Percutaneous kyphoplasty: Risk Factors for Recollapse of Cemented Vertebrae
Percutaneous kyphoplasty: Risk Factors for Recollapse of Cemented Vertebrae
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经皮椎体后凸成形术：骨水泥椎骨再塌陷的危险因素
DOI：
10.1016/j.wneu.2019.06.071
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发表时间：
2019-10-01
影响因子：
2
通讯作者：
Zhao, Fengdong
中科院分区：
文献类型：
--
作者：
Wang, Chongyan;Zhang, Xuyang;Zhao, Fengdong
前言：经皮椎体后凸成形术可以在术后立即缓解疼痛和恢复椎体高度；然而，对于有多少椎体在随访期间再次塌陷以及发生椎体再塌陷的原因还知之甚少。在这项研究中，我们定义了治疗后椎体再塌陷的定义，评估了经皮椎体后凸成形术后椎体再塌陷的常见程度，并调查了这种情况的危险因素。方法：总共203名接受经皮椎体后凸成形术的患者在平均12.7个月后进行了回顾，以评估骨水泥强化的椎体再塌陷的比例。复发的潜在危险因素包括年龄、性别、体重、身高、体重指数、治疗水平、症状持续时间、随访时间、术前T评分、手术入路、椎间裂隙、聚甲基丙烯酸甲酯(PMMA)与终板接触、骨水泥体积、骨水泥渗漏、中线椎体高度。结果：总体上，38.9%的增大椎体再塌陷。在再塌陷组，平均中线椎体高度比和后凸角度在随访期间有统计学意义的变化(P<；0.05)。疼痛评分在经皮椎体后凸成形术后立即降低，并在随访时通常保持在较低水平。有意义的预测中线椎体高度丢失的因素包括椎体内裂隙的存在、术后椎体高度和未接触PMMA终板。这些因素加在一起，解释了中线高度损失的28%的变异性。结论：经皮后凸成形术的好处被随后的再塌陷部分抵消。如果有椎体内裂隙，非PMMA终板接触和椎体后高度增加，则再脱位更大。
INTRODUCTION: Percutaneous kyphoplasty can offer pain relief and restoration of vertebral height immediately after the procedure; however, little is known about how many vertebrae recollapse during follow-up or why recollapse occurs. In the present study, we define recollapse of a treated vertebra, assess how common it is following percutaneous kyphoplasty, and investigate risk factors for the condition.METHODS: In total, 203 consecutive patients who underwent percutaneous kyphoplasty were reviewed after an average 12.7 months to assess what proportion of cementaugmented vertebrae had recollapsed. Potential risk factors for recollapse included age, gender, body weight, body height, body mass index, treated level, duration of symptoms, follow-up duration, preoperative T-scores, surgical approach, the intravertebral cleft, contact of polymethyl methacrylate (PMMA) with endplates, cement volume, cement leakage, and midline vertebral body height. Stepwise multivariate linear regression was conducted to predict recollapse as quantified by midline vertebral height loss.RESULTS: Overall, 38.9% of the augmented vertebrae recollapsed. In the recollapse group, the average midline vertebral height ratio and kyphotic angles statistically significantly changed during follow-up (P < 0.05). Pain scores decreased immediately after percutaneous kyphoplasty and generally remained low at follow-up. Significant predictors of midline vertebral height loss at follow-up included presence of an intravertebral cleft, postoperative vertebral height, and non-PMMA-endplate-contact. Together, these factors accounted for 28% of the variability in midline height loss.CONCLUSIONS: Benefits of percutaneous kyphoplasty are partly offset by subsequent recollapse. Recollapse is greater if there is an intravertebral cleft, non-PMMAendplate-contact and an increase in the post vertebral height.