Predictors of treatment effect and subsequent fracture after percutaneous vertebroplasty

背景和目的：经皮椎体成形术后常可见继发性骨折。这项前瞻性研究的目的是评估术前多层螺旋CT(MDCT)对椎体成形术后再骨折的预测。材料和方法：这项研究包括26例(18例女性和8例男性)骨质疏松性压缩骨折患者(58个椎体)。术前1天内行64层多层螺旋CT多平面重建。常规治疗至少三个月后，使用重复磁共振(MR)成像来评估新骨折或是否有复发疼痛。结果：13例患者的14个相邻椎体(12.1%)和6例患者的14个远端椎体(23.1%)发生了继发骨折。治疗前相邻椎体的后续骨折倾向于发生在小椎体(P&lt；0.05)。未骨折椎体的类固醇药物和低CT值与远端椎体继发骨折相关(P&lt；0.05)。在10名患者(11个椎体，19.0%)中，观察到治疗后椎体进一步塌陷，但无特殊发现(P&gt；0.05)。结论：治疗后椎体体积较小可能与邻近椎体骨折有关。术前MDCT上未骨折椎体的激素使用和低CT值可能与远端椎体的继发骨折有关。

BACKGROUND AND PURPOSE : Subsequent fracture is often seen after percutaneous vertebroplasty. The purpose of this prospective study was to evaluate preoperative multi-detector row computed tomography (MDCT) for predicting subsequent fractures after vertebroplasty.MATERIALS AND METHODS : This study included 26 consecutive patients (18 women and 8 men) with osteoporotic compression fractures (58 vertebrae). Sixty-four-slice MDCT with multiplanar reformation was obtained within a day before the procedure. Repeat magnetic resonance (MR) imaging was used to evaluate new fractures at least three months after treatment on a routine basis or if there was recurrent pain. We used logistic regression analysis with MDCT findings and clinical data for statistical evaluation according to the location of new fractures.RESULTS : Subsequent fractures were noted at 14 adjacent vertebrae (12.1%) in 13 patients and at 14 remote vertebrae in 6 patients (23.1%). Subsequent fractures in adjacent vertebrae tended to occur in small vertebrae before treatment (P < .05). Steroid medication and low CT value in nonfractured vertebrae were associated with subsequent fractures in remote vertebrae (P < .05). Further collapse of the treated vertebral bodies was noted in 10 patients (11 vertebrae, 19.0 %) without specific findings (P > .05). CONCLUSION: The small size of the treated vertebrae may relate to subsequent fracturesin adjacent vertebrae. Steroid use and low CT value of nonfractured vertebrae on preoperative MDCT can be associated with subsequent fractures in remote vertebrae.