CAJ | 학술논문

目的：探讨骨质疏松性椎体骨折行椎体强化术[包括经皮椎体后凸成形术（ percutaneous kyphoplasty， PKP）及经皮椎体成形术（ percutaneous vertebroplasty， PVP）]后，椎体发生再骨折的临床特点及危险因素。方法：回顾性分析2006年3月到2013年10月于北京大学人民医院因单节段椎体压缩骨折行PKP或PVP的患者148例，其中再发椎体骨折29例（共42个椎体），未再发椎体骨折119例，所有患者随访（34．4±26．8）个月。记录患者性别、年龄、身高、体重、体质指数、有无糖尿病、有无合并其他骨折病史、受伤节段、是否再次骨折、再次骨折与首次手术的间隔时间、再次骨折的节段、有无规律抗骨质疏松治疗、骨水泥用量、手术方式（ PKP或PVP）、单侧或双侧穿刺、骨水泥是否渗透、骨水泥弥散好坏、椎体前缘高度纠正的百分比、术后Cobb角的改变、腰椎骨密度T值，并进行Cox回归分析。结果：相邻椎体骨折有16人（55．17％，16／29），非相邻椎体骨折13人（44．83％，13／29）。3个月内再骨折人数占总人数的31．03％（9／29），1年内再骨折人数占总人数的55．17％（16／29）。高龄（P＝0．027， HR＝1．051，95％CI＝1．006～1．098）、既往存在其他骨折病史（P＝0．012，HR＝0．386，95％CI＝0．184～0．812）是预测再骨折的独立危险因素，上述其他因素与再骨折无关（P＞0．05）。结论：高龄、既往存在其他骨折病史是再骨折的独立危险因素，骨质疏松性骨折行椎体强化术后再骨折的原因多是由于骨质疏松症的自然病程所致。
목적：탐토골질소송성추체골절행추체강화술[포괄경피추체후철성형술（ percutaneous kyphoplasty， PKP）급경피추체성형술（ percutaneous vertebroplasty， PVP）]후，추체발생재골절적림상특점급위험인소。방법：회고성분석2006년3월도2013년10월우북경대학인민의원인단절단추체압축골절행PKP혹PVP적환자148례，기중재발추체골절29례（공42개추체），미재발추체골절119례，소유환자수방（34．4±26．8）개월。기록환자성별、년령、신고、체중、체질지수、유무당뇨병、유무합병기타골절병사、수상절단、시부재차골절、재차골절여수차수술적간격시간、재차골절적절단、유무규률항골질소송치료、골수니용량、수술방식（ PKP혹PVP）、단측혹쌍측천자、골수니시부삼투、골수니미산호배、추체전연고도규정적백분비、술후Cobb각적개변、요추골밀도T치，병진행Cox회귀분석。결과：상린추체골절유16인（55．17％，16／29），비상린추체골절13인（44．83％，13／29）。3개월내재골절인수점총인수적31．03％（9／29），1년내재골절인수점총인수적55．17％（16／29）。고령（P＝0．027， HR＝1．051，95％CI＝1．006～1．098）、기왕존재기타골절병사（P＝0．012，HR＝0．386，95％CI＝0．184～0．812）시예측재골절적독립위험인소，상술기타인소여재골절무관（P＞0．05）。결론：고령、기왕존재기타골절병사시재골절적독립위험인소，골질소송성골절행추체강화술후재골절적원인다시유우골질소송증적자연병정소치。
Objective:To identify the characteristics and risk factors of the refractures after percuta-neous kyphoplasty ( PKP) and percutaneous vertebroplasty ( PVP) .Methods:A retrospective analysis of 148 patients who had undergone PKP or PVP between March 2006 and October 2013 inPeking University People’ s Hospital was conducted.In the study, 29 patients with 42 refractured vertebra and 119 patients without refracture were included.All the patients were observed for a time of (34.4 ±26.8) months. Clinical, imaging and procedure related factors ( gender, age, height, weight, body mass index, the level of the injured vertebra, the time interval between the procedure and the refracture, the level of the refractured vertebra, the bone cement volume injected, performed PKP or PVP,performed unilateral or bilateral, the percentage of anterior vertebral height restoration, the correction of the Cobb angle, cement diffusion, bone mineral density, presence or absence of diabetes mellitus, history of fractures of the whole body, anti-osteoporosis treatment, cement leakage) for each group were analyzed by Cox propor-tional hazards regression analysis.Results:Of all the patients,16 (55.17%, 16/29) had refractures in the adjacent vertebra, and 13 (44.83%, 13/29) had refractures in the nonadjacent vertebra.Refrac-tures within 3 months accounted for 31.03%(9/29) of all the refractures, and within 1 year accounted for 55.17%(16/29).Both older age (P=0.027, HR=1.051, 95%CI=1.006-1.098) and a his-tory of fractures of the whole body (P=0.012, HR=0.386, 95%CI=0.184-0.812) were statistical-ly significant as the independent risk factors for predicting refractures.Others were not associated with re-fractures ( P>0.05) .Conclusion:Older age and a history of fractures of the whole body are the inde-pendent risk factors of the refractures after PKP and PVP.The mechanism of the refractures after PKP and PVP is mainly the natural development of osteoporosis.