CAJ | 학술논문

目的：探讨经皮椎体后凸成形术(percutaneous kyphoplasty，PKP)术后邻近椎间盘退变与邻近椎体再发骨折的相关性。方法收集2008年12月-2012年2月安徽医科大学第二附属医院骨科135例骨质疏松性椎体压缩性骨折患者资料进行回顾性分析研究，根据术前MRI结果，确认病椎邻近椎间盘无明显退变患者82例，纳入研究范围，其中男性16例，女性66例。所有病椎均给予双侧入路经皮椎体后凸成形术治疗。手术前、后及随访期间均行X线及MRI检查，根据术后邻近骨折椎体的椎间盘是否发生退变分为退变组及非退变组。结果平均随访2年，随访率为96.3%(79/82)。术后病椎邻近椎间盘出现退变42例(53.2%)。术后邻近椎体发生骨折19例，退变组出现邻近椎体骨折14例(14/42)，非退变组邻近椎体骨折5例(5/37)，两组再发骨折发生率的差异有统计学意义(P=0.04)。对末次随访退变组进行分析，在排除椎体再发骨折影响下，其VAS及ODI评分与术后比较差异无统计学意义(P＞0.05)，但增加骨折因素下再次进行统计分析发现其差异有统计学意义(P＜0.05)。结论 PKP术后邻近椎间盘退变的发生并不影响治疗效果，但可能会增加邻近椎体再发骨折的风险。
목적：탐토경피추체후철성형술(percutaneous kyphoplasty，PKP)술후린근추간반퇴변여린근추체재발골절적상관성。방법수집2008년12월-2012년2월안휘의과대학제이부속의원골과135례골질소송성추체압축성골절환자자료진행회고성분석연구，근거술전MRI결과，학인병추린근추간반무명현퇴변환자82례，납입연구범위，기중남성16례，녀성66례。소유병추균급여쌍측입로경피추체후철성형술치료。수술전、후급수방기간균행X선급MRI검사，근거술후린근골절추체적추간반시부발생퇴변분위퇴변조급비퇴변조。결과평균수방2년，수방솔위96.3%(79/82)。술후병추린근추간반출현퇴변42례(53.2%)。술후린근추체발생골절19례，퇴변조출현린근추체골절14례(14/42)，비퇴변조린근추체골절5례(5/37)，량조재발골절발생솔적차이유통계학의의(P=0.04)。대말차수방퇴변조진행분석，재배제추체재발골절영향하，기VAS급ODI평분여술후비교차이무통계학의의(P＞0.05)，단증가골절인소하재차진행통계분석발현기차이유통계학의의(P＜0.05)。결론 PKP술후린근추간반퇴변적발생병불영향치료효과，단가능회증가린근추체재발골절적풍험。
Objective To study the correlation between adjacent intervertebral disc degeneration and recurrent adjacent vertebral fracture after percutaneous kyphoplasty (PKP).Methods Clinical data about 135 patients with vertebral compression fractures due to osteoporosis admitted to our hospital From December 2008 to February 2012 were retrospectively analyzed. Of these 135 patients, 82 (16 males and 66 females) with no significant adjacent disc degeneration according to their MRI underwent bilateral PKP, and X-ray and MRI before and after PKP and during the follow-up period. The patients were divided into non-degeneration group and degeneration group according to whether they had degeneration after operation.Results Of the 82 patients, 79 (96.3%) were followed up for an average period of 2 years. Adjacent disc degeneration occurred in 42 (53.2%) after PKP. Of the 19 patients who developed adjacent vertebral degeneration, 14 (33.3%) were in the degeneration group and 5 (13.5%) were in the non-degeneration group (P= 0.04). No significant difference was observed in the VAS and ODI scores of degeneration group at the last follow-up. However, analysis of the factors for fracture showed that the VAS and ODI scores were significantly different.Conclusion Adjacent disc degeneration does not affect the treatment of recurrent adjacent vertebral fracture but may increase its risk after PKP.