CAJ | 학술논문

目的：回顾性研究经皮椎体成形术（percutaneous vertebroplasty，PVP）或经皮后凸成形术（percutaneous ky-phoplasty，PKP）治疗糖皮质激素诱导骨质疏松性椎体压缩骨折的临床特点和术后再发骨折的风险。方法：2010年1月至2013年12月北京大学第一医院骨科应用PVP或PKP治疗的骨质疏松性椎体压缩骨折病例570例，其中糖皮质激素诱导骨质疏松性椎体压缩骨折42例，完整随访21例定为糖皮质激素诱导的骨质疏松（ glucocorticosteroid-induced osteoporosis，GIOP）组；原发性骨折疏松椎体压缩骨折病例528例，完整随访391例，按照性别、年龄匹配的原则1∶4配比84例定为对照组。记录两组病例胸腰椎椎体骨折节段；比较两组病例中单节段骨折和多节段骨折的比例；比较两组病例胸椎节段、胸腰段节段和腰椎节段骨折的比例；以再发骨折行二次手术为终点事件计算患者骨水泥灌注术后生存率及绘制生存曲线，比较两组病例的生存率。结果：GIOP组随访（24．0±13．1）个月，对照组随访（25．8±14．4）个月（ P＞0．05）。 GIOP组单节段骨折11例，双节段骨折2例，三节段骨折3例，四节段骨折2例，五节段骨折2例，八节段骨折1例。对照组单节段骨折67例，双节段骨折12例，三节段骨折2例，四节段骨折3例。 GIOP组单节段骨折比例明显低于对照组（52．4％vs．79．8％，P＝0．01）。 GIOP组骨折节段共50节段，对照组骨折节段共109节段。胸椎节段（T1～T10）比例GIOP组18％，对照组11．9％（P＞0．05）；胸腰段节段（T11～L1）比例GIOP组46％，对照组58．7％（P＞0．05）；腰椎节段（L2～L5）比例GIOP组36％，对照组29．4％（P＞0．05）。随访期内GIOP组和对照组因胸腰椎椎体再发骨折行二次PVP或PKP手术的比例分别为23．8％和6．0％，GIOP组生存率明显低于对照组（P＜0．01）。结论：GIOP椎体压缩骨折好发部位与原发性骨质疏松椎体压缩骨折类似（胸腰段节段＞腰椎节段＞胸椎节段），但GIOP椎体压缩骨折多节段骨折的风险高，PVP或PKP治疗后椎体再发骨折风险高。目的：迴顧性研究經皮椎體成形術（percutaneous vertebroplasty，PVP）或經皮後凸成形術（percutaneous ky-phoplasty，PKP）治療糖皮質激素誘導骨質疏鬆性椎體壓縮骨摺的臨床特點和術後再髮骨摺的風險。方法：2010年1月至2013年12月北京大學第一醫院骨科應用PVP或PKP治療的骨質疏鬆性椎體壓縮骨摺病例570例，其中糖皮質激素誘導骨質疏鬆性椎體壓縮骨摺42例，完整隨訪21例定為糖皮質激素誘導的骨質疏鬆（ glucocorticosteroid-induced osteoporosis，GIOP）組；原髮性骨摺疏鬆椎體壓縮骨摺病例528例，完整隨訪391例，按照性彆、年齡匹配的原則1∶4配比84例定為對照組。記錄兩組病例胸腰椎椎體骨摺節段；比較兩組病例中單節段骨摺和多節段骨摺的比例；比較兩組病例胸椎節段、胸腰段節段和腰椎節段骨摺的比例；以再髮骨摺行二次手術為終點事件計算患者骨水泥灌註術後生存率及繪製生存麯線，比較兩組病例的生存率。結果：GIOP組隨訪（24．0±13．1）箇月，對照組隨訪（25．8±14．4）箇月（ P＞0．05）。 GIOP組單節段骨摺11例，雙節段骨摺2例，三節段骨摺3例，四節段骨摺2例，五節段骨摺2例，八節段骨摺1例。對照組單節段骨摺67例，雙節段骨摺12例，三節段骨摺2例，四節段骨摺3例。 GIOP組單節段骨摺比例明顯低于對照組（52．4％vs．79．8％，P＝0．01）。 GIOP組骨摺節段共50節段，對照組骨摺節段共109節段。胸椎節段（T1～T10）比例GIOP組18％，對照組11．9％（P＞0．05）；胸腰段節段（T11～L1）比例GIOP組46％，對照組58．7％（P＞0．05）；腰椎節段（L2～L5）比例GIOP組36％，對照組29．4％（P＞0．05）。隨訪期內GIOP組和對照組因胸腰椎椎體再髮骨摺行二次PVP或PKP手術的比例分彆為23．8％和6．0％，GIOP組生存率明顯低于對照組（P＜0．01）。結論：GIOP椎體壓縮骨摺好髮部位與原髮性骨質疏鬆椎體壓縮骨摺類似（胸腰段節段＞腰椎節段＞胸椎節段），但GIOP椎體壓縮骨摺多節段骨摺的風險高，PVP或PKP治療後椎體再髮骨摺風險高。
목적：회고성연구경피추체성형술（percutaneous vertebroplasty，PVP）혹경피후철성형술（percutaneous ky-phoplasty，PKP）치료당피질격소유도골질소송성추체압축골절적림상특점화술후재발골절적풍험。방법：2010년1월지2013년12월북경대학제일의원골과응용PVP혹PKP치료적골질소송성추체압축골절병례570례，기중당피질격소유도골질소송성추체압축골절42례，완정수방21례정위당피질격소유도적골질소송（ glucocorticosteroid-induced osteoporosis，GIOP）조；원발성골절소송추체압축골절병례528례，완정수방391례，안조성별、년령필배적원칙1∶4배비84례정위대조조。기록량조병례흉요추추체골절절단；비교량조병례중단절단골절화다절단골절적비례；비교량조병례흉추절단、흉요단절단화요추절단골절적비례；이재발골절행이차수술위종점사건계산환자골수니관주술후생존솔급회제생존곡선，비교량조병례적생존솔。결과：GIOP조수방（24．0±13．1）개월，대조조수방（25．8±14．4）개월（ P＞0．05）。 GIOP조단절단골절11례，쌍절단골절2례，삼절단골절3례，사절단골절2례，오절단골절2례，팔절단골절1례。대조조단절단골절67례，쌍절단골절12례，삼절단골절2례，사절단골절3례。 GIOP조단절단골절비례명현저우대조조（52．4％vs．79．8％，P＝0．01）。 GIOP조골절절단공50절단，대조조골절절단공109절단。흉추절단（T1～T10）비례GIOP조18％，대조조11．9％（P＞0．05）；흉요단절단（T11～L1）비례GIOP조46％，대조조58．7％（P＞0．05）；요추절단（L2～L5）비례GIOP조36％，대조조29．4％（P＞0．05）。수방기내GIOP조화대조조인흉요추추체재발골절행이차PVP혹PKP수술적비례분별위23．8％화6．0％，GIOP조생존솔명현저우대조조（P＜0．01）。결론：GIOP추체압축골절호발부위여원발성골질소송추체압축골절유사（흉요단절단＞요추절단＞흉추절단），단GIOP추체압축골절다절단골절적풍험고，PVP혹PKP치료후추체재발골절풍험고。
