Zhao He, He Yan, Yang Jun-Song, Bao Wei, Chen Jian, Liu Ji-Jun, Li Qing-Da, Liu Peng, Qian Bing, Zhao Yuan-Ting, Hao Ding-Jun
Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 76 Nanguo Road, Xi'an, 710054, Shaanxi, People's Republic of China.
Department of emergency, Honghui Hospital, Xi'an Jiaotong University, No. 76 Nanguo Road, Xi'an, 710054, Shaanxi, People's Republic of China.
J Orthop Surg Res. 2021 Aug 3;16(1):476. doi: 10.1186/s13018-021-02623-y.
Vertebral augmentation (VA) techniques are used to treat acute osteoporotic vertebral compression fractures (OVCFs). However, the incidence of recurrent vertebral fractures after VA is controversial. Various factors have been discussed in the literature, but no convincing study on the quality of paraspinal muscles has been reported. The purposes of this study were to evaluate the changes in paraspinal muscles and discuss the relationship between paraspinal muscle degeneration and vertebral refractures after percutaneous kyphoplasty (PKP).
This retrospective study was conducted in patients who underwent PKP for an initial OVCF between July 2017 and August 2018. Patients were followed up and categorized in the refractured or non-refractured group. A final magnetic resonance imaging (MRI) scan and a preoperative MRI scan were used to determine the measurements. The paraspinal muscles at the mid-height level of the initial fractured vertebral body were measured using regions of interest (ROIs), including the cross-sectional area (CSA) and signal intensity (SI). The changes in the observed data were compared between the groups using rank-sum tests.
Overall, 92 patients were enrolled in the study; 33 of them sustained vertebral refractures during the follow-up and the other 59 patients did not. There were no significant differences in terms of sex, age, preoperative bone mineral density, and body mass index between the groups (all, P > 0.05). The refractured group had a significantly higher decrease in the ROI-CSA and CSA/SI, and a higher increase in ROI-SI, compared with the preoperative data (all, P < 0.05).
The quality of paraspinal muscles significantly decreased in patients with new OVCFs after PKP. This brings a new perspective to the study of postoperative recurrent fractures; patients and physicians need to pay more attention to the efficacy of bed rest and bracing.
椎体强化（VA）技术用于治疗急性骨质疏松性椎体压缩骨折（OVCFs）。然而，VA术后椎体再骨折的发生率存在争议。文献中讨论了各种因素，但尚未有关于椎旁肌质量的令人信服的研究报道。本研究的目的是评估经皮椎体后凸成形术（PKP）后椎旁肌的变化，并探讨椎旁肌退变与椎体再骨折之间的关系。
本回顾性研究纳入了2017年7月至2018年8月期间因初次OVCF接受PKP治疗的患者。对患者进行随访，并分为再骨折组和未再骨折组。使用末次磁共振成像（MRI）扫描和术前MRI扫描来确定测量值。使用感兴趣区（ROIs）测量初始骨折椎体中高度水平的椎旁肌，包括横截面积（CSA）和信号强度（SI）。使用秩和检验比较两组间观察数据的变化。
总体而言，92例患者纳入本研究；其中33例在随访期间发生椎体再骨折，另外59例未发生。两组在性别、年龄、术前骨密度和体重指数方面无显著差异（均P>0.05）。与术前数据相比，再骨折组的ROI-CSA和CSA/SI显著降低，ROI-SI显著升高（均P<0.05）。
PKP术后新发OVCF患者的椎旁肌质量显著下降。这为术后再骨折的研究带来了新的视角；患者和医生需要更加关注卧床休息和支具固定的效果。
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