球囊扩张椎体后凸成形术治疗类风湿关节炎骨质疏松性椎体压缩骨折的影像学和临床疗效。
Radiological and clinical outcomes of balloon kyphoplasty for osteoporotic vertebral compression fracture in patients with rheumatoid arthritis.
机构信息
Department of Spine Surgery, Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.540 Xinhua Road, Shanghai, 200052, China.
Shanghai Guanghua Hospital of Integrative Medicine, Shanghai, 200052, China.
出版信息
J Orthop Surg Res. 2021 Jul 6;16(1):435. doi: 10.1186/s13018-021-02573-5.
BACKGROUND
This study was conducted to investigate the outcomes and complications of balloon kyphoplasty (KP) for the treatment of osteoporotic vertebral compression fracture (OVCF) in patients with rheumatoid arthritis (RA) and compare its radiological and clinical effects with OVCF patients without RA.
METHODS
Ninety-eight patients in the RA group with 158 fractured vertebrae and 114 patients in the control group with 150 vertebrae were involved in this study. Changes in compression rate, local kyphotic angle, visual analog scale (VAS) and Oswestry disability index (ODI) scores, conditions of bone cement leakage, refracture of the operated vertebrae, and new adjacent vertebral fractures were examined after KP. In addition, patients in the RA group were divided into different groups according to the value of erythrocyte sedimentation rate (ESR), c-reactive protein (CRP), and whether they were glucocorticoid users or not to evaluate their influence on the outcomes of KP.
RESULTS
KP procedure significantly improved the compression rate, local kyphotic angle, and VAS and ODI scores in both RA and control groups (p<0.05). Changes in compression rate and local kyphotic angle in the RA group were significantly larger than that in the control group (p<0.05), and patients with RA suffered more new adjacent vertebral fractures after KP. The outcomes and complications of KP from different ESR or CRP groups did not show significant differences. The incidence of cement leakage in RA patients with glucocorticoid use was significantly higher than those who did not take glucocorticoids. In addition, RA patients with glucocorticoid use suffered more intradiscal leakage and new adjacent vertebral fractures.
CONCLUSIONS
OVCF patients with RA obtained more improvement in compression rate and local kyphotic angle after KP when compared to those without RA, but they suffered more new adjacent vertebral fractures. Intradiscal leakage and new adjacent vertebral fractures occurred more in RA patients with glucocorticoid use.
TRIAL REGISTRATION
Retrospectively registered.
背景
本研究旨在探讨球囊扩张椎体后凸成形术（KP）治疗类风湿关节炎（RA）患者骨质疏松性椎体压缩性骨折（OVCF）的疗效和并发症，并与非 RA 的 OVCF 患者进行比较。
方法
共纳入 RA 组 98 例 158 个椎体骨折和对照组 114 例 150 个椎体骨折患者。比较两组患者 KP 术后伤椎前缘高度压缩率、局部后凸角、视觉模拟评分（VAS）和 Oswestry 功能障碍指数（ODI）评分的变化，骨水泥渗漏、手术椎体再骨折及新发相邻椎体骨折情况。同时根据红细胞沉降率（ESR）、C 反应蛋白（CRP）值以及是否使用糖皮质激素，将 RA 组患者分为不同亚组，评估其对 KP 疗效的影响。
结果
KP 治疗后两组患者伤椎前缘高度压缩率、局部后凸角、VAS 和 ODI 评分均显著改善（p<0.05）。RA 组患者伤椎前缘高度压缩率和局部后凸角的改善程度显著大于对照组（p<0.05），且术后新发相邻椎体骨折发生率更高。不同 ESR 或 CRP 亚组间 KP 疗效和并发症差异无统计学意义。RA 组中使用糖皮质激素患者骨水泥渗漏发生率显著高于未使用者，且前者更易发生椎间盘内渗漏和新发相邻椎体骨折。
结论
与非 RA 患者相比，RA 患者 KP 术后伤椎前缘高度压缩率和局部后凸角改善更明显，但新发相邻椎体骨折发生率更高；使用糖皮质激素的 RA 患者更易发生椎间盘内渗漏和新发相邻椎体骨折。
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