中国组织工程研究

中国组织工程研究 ›› 2025, Vol. 29 ›› Issue (27): 5854-5861.doi: 10.12307/2025.843

• 骨科植入物Orthopedic implants • 上一篇    下一篇

超高龄椎体压缩骨折患者经皮椎体后凸成形术后脊柱局部后凸的矫正效果

吴永昊，朱帅旗，李玉乔，张宸菲，夏威威，朱震奇，王凯丰   

  1. 北京大学人民医院脊柱外科，北京市   100044
  • 收稿日期:2024-08-06 接受日期:2024-09-14 出版日期:2025-09-28 发布日期:2025-03-06
  • 通讯作者: 王凯丰，博士，副主任医师，副教授，硕士生导师，北京大学人民医院脊柱外科，北京市 100044
  • 作者简介:吴永昊，男，1998年生，山东省寿光市人，汉族，北京大学在读硕士，医师，主要从事脊柱外科方面的研究。 共同第一作者：朱帅旗，男，2001年生，河南省周口市人，汉族，北京大学在读硕士，医师，主要从事脊柱外科方面的研究。
  • 基金资助:
    国家重点研发计划项目(2022YFB4703000)，项目名称：经皮脊柱内镜智能手术机器人关键技术及系统，项目参与人：王凯丰、夏威威

Correction effect of local kyphosis of the spine after percutaneous kyphoplasty in super-aging patients with vertebral compression fractures

Wu Yonghao, Zhu Shuaiqi, Li Yuqiao, Zhang Chenfei, Xia Weiwei, Zhu Zhenqi, Wang Kaifeng   

  1. Department of Spinal Surgery, Peking University People’s Hospital, Beijing 100044, China
  • Received:2024-08-06 Accepted:2024-09-14 Online:2025-09-28 Published:2025-03-06
  • Contact: Wu Yonghao, Master candidate, Physician, Department of Spinal Surgery, Peking University People’s Hospital, Beijing 100044, China Zhu Shuaiqi, Master candidate, Physician, Department of Spinal Surgery, Peking University People’s Hospital, Beijing 100044, China Wu Yonghao and Zhu Shuaiqi contributed equally to this article.
  • About author:Wang Kaifeng, MD, Associate chief physician, Associate professor, Master’s supervisor, Department of Spinal Surgery, Peking University People’s Hospital, Beijing 100044, China
  • Supported by:
    National Key Research and Development Program of China, No. 2022YFB4703000 (to WKF, XWW)

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摘要：

文题释义：

骨质疏松性椎体压缩骨折：由骨质疏松症导致的一种常见骨折类型，是指椎体在没有外力或仅受到轻微外力作用(相当于从站立或者更低高度跌倒所受的外力)后发生的骨折，伴有椎体高度下降、不同程度脊柱局部后凸及背痛。
经皮椎体后凸成形：是椎体成形手术的一种代表术式，在向椎体注入骨水泥前，先通过扩张球囊压实球囊周围骨质，纠正脊柱后凸，减少骨水泥注入阻力，相比于经皮穿刺椎体成形手术能够有效降低骨水泥渗漏率。

