摘要
目的 探讨非外伤性与外伤性骨质疏松性椎体压缩骨折(OVCF)采用经皮椎体成形术(PVP)治疗患者的临床因素及伤椎影像学因素是否存在差异.方法 回顾性分析2015年10月至2017年3月首都医科大学附属北京潞河医院骨科行PVP治疗的369例(458个伤椎)OVCF患者资料.男77例,女292例;年龄73(66,79)岁.根据骨折原因不同将患者分为非外伤组(127例160个伤椎)和外伤组(242例298个伤椎).记录两组患者的临床因素:性别、年龄、体重指数、症状时长、伤椎个数、疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)评分、随访时间、新发椎体骨折;伤椎影像学因素:伤椎位置、骨折形态、椎体压缩程度、骨折范围、皮质缺损位置、裂隙征、椎管侵占、椎基底静脉孔、骨水泥分布状态、骨水泥分布范围、骨水泥渗漏、骨水泥量、伤椎高度恢复率、伤椎再塌陷.比较两组的患者临床因素、伤椎影像学因素是否存在差异.结果 与外伤组患者相比,非外伤组患者的年龄更大[75(71,83)岁 vs.71(65,76)岁]、女性比例更高(85.0％vs.76.0％)、症状时长更长[10.0(7.0,15.0)d vs.6.5(2.0,12.0)d]、术前疼痛VAS评分更低[7(6,8)分vs.7(7,8)分]、术后1 d疼痛VAS评分更低[2(2,3)分 vs.2(2,3)分]、术前 ODI 更低[66％(63％,72％)vs.70％(65％,73％)]、术后 1 d ODI更低[32％(30％,34％)vs.32％(31％,34％)]、随访期间新发椎体骨折率更高(3 4.6％vs.12.8％),胸腰段比例更低(51.9％vs.70.1％)、骨折形态差异显著、前缘皮质缺损率更少(20.0％vs.31.5％)、海绵型骨水泥发生率更高(83.1％vs.71.8％)、B型渗漏率更高(50.6％vs.31.9％)、C型渗漏率更低(5.6％vs.12.8％)、伤椎再塌陷率更低(43.8％vs.55.4％),差异均有统计学意义(P＜0.05).其余的临床因素、伤椎影像学因素,两组间比较差异均无统计学意义(P＞0.05).结论 非外伤性与外伤性OVCF采用PVP治疗的患者临床因素及伤椎影像学因素中,诸多因素存在显著性差异.非外伤性OVCF是OVCF的特殊亚组,值得注意.
Abstract
Objective To explore the differences in clinical and injured vertebra radiological parameters between patients with non-traumatic osteoporotic vertebral compression fracture(OVCF)and those with traumatic OVCF after percutaneous vertebroplasty(PVP).Methods A retrospective study was conducted to analyze the 369 OVCF patients(with 458 vertebrae injured)who had been treated by PVP at Department of Orthopaedics,Bei-jing Luhe Hospital between October 2015 and March 2017.There were 292 females and 77 males with a mean age of 73(60,79)years.Based on the absence or presence of a trauma history,the patients were stratified into a non-traumatic group(127 patients with 160 vertebrae injured)and a traumatic group(242 patients with 298 verte-brae injured).Clinical parameters[age,gender,body mass index,symptomatic duration,and number of injured vertebrae,visual analogue scale(VAS),Oswestry disability index(ODI),duration of follow-up,and rate of new OVCFs]and injured vertebra radiological parameters(position of injured vertebra,fracture type,com-pression severity,fracture range,cortical defect,intravertebral cleft,spinal canal compromise,basivertebral foramen,morphology of bone cement,range of bone cement,cement leakage,cement volume,rate of vertebral height restoration,recollapse of cemented vertebrae)were recorded perioperatively.All the clinical and radio-logical parameters were compared between the 2 groups.Results Compared with the traumatic group,the non-traumatic group had an older age[75(71,83)years versus 71(65,76)years],more females(85.0％versus 76.0％),a longer symptomatic duration[10.0(7.0,15.0)d versus 6.5(2.0,12.0)d],a lower preoperative VAS pain score[7(6,8)points versus 7(7,8)points],a lower VAS pain score at postopera-tive day 1[2(2,3)points versus 2(2,3)points],a lower preoperative ODI[66％(63％,72％)versus 70％(65％,73％)],a lower ODI at postoperative day 1[32％(30％,34％)versus 32％(31％,34％)],a higher rate of new OVCFs during follow-up(34.6％versus 12.8％),a lower rate of thoracolumbar lesions(51.9％versus 70.1％),more deformed fractures(mostly amphicoelous type),a lower rate of cortical defects in the anterior wall(20.0％versus 31.5％),a higher rate of trabecular pattern of cement(83.1％versus 71.8％),a higher rate of type-B cement leakage(50.6％versus 31.9％),a lower rate of type-C cement leakage(5.6％versus 12.8％),a lower rate of recollapse of cemented vertebrae(43.8％versus 55.4％).All the comparisons above were statistically significant(P＜0.05).There were no significant differences between the 2 groups in the other clinical or radiological parameters(P＞0.05).Conclusions There are statistically significant differences in a significant number of clinical and injured vertebra radiological parameters between patients with non-traumatic OVCF and those with traumatic OVCF after PVP.It is noteworthy that non-traumatic OVCFs are one specific subgroup of OVCFs.
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