骨质疏松性椎体骨折患者球囊椎体后凸成形术后相邻椎体骨折及骨水泥松动的影像学因素
Radiographic Factors for Adjacent Vertebral Fractures and Cement Loosening Following Balloon Kyphoplasty in Patients with Osteoporotic Vertebral Fractures.
作者信息
Kamei Naosuke, Yamada Kiyotaka, Nakamae Toshio, Hiramatsu Takeshi, Hashimoto Takashi, Maruyama Toshiaki, Adachi Nobuo, Fujimoto Yoshinori
机构信息
Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Department of Orthopaedic Surgery, JA Hiroshima General Hospital, Hatsukaichi, Japan.
出版信息
Spine Surg Relat Res. 2021 Oct 11;6(2):159-166. doi: 10.22603/ssrr.2021-0112. eCollection 2022.
INTRODUCTION
Balloon kyphoplasty (BKP) is a minimally invasive surgical approach for the treatment of osteoporotic vertebral fractures (OVF). Some risks have been reported after treatment with BKP; therefore, it is necessary to determine when BKP does not work. Thus, in this study, we aim to clarify the radiographic predictors of secondary vertebral fractures and cement loosening after BKP for OVF.
METHODS
This study enrolled patients with single-level OVF at the thoracolumbar junction (T11-L2) who underwent BKP for the first time between January 2011 and March 2014. The clinical outcomes were evaluated using the visual analog scale (VAS) and a modified Oswestry Disability Index (ODI) at 1 week and 1, 3, 6, and 12 months after surgery. Radiographic assessments were performed preoperatively and within 1 year after BKP using plain radiography and computed tomography.
RESULTS
The 85 patients who met the inclusion criteria underwent BKP. The average age of participants (21 men, 64 women) was 77.8 years (range, 57-92 years). Postoperative VAS and ODI scores were all significantly better than preoperative scores. Polymethyl methacrylate (PMMA)-cement leakage was observed in 18 patients (21.2%) but was asymptomatic in all cases. Secondary vertebral fractures were detected in 20 patients (23.5%), including adjacent levels in 15 patients (17.6%) and non-adjacent levels in 5 patients (5.9%). Rostral bridging osteophyte formation was found to be significantly associated with the occurrence of adjacent vertebral fractures (odds ratio 12.746; =0.010). PMMA-cement loosening was observed in three patients (3.5%). A high prevalence (100%) of bridging osteophytes, vacuum clefts, and spinous process fractures was observed in patients with PMMA-cement loosening. PMMA-cement loosening was found in 3 out of 10 patients with all three of these factors.
CONCLUSIONS
Rostral bridging osteophyte formation was determined to be a risk factor for both adjacent vertebral fractures and PMMA-cement loosening.
UNLABELLED
Level of Evidence: 3.
引言
球囊椎体后凸成形术（BKP）是一种用于治疗骨质疏松性椎体骨折（OVF）的微创手术方法。BKP治疗后已有一些风险报道；因此，有必要确定BKP何时无效。因此，在本研究中，我们旨在阐明OVF行BKP后继发性椎体骨折和骨水泥松动的影像学预测因素。
方法
本研究纳入了2011年1月至2014年3月期间首次接受BKP治疗的胸腰段（T11-L2）单节段OVF患者。在术后1周以及1、3、6和12个月时，使用视觉模拟量表（VAS）和改良的奥斯威斯利功能障碍指数（ODI）评估临床结局。术前以及BKP术后1年内使用X线平片和计算机断层扫描进行影像学评估。
结果
符合纳入标准的85例患者接受了BKP。参与者（21例男性，64例女性）的平均年龄为77.8岁（范围57-92岁）。术后VAS和ODI评分均显著优于术前评分。18例患者（21.2%）观察到聚甲基丙烯酸甲酯（PMMA）骨水泥渗漏，但所有病例均无症状。20例患者（23.5%）检测到继发性椎体骨折，其中15例患者（17.6%）为相邻节段骨折，5例患者（5.9%）为非相邻节段骨折。发现椎体前缘骨桥形成与相邻椎体骨折的发生显著相关（比值比12.746；P=0.010）。3例患者（3.5%）观察到PMMA骨水泥松动。在PMMA骨水泥松动的患者中，椎体前缘骨桥、真空裂隙和棘突骨折的发生率很高（100%）。在具有所有这三个因素的10例患者中，有3例出现PMMA骨水泥松动。
结论
椎体前缘骨桥形成被确定为相邻椎体骨折和PMMA骨水泥松动的危险因素。
未标注
证据级别：3级。
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