摘要
背景：经皮椎体后凸成形是治疗骨质疏松性椎体压缩骨折的常用术式，然而，目前尚无研究证实经皮椎体后凸成形手术能否有效矫正超高龄(年龄≥80岁)骨质疏松性椎体压缩骨折患者的脊柱局部后凸。
目的：探究经皮椎体后凸成形对超高龄骨质疏松性椎体压缩骨折患者脊柱局部后凸的矫正效果。
方法：选择2016年3月至2022年8月于北京大学人民医院脊柱外科接受经皮椎体后凸成形治疗的单节段骨质疏松性椎体压缩骨折患者为研究队列，收集患者住院及门诊随访资料，按照年龄将患者分为高龄组(60-79岁，n=126)、超高龄组(≥80岁，n=52)。根据性别、体质量指数、基础疾病(高血压、糖尿病、心血管疾病)、骨折节段、有无术前椎体内裂隙征，采用倾向性评分匹配对两组患者进行1:2匹配，比较两组患者的腰椎CT值、骨水泥注入量、手术前后椎体高度、术前椎体塌陷率、手术前后Cobb角、Cobb角恢复率、术后骨水泥距椎体前缘距离、骨水泥矢状位填充位置、骨水泥接触上下椎板、骨水泥距椎板距离、骨水泥分布评分、骨水泥渗漏、椎体再骨折情况。
结果与结论：①倾向性评分匹配后，共115例患者完成匹配，其中高龄组71例、超高龄组44例，两组患者的性别、体质量指数、高血压比率、糖尿病比率、心血管疾病比率、骨折节段、术前椎体内裂隙征比率基线资料比较均无显著性意义(P > 0.05)，超高龄组术后Cobb角低于高龄组(P < 0.05)，两组患者的腰椎CT值、骨水泥注入量、手术前后椎体高度、术前椎体塌陷率、术前Cobb角、Cobb角恢复率、术后骨水泥距椎体前缘距离、骨水泥矢状位填充位置、骨水泥接触上下椎板、骨水泥距椎板距离、骨水泥分布评分、骨水泥渗漏比率、椎体再骨折比率比较差异均无显著性意义(P > 0.05)。②结果表明，经皮椎体后凸成形能够有效矫正超高龄骨质疏松性椎体压缩骨折患者的脊柱局部后凸。

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 骨质疏松性椎体压缩骨折, 经皮椎体后凸成形, 脊柱局部后凸, Cobb角, 超高龄, 倾向性评分匹配, 队列研究, 工程化骨材料

Abstract: BACKGROUND: Percutaneous kyphoplasty was a common surgical procedure for the treatment of osteoporotic vertebral compression fracture. However, there was no research to confirm whether percutaneous kyphoplasty could effectively correct the local kyphoplasty of the spine in patients over 80 years old with osteoporotic vertebral compression fracture. 
OBJECTIVE: To investigate the effect of percutaneous kyphoplasty on local kyphosis in super-aging patients with osteoporotic vertebral compression fracture.   
METHODS: Single-segment osteoporotic vertebral compression fracture patients treated with percutaneous kyphoplasty at the Department of Spinal Surgery, Peking University People's Hospital, from March 2016 to August 2022, were selected as the research cohort, and the follow-up data of patients in hospital and out-patient were collected. According to patients' age, patients were divided into the advanced age group (60-79 years old, n=126) and the super-aged group (≥ 80 years old, n=52). According to gender, body mass index, basic diseases (hypertension, diabetes, and cardiovascular diseases), fracture segments and the presence or absence of preoperative intravertebral cleft, the two groups of patients were matched 1:2 by propensity score matching. The lumbar CT values, injection amount of bone cement, preoperative and postoperative vertebral height, preoperative collapse rate of the vertebral body, preoperative and postoperative Cobb angle, recovery rate of Cobb angle, distance between the bone cement and anterior edge of the vertebral body, sagittal position of cement filling, contact between the bone cement and endplate, distance between the bone cement and vertebral endplates, bone cement distribution score, bone cement leakage, and vertebral refracture were compared between the two groups. 
RESULTS AND CONCLUSION: (1) After matching the propensity score, 115 patients were included, with 71 patients in the advanced age group and 44 patients in the super-aged group. There was no statistically significant difference in baseline data, including gender, body mass index, hypertension ratio, diabetes ratio, cardiovascular disease ratio, fracture section, and preoperative intravertebral cleft, between the two groups (P > 0.05). The postoperative Cobb angle of the super-aged patients was significantly smaller than that of the elderly patients (P < 0.05). There was no significant difference in lumbar CT values, injection amount of bone cement, preoperative and postoperative vertebral height, preoperative collapse rate of the vertebral body, preoperative Cobb angle, recovery rate of Cobb angle, postoperative distance between the bone cement and anterior edge of the vertebral body, sagittal position of cement filling, contact between the bone cement and endplate, distance between the bone cement and vertebral endplates, bone cement distribution score, bone cement leakage, and vertebral refracture ratio between the two groups (P > 0.05). (2) These findings indicate that percutaneous kyphoplasty can effectively correct local kyphosis of the spine in super-aging patients with osteoporotic vertebral compression fractures.

Key words: osteoporotic vertebral compression fracture, percutaneous kyphoplasty, local kyphosis of the spine, Cobb angle, super-aging, propensity score matching, cohort study, engineered bone material

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