经皮椎体强化术后液体信号征与邻近椎体骨折相关性分析
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摘要
目的探讨经皮椎体强化术(PVA)后MRI手术椎体内液体信号征与邻近椎体骨折(AVF)相关性。方法回顾性研究经PVA治疗的105例骨质疏松性椎体压缩性骨折(OVCF)患者的临床及MRI资料,分析术前、术后MRI手术椎体内是否存在液体信号征及与AVF发生率的关系,并比较不同年龄、性别、手术方式、骨水泥注入量间AVF发生率的差异。结果 105例OVCF患者中,手术椎体共200个。术前MRI手术椎体内液体信号征发生率为15%(30/200),AVF发生率为53.3%(16/30),明显高于术前无液体信号征组(P<0.05);术后MRI手术椎体内液体信号征发生率为27.5%(55/200),AVF发生率为54.5%(30/55),明显高于术后无液体信号征组(P<0.05)。手术椎体术后液体信号征有吸收与无吸收AVF发生率分别为53.9%(9/17)、50%(5/10),两组比较差异无统计学意义(P=0.883)。骨水泥注入量≤5 ml组AVF发生率29.4%(42/143),明显低于骨水泥注入量> 5 ml组(50.9%,29/57)(P<0.05)。年龄、性别及手术方式对AVF的影响无统计学意义。结论术前或术后MRI手术椎体内液体信号征是术后AVF的危险因素,严格控制骨水泥注入量,对减少术后AVF发生率具有帮助。
Objective To investigate the correlation between fluid signals in the vertebral body and the adjacent vertebral fracture(AVF) after MRI in percutaneous vertebroplasty(PVA). Methods The clinical and MRI data of 105 patients with osteoporotic vertebral compression fracture(OVCF) treated with PVA were retrospectively analyzed. The presence of fluid signals and AVF in the vertebral body before and after MRI were analyzed. Relationships, and the differences in the incidence of AVF between different ages, genders, surgical procedures, and bone cement injections were compared. Results Of the 105 patients with OVCF, there were 200 surgical vertebral bodies. The incidence of fluid signal in the vertebral body before operation was 15%(30/200), and the incidence of AVF was 53.3%(16/30), which was significantly higher than that in the preoperative fluid-free group(P<0.05). The incidence of fluid signal in the vertebral body of MRI was 27.5%(55/200), and the incidence of AVF was 54.5%(30/55), which was significantly higher than that in the no-fluid group(P<0.05). The incidence of fluid recruitment and non-absorbed AVF after surgical vertebral body surgery were 53.9%(9/17) and 50%(5/10), respectively. There was no significant difference between the two groups(P=0.883). The incidence of AVF in the amount of bone cement injection ≤ 5 ml was 29.4%(42/143), which was significantly lower than that of bone cement injection > 5 ml group(50.9%, 29/57)(P<0.05). The effects of age, gender, and surgical procedure on AVF were not statistically significant. Conclusion The preoperative or postoperative MRI vertebral fluid signal is a risk factor for postoperative AVF. Strict control of bone cement injection is helpful to reduce the incidence of postoperative AVF.
Objective To investigate the correlation between fluid signals in the vertebral body and the adjacent vertebral fracture(AVF) after MRI in percutaneous vertebroplasty(PVA). Methods The clinical and MRI data of 105 patients with osteoporotic vertebral compression fracture(OVCF) treated with PVA were retrospectively analyzed. The presence of fluid signals and AVF in the vertebral body before and after MRI were analyzed. Relationships, and the differences in the incidence of AVF between different ages, genders, surgical procedures, and bone cement injections were compared. Results Of the 105 patients with OVCF, there were 200 surgical vertebral bodies. The incidence of fluid signal in the vertebral body before operation was 15%(30/200), and the incidence of AVF was 53.3%(16/30), which was significantly higher than that in the preoperative fluid-free group(P<0.05). The incidence of fluid signal in the vertebral body of MRI was 27.5%(55/200), and the incidence of AVF was 54.5%(30/55), which was significantly higher than that in the no-fluid group(P<0.05). The incidence of fluid recruitment and non-absorbed AVF after surgical vertebral body surgery were 53.9%(9/17) and 50%(5/10), respectively. There was no significant difference between the two groups(P=0.883). The incidence of AVF in the amount of bone cement injection ≤ 5 ml was 29.4%(42/143), which was significantly lower than that of bone cement injection > 5 ml group(50.9%, 29/57)(P<0.05). The effects of age, gender, and surgical procedure on AVF were not statistically significant. Conclusion The preoperative or postoperative MRI vertebral fluid signal is a risk factor for postoperative AVF. Strict control of bone cement injection is helpful to reduce the incidence of postoperative AVF.
