| Objective:To study the related risk factors of adjacent vertebral fractures after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures,and to explore the strategy about prevention and treatment of adjacent vertebral fractures after percutaneous vertebroplasty.MethodsA total of 198 patients with the new single OVCF who were treated with PVP in Guangdong Province Hospital of Traditional Chinese Medicine from Jan 2015 to Dec 2016,followed-up for 12-24 months.All patients had complete electronic medical records and images(Huahai imaging system),divided into adjacent vertebral fracture fractures group and non-fracture group according to the outcomes of follow-up.Adjacent vertebral fracture group have 32 patients,whose fractures occurred at(8.44 + 4.49)months,of which the average age was(77.97 + 7.62)years old,6 of male,26 of female.Non-fracture group of 166 patients,the average age was(75.02 + 8.34)years old,37 of males,129 of females.Age,gender,bone mineral density of T value,body mass index(BMI),operation segment,operation time,puncture methods,bone cement leakage in intervertebral disc,antiosteoporosis treatment,preoperative and postoperative Cobb angle and postoperative Corrected Cobb angle were recorded.SPSS 22 software is used for manipulation data and statistical analysis.Results:Single factor analysis showed that there was no significant difference in age,sex and BMI(P > 0.05)between two groups.The mean value of bone mineral density(T)in adjacent vertebral fracture group was(-2.30 + 0.97)SD,and the mean value of bone mineral density(T)in non-fracture group was(-1.71 + 0.68)SD,there was a significant difference between groups(P < 0.05).18 patients(56.25%)of adjacent vertebral fracture group were treated with anti-osteoporosis therapy,and 139 patients(83.73%)in the non-fracture group were treated with anti-osteoporosis therapy,and the difference between two groups was statistically significant(P < 0.05).The operative time in adjacent vertebral fracture group was(38.22 + 5.06)min,and non-fracture group of operative time was(36.87 + 4.61)min,there was no significant difference between two groups(P > 0.05).Bilateral puncture was performed in 22 cases(68.75%)in adjacent vertebral fracture group,and unilateral puncture of 10 cases(31.25%).In non-fracture group,bilateral puncture was performed in 109 cases(65.66%),and unilateral puncture was in 57 cases(34.34%).There was no significant difference between groups(P > 0.05).The average injection volume of bone cement in adjacent vertebral fracture group was(4.31 + 0.51)ml,and the average volume of bone cement in non-fracture group was(4.28 + 0.50)ml,there was no significant difference between two groups(P > 0.05).Preoperative and postoperative vertebral kyphosis angle in adjacent vertebral fracture group were(10.38 + 3.17)° and(15.81 + 4.89)°,which in non-fracture group were(14.79 + 4.19)° and(10.98 + 3.79)°.There was no significant difference between groups(P > 0.05).The average corrected angle of vertebral kyphosis in the adjacent vertebral fracture group was(5.44 + 3.95)degrees.The average of corrected angle of vertebral kyphosis in the non-fracture group was(3.81 + 3.90)degrees,and the difference between the groups was statistically significant(P < 0.05).In adjacent vertebral fracture group,there were T5-T10 of 2 patients(6.25%),T11-L2 of 29 patients(90.62%),L3-L4 of 1 patient(3.13%).In non-fracture group,there were T5-T10 of 17 patients(10.24%),T11-L2 of 125 patients(75.30%),L3-L4 of 24 patients(14.46%).There was no significant difference(P > 0.05)in two groups about distribution.There were 19 patients(59.38%)of bone cement leakage in intervertebral disc of adjacent vertebral fracture group,and 17 patients(10.24%)in bone cement leakage in intervertebral disc of non-fracture group.The difference between groups was statistically significant(P < 0.05).Logistic regression analysis showed that bone mineral density(T?-2.5 SD),without anti-osteoporosis treatment and bone cement leakage in intervertebral disc were independent risk factors for adjacent vertebral fracture after PVP(P < 0.05).ConclusionThe incidence of adjacent vertebral fractures after PVP for OVCF patient was 14.7%.Bone mineral density,anti-osteoporotic treatment,bone cement leakage in intervertebral disc and postoperative Cobb correction are risk factors for adjacent vertebral fractures after PVP.Severe osteoporosis(T?-2.5),bone cement leakage and intervertebral disc and without the standard anti-osteoporosis treatment will increase the risk of adjacent vertebral fracture after PVP.Standard anti-osteoporosis therapy for postoperative adjacent vertebral fracture has protective effect.Postoperative leakage of bone cement,especially the leakage in intervertebral disc,should alert us as a danger signal.We should pay attention to closely follow-up,formulate strict and standard antiosteoporosis therapy to prevent secondary vertebral fractures. |
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