Chien Hung Yang, Yang Yao Chun, Hsieh Min Hong, Yang Chang Chen
Department of Orthopedics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan.
College of Medicine, National Taiwan University, Taipei, Taiwan.
World Neurosurg. 2021 Dec;156:e283-e290. doi: 10.1016/j.wneu.2021.09.050. Epub 2021 Sep 20.
Percutaneous vertebroplasty (PVP) is widely used for treatment of osteoporotic vertebral compression fractures (VCFs). However, the influence of PVP timing (early vs. late) on development of adjacent vertebral fractures has rarely been discussed. This retrospective cohort study aimed to evaluate bone-cement binding for thoracolumbar fractures (T8-L3) using a new assessment method to predict risk for adjacent vertebral fractures.
Patients with a single-level T-score ≤ -1.0 of lumbar bone mineral density and a primary osteoporotic VCF in the thoracolumbar region (T8-L3) who underwent PVP from October 2016 to February 2018 at our medical university-affiliated hospital were included. Patients were divided into refracture and non-refracture groups. All patients underwent computed tomography after vertebroplasty. Bone-cement distribution patterns were evaluated using standardized axial computed tomography images of each cemented vertebra by 4 independent observers with ImageJ software. The smoothness index was calculated as a percentage of smooth margins.
Of 51 VCFs, 15 (29.4%) and 36 (70.6%) were refracture and non-refracture VCFs, respectively. The mean smoothness index (MSI) was higher in the refracture group than in the non-refracture group (P < 0.01), with an increased refracture risk that corresponded to increased MSI values (P = 0.004). Spearman correlation coefficient (0.375) showed a positive correlation between the fracture-vertebroplasty interval and MSI (P = 0.01).
Axial computed tomography images were used to characterize bone-cement binding properties. Patients who underwent early PVP had a lower MSI, better bone-cement integration, and fewer adjacent fractures.
经皮椎体成形术（PVP）广泛用于治疗骨质疏松性椎体压缩骨折（VCF）。然而，PVP时机（早期与晚期）对相邻椎体骨折发生的影响鲜有讨论。这项回顾性队列研究旨在使用一种新的评估方法来评估胸腰椎骨折（T8-L3）的骨水泥结合情况，以预测相邻椎体骨折的风险。
纳入2016年10月至2018年2月在我校附属医院接受PVP治疗的单节段腰椎骨密度T值≤ -1.0且胸腰椎区域（T8-L3）原发性骨质疏松性VCF患者。患者分为再骨折组和未再骨折组。所有患者椎体成形术后均行计算机断层扫描。由4名独立观察者使用ImageJ软件，通过每个注入骨水泥椎体的标准化轴向计算机断层扫描图像评估骨水泥分布模式。平滑度指数以平滑边缘的百分比计算。
51例VCF中，15例（29.4%）为再骨折VCF，36例（70.6%）为未再骨折VCF。再骨折组的平均平滑度指数（MSI）高于未再骨折组（P < 0.01），再骨折风险随MSI值增加而增加（P = 0.004）。Spearman相关系数（0.375）显示骨折-椎体成形术间隔与MSI呈正相关（P = 0.01）。
轴向计算机断层扫描图像用于表征骨水泥结合特性。早期接受PVP的患者MSI较低，骨水泥整合较好，相邻骨折较少。
