Tianjin University of Traditional Chinese Medicine, Tianjin, China.
Liuyang Hospital of Traditional Chinese Medicine, Liuyang City, China.
World Neurosurg. 2023 Oct;178:e766-e772. doi: 10.1016/j.wneu.2023.08.008. Epub 2023 Aug 9.
We investigated the correlation between bone cement distribution and adjacent vertebral fractures (AVFs) after percutaneous vertebroplasty (PVP).
We retrospectively analyzed patients who underwent single-segment PVP for osteoporotic compression fractures in our hospital from January 2016 to January 2021 and divided the patients into 2 groups, A and B, on the basis of the criterion of whether there were AVFs of the operated vertebrae within 1 year after surgery. We compared the general data of the 2 groups, assessed the ability of 3 simple X-ray-based evaluation methods to predict the occurrence of AVF within 1 year after surgery and derived a simple and accurate evaluation method.
A total of 570 patients were included in this study: 511 patients in group A and 59 patients in group B. There were no statistical differences in the general data such as age, gender, and fracture site between the 2 groups. The posterior-anterior (PA), lateral (LAT), and PA and LAT methods showed receiver operating characteristic curve (ROC) predicted postoperative AVF of 0.611, 0.691, and 0.714, respectively. The difference between the area under curve (AUC) of the PA method and LAT method was statistically significant (P = 0.0307), the difference between the AUC of PA method and PA and LAT method was statistically significant (P < 0.001), and the difference between the AUC of LAT method and PA and LAT method was not statistically significant (P = 0.3308).There was no statistical difference between the 2 groups of patients with PA method point of 1 and statistically different between patients with points of 2 and 3. There was statistical difference in points of 1, 2 and 3 in the LAT method between the 2 groups. There was a positive correlation between cement distribution scores and AVF by linear regression analysis of the 3 evaluation methods.
The 3 evaluation methods reliably predict AVF after PVP, with the LAT method, PA and LAT method being more predictive than the PA method, but the LAT method is simpler, with bone cement being widely distributed after crossing the midline in the PA method and contact with the upper and lower end plates in the LAT method being a risk factor for AVF.
研究经皮椎体后凸成形术（PVP）后骨水泥分布与相邻椎体骨折（AVF）的相关性。
回顾性分析 2016 年 1 月至 2021 年 1 月在我院行单节段 PVP 治疗骨质疏松性压缩骨折的患者，根据术后 1 年内手术椎体是否发生 AVF 将患者分为 A、B 两组。比较两组患者的一般资料，评估 3 种简单 X 线评估方法预测术后 1 年内发生 AVF 的能力，并得出一种简单准确的评估方法。
本研究共纳入 570 例患者：A 组 511 例，B 组 59 例。两组患者年龄、性别、骨折部位等一般资料比较，差异无统计学意义。PA、LAT 和 PA 和 LAT 方法的 ROC 预测术后 AVF 的曲线下面积（AUC）分别为 0.611、0.691 和 0.714。PA 法与 LAT 法 AUC 差异有统计学意义（P=0.0307），PA 法与 PA 和 LAT 法 AUC 差异均有统计学意义（P<0.001），LAT 法与 PA 和 LAT 法 AUC 差异无统计学意义（P=0.3308）。PA 法 1 分组与 2 分组、3 分组患者比较，差异均有统计学意义（P<0.05）；LAT 法 1 分组、2 分组、3 分组患者比较，差异均有统计学意义（P<0.05）。通过对 3 种评估方法进行线性回归分析，发现骨水泥分布评分与 AVF 呈正相关。
3 种评估方法均可可靠预测 PVP 后 AVF，LAT 法、PA 和 LAT 法优于 PA 法，但 LAT 法更简单，PA 法中骨水泥分布越过中线、LAT 法中骨水泥与上下终板接触是发生 AVF 的危险因素。
