報告同學：楊昌蓁
題
指導老師：李茹萍, 吳文田, 賴寧生
目：
Risk factors of new symptomatic vertebral compression fractures in osteoporotic
patients undergone percutaneous vertebroplasty
Abstract
Background
Percutaneous Vertebroplasty (PVP) is likely become a standard treatment option for painful
osteoporotic vertebral compression fractures (VCF). This procedure dramatically improves back pain
within hours and provides long-term pain relief. However, recurrent of back pain caused by subsequent
fracture happens. A hypothesis that cement injection exaggerates force transmission to the adjacent
vertebral bodies and predisposing those levels to future fractures has been suggested. These new
fractures after PVP are usually without history of injury. The incidence and the risk factors for a new
VCF are also inconsistent. Several factors have been mentioned in previous studies including BMD,
BMI, bone morphology, global alignment of spine, and technique of cementing such as leakage. This
study evaluated the risk factors of new vertebral compression fractures (VCFs) following percutaneous
vertebroplasty (PVP).
Methods
From June 2005 to January 2011, patients with osteoporotic VCFs who were treated with PVP were
retrospectively reviewed. Parameters such as age, sex, bone mineral density, body mass index, amount
of bone cement, cement leakage into the disk, preoperative kyphosis, preoperative degree of anterior
vertebral compression, preoperative degree of middle vertebral compression, kyphosis correction,
anterior vertebral height restoration, middle vertebral height restoration, and number of initial
symptomatic fractures were collected. These data were analyzed by univariate and multivariate
analysis for the emergence of new fractures after PVP to determine related risk factors.
Results
After exclusion of pathologic fracture and steroid user, 182 patients was considered as primary
osteoporosis were included in the study. A total of 294 VCFs among 182 patients were reviewed. There
were 155 female and 27 male patients with a mean age of 69.7 years (range 49–91 years). The
follow-up period was 24–50 months (average 26.4 months). During follow-up, 28 new VCFs occurred
in 21 patients (21/182, 11.5 %) and fractures adjacent to procedure level comprised of only
21.4%(6/28). Statistical analysis indicated that only higher BMI (P = 0.004) and a greater number of
initial symptomatic fractures (P = 0.017) were significantly associated with new VCFs after PVP. It is
the most obvious that the risk of new fractures increased 2.518-fold (95 % CI 1.176–5.395), when the
number of initial VCFs increased by one level. Otherwise, age, sex, BMD (T-score), amount of bone
cement injected, cement leakage into the disk, preoperative kyphosis, preoperative DAVC,
preoperative DMVC, kyphosis correction, anterior vertebral height restoration, and middle vertebral
height restoration did not increase the risk of new fractures after PVP.
Conclusions
Although some studies address that BMD and leakage of cement into disc should be considered as risk
factors of adjacent fractures after vertebroplasty, the current study showed no increasing risk
statistically. Higher BMI and initial multiple-level fractures in osteoporotic patients could be the most
dependable risk factors for the new symptomatic VCFs after PVP instead of the effect of procedure
intervention.