Department of Orthopedics, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
PLoS One. 2018 Jun 1;13(6):e0198407. doi: 10.1371/journal.pone.0198407. eCollection 2018.
Osteoporotic vertebral compression fracture, always accompanied with pain and height loss of vertebral body, has a significant negative impact on life quality of patients. Vertebroplasty or kyphoplasty is minimal invasive techniques to reconstruct the vertebral height and prevent further collapse of the fractured vertebrae by injecting polymethylmethacrylate into vertebral body. However, recompression of polymethylmethacrylate augmented vertebrae with significant vertebral height loss and aggressive local kyphotic was observed frequently after VP or KP. The purpose of this study was to investigate the effect of polymethylmethacrylate distribution on recompression of the vertebral body after vertebroplasty or kyphoplasty surgery for osteoporotic vertebral compression fracture.
A total of 281 patients who were diagnosed with vertebral compression fracture (T5-L5) from June 2014 to June 2016 and underwent vertebroplasty or kyphoplasty by polymethylmethacrylate were retrospectively analyzed. The X-ray films at 1 day and 12 months after surgery were compared to evaluate the recompression of operated vertebral body. Patients were divided into those without recompression (non-recompression group) and those with recompression (recompression group). Polymethylmethacrylate distribution pattern, including location and relationship to endplates, was compared between the two groups by lateral X-ray film. Multivariate logistic regression analysis was performed to assess the potential risk factors associated with polymethylmethacrylate distribution for recompression.
One hundred and six (37.7%) patients experienced recompression after surgery during the follow-up period. The polymethylmethacrylate distributed in the middle of vertebral body showed significant differences between two groups. In non-recompression group, the polymethylmethacrylate in the middle portion of vertebral body were closer to endplates than that in the recompression group (upper: t = 31.41, p<0.001; lower: t = 12.19, p<0.001). The higher percentage of the height of polymethylmethacrylate in the middle portion of vertebral body indicates the lower risk of recompression (odds ratio [OR]<0.01, p<0.001). The recompression group and non-recompression group showed significant difference in "contacted" polymethylmethacrylate distribution pattern (polymethylmethacrylate contacted to the both upper/lower endplates) (χ2 = 66.23, p<0.001). The vertebra with a "contacted" polymethylmethacrylate distribution pattern has lower risk of recompression (OR = 0.09, p<0.001).
Either more polymethylmethacrylate in the middle portion of vertebral body or "contacted" polymethylmethacrylate distribution pattern had a significantly less incidence of recompression. The findings indicated that the control of polymethylmethacrylate distribution during surgery may reduce the risks of recompression after vertebroplasty or kyphoplasty.
骨质疏松性椎体压缩骨折常伴有椎体疼痛和高度丢失，对患者的生活质量有显著的负面影响。经皮椎体成形术或椎体后凸成形术是通过向椎体注入聚甲基丙烯酸甲酯来重建椎体高度并防止骨折椎体进一步塌陷的微创技术。然而，在 VP 或 KP 后，经常观察到椎体高度显著丢失和局部严重后凸畸形的聚甲基丙烯酸甲酯再压缩。本研究旨在探讨聚甲基丙烯酸甲酯分布对骨质疏松性椎体压缩骨折经皮椎体成形术或椎体后凸成形术后椎体再压缩的影响。
回顾性分析 2014 年 6 月至 2016 年 6 月期间因 T5-L5 椎体压缩骨折接受聚甲基丙烯酸甲酯经皮椎体成形术或椎体后凸成形术的 281 例患者。比较术后 1 天和 12 个月的 X 线片，评估手术椎体的再压缩情况。将患者分为无再压缩组（非再压缩组）和再压缩组。通过侧位 X 线片比较两组聚甲基丙烯酸甲酯的分布模式，包括位置和与终板的关系。采用多变量 logistic 回归分析评估与聚甲基丙烯酸甲酯分布再压缩相关的潜在危险因素。
在随访期间，106 例（37.7%）患者术后出现再压缩。聚甲基丙烯酸甲酯分布在椎体中部的两组之间存在显著差异。在非再压缩组中，椎体中部的聚甲基丙烯酸甲酯更接近终板（上：t=31.41，p<0.001；下：t=12.19，p<0.001）。椎体中部聚甲基丙烯酸甲酯高度的百分比越高，再压缩的风险越低（比值比[OR]<0.01，p<0.001）。再压缩组和非再压缩组的“接触”聚甲基丙烯酸甲酯分布模式（聚甲基丙烯酸甲酯与上下终板接触）存在显著差异（χ2=66.23，p<0.001）。具有“接触”聚甲基丙烯酸甲酯分布模式的椎体再压缩风险较低（OR=0.09，p<0.001）。
椎体中部聚甲基丙烯酸甲酯越多或“接触”聚甲基丙烯酸甲酯分布模式，再压缩发生率越低。研究结果表明，术中控制聚甲基丙烯酸甲酯的分布可能会降低经皮椎体成形术或椎体后凸成形术后再压缩的风险。
