骨质疏松性椎体压缩骨折患者伤椎裂隙征的临床意义

Clinical significance of intravertebral cleft in patients with osteoporotic vertebral compression fractures

中文关键词:  骨质疏松性椎体压缩骨折  经皮椎体成形术  临床因素  影像学因素  裂隙征

英文关键词:Osteoporotic vertebral compression fractures  Percutaneous vertebroplasty  Clinical parameters  Radiological parameters  Intravertebral cleft

中文摘要:

  【摘要】 目的：对比骨质疏松性椎体压缩骨折患者有裂隙征与无裂隙征伤椎的临床特点及影像学差异，探讨裂隙征的临床意义。方法：回顾性分析2016年1月~2017年12月我院连续性行经皮椎体成形术治疗的骨质疏松性椎体压缩骨折患者。共纳入501例患者（614伤椎），女性393例，男性108例，年龄73.1±8.3岁，随访29.2±14.7个月（12~60个月）。根据伤椎有无裂隙征，分为裂隙征组（147例，163伤椎）和非裂隙征组（354例，451伤椎）。记录患者临床因素，包括年龄、性别、外伤史、体质指数（body mass index，BMI）、症状时长、伤椎个数、术前、术后1d及末次随访时疼痛视觉模拟量表（visual analogue scale，VAS）评分及Oswestry功能障碍指数（Oswestry disability index，ODI）、新发椎体骨折、邻近椎体再骨折；影像学因素，包括伤椎位置、骨折形态、压缩程度、骨折范围、皮质骨缺损、椎管侵占、椎基底静脉孔、骨水泥状态、骨水泥范围、骨水泥渗漏、骨水泥量、伤椎高度恢复率及伤椎再塌陷。对比两组患者临床及影像学参数及术中并发症情况。结果：临床方面，与非裂隙征组相比，裂隙征组平均年龄大（74.3±8.2岁 vs 72.2±8.9岁，P=0.016）、症状时间长（18.8±28.9d vs 11.3±14.4d，P=0.000）、单节段比例大（89.8% vs 74.0%，P=0.027）、末次随访时VAS评分高（2.6±0.7分 vs 2.4±0.6分，P=0.001）、末次随访时ODI高[（32.5±6.7）% vs （30.9±5.8）%，P=0.011]，其余指标两组间均无显著统计学差异（P>0.05）。影像学方面，与非裂隙征组相比，裂隙征组胸腰段比例高（76.1% vs 59.0%，P=0.000）、骨折形态差异显著（全椎压缩占比多）（P=0.000）、椎体压缩程度大（P=0.000）、骨折范围大（P=0.000）、皮质骨缺损率大（78.5% vs 41.5%，P=0.000）、椎管侵占发生率高（52.1% vs 22.0%，P=0.000）、椎基底静脉孔阳性率低（21.5% vs 32.8%，P=0.007）、团块型骨水泥比例大（42.3% vs 15.7%，P=0.000）、B型渗漏率低（28.8% vs 42.1%，P=0.000）、S型渗漏率低（31.3% vs 43.5%，P=0.000）、C型渗漏率高（19.0% vs 4.4%，P=0.000）、D型渗漏率高（18.4% vs 6.7%，P=0.000）、伤椎高度恢复率大[（16.3±16.8）% vs （9.3±9.6）%，P=0.000]、伤椎再塌陷率高（64.4% vs 41.7%，P=0.000）。其余影像学参数，两组相比均无显著性差异（P>0.05）。结论：骨质疏松性椎体压缩骨折伤椎裂隙征意味着患者的年龄更大、椎体压缩程度及伤椎再塌陷率更高，且经皮椎体成形术术后远期临床效果更差。

英文摘要:

  【Abstract】 Objectives: To compare the clinical and radiological parameters between osteoporotic vertebral compression fractures(OVCFs) patients with or without intravertebral cleft(IVC), and to evaluate the clinical significance of IVC. Methods: The OVCFs patients consecutively treated with percutaneous vertebroplasty(PVP) between January 2016 and December 2017 in our center were retrospectively reviewed. A total of 501 patients(614 vertebrae) were enrolled, including 393 females and 108 males with a mean age of 73.1±8.3 years. Mean duration of follow-up was 29.2±14.7 months(range, 12-60 months). Based on with or without IVC, the patients were stratified into IVC group(147 patients, 163 vertebrae) and non-IVC group(354 patients, 451 vertebrae). Clinical parameters[age, gender, trauma history, body mass index(BMI), duration of symptom, fracture levels, as well as preoperative, postoperative 1d, and final follow-up visual analogue scale(VAS) score and Oswestry disability index(ODI), rate of new vertebral compression fracture, rate of new vertebral compression fracture in adjacent levels] and radiological parameters(fracture location, fracture type, compression severity, fracture range, cortical defect, spinal canal compromise, basivertebral foramen, morphology of bone cement, range of bone cement, cement leakage, cement volume, restoration rate of vertebral height, recollapse of cemented vertebrae) before and at final follow-up were recorded and compared. Results: In terms of clinical parameters, IVC group had an older age(74.3±8.2 years vs 72.2±8.9 years, P=0.016), longer duration of symptom(18.8±28.9d vs 11.3±14.4d, P=0.027), higher rate of one-level fracture(89.8% vs 74.0%, P=0.000), higher VAS score at final follow-up(2.6±0.7 vs 2.4±0.6，P=0.001), higher ODI at final follow-up[(32.5±6.7)% vs (30.9±5.8)%，P=0.011], compared to non-IVC group. In terms of radiological parameters, IVC group had a higher probability of fracture in thoracolumbar region(76.1% vs 59.0%, P=0.000), more deformed fracture(P=0.000), more severity of compression(P=0.000), more ranges of fracture (P=0.000), higher rate of cortical defect(78.5% vs 41.5%, P=0.000), higher rate of spinal canal compromise(52.1% vs 22.0%, P=0.000), lower rate of basivertebral foramen(21.5% vs 32.8%, P=0.007), higher rate of solid pattern of cement(42.3% vs 15.7%, P=0.000), lower rate of type-B cement leakage(28.8% vs 42.1%, P=0.000), lower rate of type-S cement leakage(31.3% vs 43.5%, P=0.000), higher rate of type-C cement leakage(19.0% vs 4.4%, P=0.000), higher rate of type-D cement leakage(18.4% vs 6.7%, P=0.000), higher rate of height restoration[(16.3±16.8)% vs (9.3±9.6)%, P=0.000], higher rate of recollapse of cemented vertebrae(64.4% vs 41.7%, P=0.000). Other radiological parameters were not significantly different between the two groups(P>0.05). Conclusions: OVCF IVC patients are older in age, higher in severity of compression and rate of recollapse, with a poorer long-term clinical effect after PVP when comparing with non-IVC patients.