17.5%）存在水泥渗漏。后凸成形术后无复发性骨折的患者 25(OH)D 水平较高（22.6±5.51 比 14.39±7.47；p=.001），N 端交联端肽值较低（17.11±10.20 比 12.90±4.05；p=.067）。