早期经皮椎体成形术治疗骨质疏松性胸腰椎压缩性骨折可能减少相邻骨折的发生：一项回顾性研究。

Earlier Vertebroplasty for Osteoporotic Thoracolumbar Compression Fracture May Minimize the Subsequent Development of Adjacent Fractures: A Retrospective Study.

机构信息

Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan; Department of Orthopedics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.

Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan; Department of Orthopedics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan.

出版信息

Pain Physician. 2018 Sep;21(5):E483-E491.

PMID:30282396

Abstract

BACKGROUND

Percutaneous vertebroplasty (PVP) is widely used to treat osteoporotic vertebral compression fractures (OVCFs). The influence of timing (early vs. late) of PVP on the development of adjacent vertebral fractures (AVF) has rarely been discussed.

OBJECTIVE

This study aimed to compare the incidence of AVF among patients who received early PVP (= 30 days after symptom onset, EPVP) or late PVP (> 30 days after symptom onset, LPVP) in the thoracolumbar region (T10 to L2) after a 1-year follow up.

STUDY DESIGN

A retrospective cohort study.

SETTING

Department of Orthopedic, an affiliated hospital of a medical university.

METHODS

Patients who had single-level, T-score = -2.5 of lumbar bone mineral density (BMD), primary OVCF in the thoracolumbar region (T10 to L2) and who received PVP between July 2012 and June 2014 were included in the study. They were divided into early PVP and late PVP groups according to the interval between symptom onset and treatment. The risk factors associated with subsequent AVFs were analyzed.

RESULTS

Of the 225 patients reviewed, 124 met the criteria and were followed for a minimum of 1 year. Eleven patients (14.1%) in the EPVP group (n = 78) and 18 patients (39.1%) in the LPVP group (n = 46) experienced an AVF during the first year following vertebroplasty. Outcomes were significantly better in patients with higher bone mineral density, lower cement volume, and without cement leakage (P < 0.01). Cox regression indicated an increase risk for AVF for LPVP, with an adjusted hazard ratio of 6.08 (95% confidence interval: 2.50-14.81).

LIMITATION

The incidence of AVFs could be over estimated due to this being a retrospective study with a small case number and lack of either biomechanical study of intra-vertebral cement distribution by times to support the result.

CONCLUSIONS

Compared with later interventions, PVP performed within 30 days after fracture development may be associated with a lower risk of adjacent fractures in the thoracolumbar region.

KEY WORDS

Percutaneous vertebroplasty, osteoporosis, osteoporotic vertebral compression fracture, adjacent vertebral fracture.

摘要

背景

经皮椎体成形术（PVP）被广泛用于治疗骨质疏松性椎体压缩骨折（OVCF）。然而，关于 PVP 治疗时机（早期与晚期）对邻近椎体骨折（AVF）发展的影响，鲜有研究讨论。

目的

本研究旨在比较胸腰椎（T10 至 L2）区接受早期 PVP（=症状出现后 30 天内，EPVP）或晚期 PVP（>症状出现后 30 天，LPVP）治疗的患者在 1 年随访期间发生 AVF 的发生率。

研究设计

回顾性队列研究。

设置

某医科大学附属医院骨科。

方法

纳入研究的患者为单节段、腰椎骨密度 T 评分（BMD）≤-2.5、胸腰椎（T10 至 L2）区原发性 OVCF 且在 2012 年 7 月至 2014 年 6 月期间接受 PVP 治疗的患者。根据症状出现与治疗之间的时间间隔，将患者分为早期 PVP 组和晚期 PVP 组。分析与随后发生 AVFs 相关的危险因素。

结果

共纳入 225 例患者进行回顾性分析，其中 124 例患者至少随访 1 年。在 EPVP 组（n=78）中，有 11 例（14.1%）患者和 LPVP 组（n=46）中 18 例（39.1%）患者在 PVP 治疗后 1 年内发生 AVF。骨密度较高、骨水泥体积较小且无骨水泥渗漏的患者的结果明显更好（P＜0.01）。Cox 回归分析表明，LPVP 与 AVF 的发生风险增加相关，调整后的风险比为 6.08（95%置信区间：2.50-14.81）。