引文
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15 Zhao H,Ni CF,Huang J,et al.Effects of bone cement on intervertebral disc degeneration[J].Exp Ther Med,2014,7:963-969.
16 Huang KY,Yan JJ,Lin RM.Histopathologic findings of retrieved specimens of vertebroplasty with polymethylmethacrylate cement:case control study[J].Spine(Phila Pa 1976),2005,30:E585-588.
17 Qi F,LI QJ,Yong Y,et al.Three-dimensional finite element model of thoracolumbar spine with osteoporotic vertebral compression fracture[J].National Medical Journal of China,2010,90:2943-2946.
18 Lin D,Hao J,Li L,et al.Effect of Bone Cement Volume Fraction on Adjacent Vertebral Fractures After Unilateral Percutaneous Kyphoplasty[J].Clin Spine Surg,2017,30:E270-E275.
19李亮,于学忠,隋海涛,等.伴裂隙征的骨质疏松椎体骨折椎体强化后骨水泥分布模式[J].中国组织工程研究,2013,17:4789-4796.
2 Santiago FR,Abela AP,Alvarez LG,et al.Pain and functional outcome after vertebroplasty and kyphoplasty[J].A comparative study.Eur J Radiol,2010,75:e108-113.
3 Hiwatashi A,Westesson PL.Patients with osteoporosis on steroid medication tend to sustain subsequent fractures[J].AJNR,2007,28:1055-1057.
4 Trout AT,Kallmes DF,Kaufmann TJ.New fractures after vertebroplasty:adjacent fractures occur significantly sooner[J].AJNR,2006,27:217-223.
5蔡金辉,刘庆余,曾玉蓉,等.MRI预测经皮椎体强化术骨水泥椎间盘渗漏的价值[J].中国医学影像技术,2017,33:1061-1065.
6 Lin CC,Wen SH,Chiu CH,et al.The clinical influence of fluid sign in treated vertebral bodies after percutaneous vertebroplasty[J].Radiology,2009,251:866-872.
7 Lin CC,Yen PS,Wen SH.Fluid sign in the treated bodies after percutaneous vertebroplasty[J].Neuroradiology,2008,50:955-961.
8 Lin CL,Lin RM,Huang KY,et al.MRI fluid sign is reliable in correlation with osteonecrosis after vertebral fractures:a histopathologic study[J].Eur Spine J,2013,22:1617-1623.
9中华医学会放射学分会介入学组.经皮椎体成形术操作技术专家共识[J].中华放射学杂志,2014,48:6-9.
10 Gang S,Peng J,Min LI,et al.Imaging and pathologic study of intravertebral vacuum phenomenon in vertebral compression fracture[J].Chinese Journal of Radiology,2010,44:165-168.
11 Wu AM,Chi YL,Ni WF.Vertebral compression fracture with intravertebral vacuum cleft sign:pathogenesis,image,and surgical intervention[J].Asian Spine J,2013,7:148-155.
12 Fang X,Yu F,Fu S,et al.Intravertebral clefts in osteoporotic compression fractures of the spine:incidence,characteristics,and therapeutic efficacy[J].Int J Clin Exp Med,2015,8:16960-16968.
13 Nieuwenhuijse MJ,Putter H,van Erkel AR,et al.New vertebral fractures after percutaneous vertebroplasty for painful osteoporotic vertebral compression fractures:a clustered analysis and the relevance of intradiskal cement leakage[J].Radiology,2013,266:862-870.
14 Omi H,Yokoyama T,Ono A,et al.Can MRI predict subsequent pseudarthrosis resulting from osteoporotic thoracolumbar vertebral fractures[J].Eur Spine J,2014,23:2705-2710.
15 Zhao H,Ni CF,Huang J,et al.Effects of bone cement on intervertebral disc degeneration[J].Exp Ther Med,2014,7:963-969.
16 Huang KY,Yan JJ,Lin RM.Histopathologic findings of retrieved specimens of vertebroplasty with polymethylmethacrylate cement:case control study[J].Spine(Phila Pa 1976),2005,30:E585-588.
17 Qi F,LI QJ,Yong Y,et al.Three-dimensional finite element model of thoracolumbar spine with osteoporotic vertebral compression fracture[J].National Medical Journal of China,2010,90:2943-2946.
18 Lin D,Hao J,Li L,et al.Effect of Bone Cement Volume Fraction on Adjacent Vertebral Fractures After Unilateral Percutaneous Kyphoplasty[J].Clin Spine Surg,2017,30:E270-E275.
19李亮,于学忠,隋海涛,等.伴裂隙征的骨质疏松椎体骨折椎体强化后骨水泥分布模式[J].中国组织工程研究,2013,17:4789-4796.