Objective: To investigate the impact of cement distribution index on the occurrence of refracture in the adjacent segments after percutaneous vertebroplasty.
Methods: This retrospective analysis was conducted among 143 patients who received percutaneous vertebroplasty for osteoporotic vertebral compression fracture between April, 2011 and April, 2014. Of the 134 patients with complete follow-up data, 18 had adjacent segment fracture within 1 year following the surgeries (re-fracture group), and 116 patients without new fracture served as the control group. All the patients underwent X-ray examinations after the surgery and according to the position and shape, the cement in the vertebrae were classified into 5 types (I to V), and the volume-cubage index was computed based on the cement volume and vertebral cubage. Age, gender, bone mineral density (BMD), cement distribution index, volume-cubage index, and cement leakage were evaluated in the 2 groups, and the variables with significant differences between the 2 groups were analyzed in Logistic regression analysis.
Results: BMD was significantly lower and the rate of cement leakage was significantly higher in the re-fracture group than in the control group (P<0.05). Significant difference was found in cement distribution index between the 2 groups (P<0.05) but not in age, gender, cement volume or volume-cubage index (P>0.05). Logistic regression analysis indicated that BMD, cement leakage and cement distribution index all significantly affected the occurrence of adjacent vertebral fractures following percutaneous vertebroplasty.
Conclusion: A low BMD, cement leakage and a low cement distribution index are all risks factor of adjacent vertebral fracture after percutaneous vertebroplasty.
目的: 探讨骨水泥分布的评价方式及其对椎体成形术后邻椎骨折的影响。
方法: 回顾分析2011年4月~2014年4月在我院诊断为骨质疏松压缩骨折并接受椎体成形手术的患者（54~91岁）143例，术后随访1年。134例完成随访，其中18例发生邻近节段骨折，为再骨折组，116例未发生邻近节段骨折，为对照组。所有患者术后均复查x线，将骨水泥按照形态和位置分为5种类型。根据术中注射骨水泥的量和椎体体积计算骨水泥的量体指数。分析两组患者的年龄、性别、骨密度、骨水泥量、骨水泥分布指数、量体指数、骨水泥渗漏等的差异。选择有差异的变量纳入logistic回归进行多因素分析。
结果: 再骨折组的骨密度显著低于对照组（p < 0.05），骨水泥渗漏的发生率显著高于对照组（p < 0.05）。两组患者骨水泥分布指数有统计学差异（p < 0.05）。但是，两组患者性别、年龄、骨水泥量及量体指数均无显著性差异（p>0.05）。logistic回归分析表明，低骨密度、骨水泥渗漏和骨水泥的不同分布类型显著影响邻椎骨折的发生率。
结论: 骨水泥分布指数低、骨水泥渗漏及低骨密度可能是椎体成形术后邻椎再骨折的危险因素。