Objective:To investigate the clinical characteristics of vertebral compression fracture ( VCF) in glucocorticosteroid-induced osteoporosis ( GIOP) and risk of vertebral refracture after percuta-neous vertebroplasty ( PVP) or percutaneous kyphoplasty ( PKP) .Methods:In the study, 570 cases who received PVP or PKP as treatments of VCF from January 2010 to December 2013 were retrospective re-viewed, of which 42 were GIOP and 21 were followed up as GIOP group, and the other 528 were primary osteoporosis and 391 were followed up, of which 84 were selected as Control group based on age and gen-der.The fracture location, ratio of single segment fracture and multiple segments fracture in the two groups were compared.In the final follow up, the reoperation rates for vertebral refractures by the Kap-lan-Meier method in the two groups were compared.Results:The follow up periods were (24.0 ±13.1) months in GIOP group and (25.8 ±14.4) months in control group(P>0.05).In GIOP group, there were 11 cases with one-segment fracture, 2 with two-segments fracture, 3 with three-segments fracture, 2 with four-segments fracture, 2 with five-segments fracture and 1 with eight-segments fracture.In Control group, there were 67 cases with one-segment fracture, 12 with two-segments fracture, 3 with three-seg-ment fracture, and 2 with four-segments fracture.The ratio of single segment fracture in GIOP group was significantly lower than that in Control group(52.4% vs.79.8%,P=0.01).There were 50 fracture segments in GIOP group and 109 fracture segments in Control group.The ratios of fracture segments loca-ted in thoracic segments(T1-T10), thoracolumbar segments(T11-L1)and lumbar segments(L2-L5) were 18%, 46%and 36% in GIOP group and 11.9%, 58.7% and 29.4% in Control group ( P >0.05).The refracture rate in GIOP group was higher than that in control group (23.8%vs.6.0%).The survival rate was lower in GIOP group than that in control group ( P<0.01) .Conclusion:The predilection site of VCF was similar in GIOP and primary osteoporosis ( thoracolumbar segments>thoracic segments>lumbar segments).The risk of multiple segments VCF was higher in GIOP than in primary osteoporosis. The risk of vertebral refractures after PVP or PKP was higher in GIOP than in primary osteoporosis.