Li Yong-Xian, Guo Dan-Qing, Zhang Shun-Cong, Liang De, Yuan Kai, Mo Guo-Ye, Li Da-Xing, Guo Hui-Zhi, Tang Yongchao, Luo Pei-Jie
The First Clinical Academy, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China.
The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China.
Int Orthop. 2018 Sep;42(9):2131-2139. doi: 10.1007/s00264-018-3838-6. Epub 2018 Feb 20.
Re-collapse of cemented vertebrae occasionally occurs after percutaneous augmentation. However, the potential risks still remain unclear. Several articles have reported some possible risk factors which were not consistent or comprehensive. This study aimed to make a retrospective review on patients with osteoporotic vertebral compression fracture (OVCF) after percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) and to further analyse the risk factors for treated vertebral refracture.
All patients receiving the PKP/PVP with bilateral approach were retrospectively reviewed from January 2014 to January 2016, among whom 230 patients with single level augmentation (30 in refracture group and 200 in the non-refracture group) were enrolled according to inclusion criteria. The following covariates were reviewed: gender, age, height, weight, body mass index (BMI), bone mineral density (BMD), serum bone turnover markers, surgical parameters including approach, cement volume, anterior height, and Cobb angle restoration. Binary logistic regression analysis was used to determine the relative risk of re-collapse of cemented vertebrae.
Regarding the patient data, weight, BMI, and BMD were of statistical significance in refracture group (P < 0.01), among which only low BMD was a risk factor to cemented vertebral re-collapse (P = 0.022, OR = 4.197). In respect of surgical variables, the better restoration of anterior height and Cobb angle was found in refracture group (P < 0.05), both of which might increase the refracture risk but not be risk factors (P = 0.065, OR = 0.891, and P = 0.937, OR = 0.996, respectively). Besides, less injected cement (3.30 ± 0.84 ml vs 4.46 ± 1.10 ml, P = 0.000, OR = 19.433) and PKP (P = 0.007, OR = 13.332) significantly boosted the potential risk of refracture (P < 0.001).
Patients with low BMD, or undergoing PKP, or receiving a low volume of injected cement might have a high risk of re-collapse in surgical vertebrae.
经皮椎体强化术后骨水泥强化椎体偶尔会再次塌陷。然而，潜在风险仍不明确。几篇文章报道了一些可能的风险因素，但并不一致或全面。本研究旨在对经皮椎体成形术（PVP）或经皮后凸成形术（PKP）治疗骨质疏松性椎体压缩骨折（OVCF）的患者进行回顾性研究，并进一步分析治疗椎体再骨折的危险因素。
回顾性分析2014年1月至2016年1月所有接受双侧入路PKP/PVP的患者，根据纳入标准，纳入230例单节段强化患者（再骨折组30例，未再骨折组200例）。回顾以下协变量：性别、年龄、身高、体重、体重指数（BMI）、骨密度（BMD）、血清骨转换标志物、手术参数，包括入路、骨水泥体积、椎体前缘高度和Cobb角恢复情况。采用二元逻辑回归分析确定骨水泥强化椎体再次塌陷的相对风险。
关于患者数据，体重、BMI和BMD在再骨折组有统计学意义（P<0.01），其中只有低骨密度是骨水泥强化椎体再次塌陷的危险因素（P=0.022，OR=4.197）。关于手术变量，再骨折组椎体前缘高度和Cobb角恢复较好（P<0.05），两者可能会增加再骨折风险，但不是危险因素（P=0.065，OR=0.891；P=0.937，OR=0.996）。此外，注入骨水泥较少（3.30±0.84ml对4.46±1.10ml，P=0.000，OR=19.433）和PKP（P=0.007，OR=13.332）显著增加了再骨折的潜在风险（P<0.001）。
骨密度低、接受PKP或注入骨水泥量少的患者手术椎体再次塌陷的风险可能较高。
